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Last Updated

14 Jan 2003

Source: United Press International, January 14, 2003

Smallpox vaccine risky for eyes, infants

ATLANTA, Jan. 14 (UPI) -- Adults with infants should defer receiving the smallpox vaccine until the child is older than 1 year due to the risk of transmitting the virus to the child and causing severe side effects, a panel of health experts recommended Tuesday.

The panel, convened by the Centers for Disease Control and Prevention, also recommended that people who recently have undergone eye surgery to correct their vision or have other eye problems not receive the smallpox vaccine. The recommendations are for a non-emergency setting and likely would change if there were a smallpox attack.

Although vaccinia, the virus used in the smallpox vaccine, is different from the smallpox virus and cannot cause the disease, it can spread from the vaccination site to infect other people, the experts said. This is rare, occurring only 20-60 times out of every 1 million people vaccinated. Nevertheless, such cases often involve children, who are more susceptible to some of the most severe side effects of the vaccine, including death.

Due to these concerns, the CDC's Advisory Committee on Immunization Practices unanimously recommended adults with infants under 1 year old defer vaccination, assuming no emergency, until the child is older. The CDC usually adheres to the advice of the committee but is not bound by its recommendations.

The risk of serious complications of transmission from adult to child is very small, said Seymore Williams, a medical epidemiologist with the CDC. However, he noted there is a higher risk of adverse events in children under 1 year compared with older children who receive the vaccine. The CDC currently recommends children under 1 year not receive the vaccine.

The committee's recommendations are in line with the policy of the Department of Defense, which recently began vaccinating military personnel against smallpox, Williams said. The Defense Department policy recommends "minimizing close physical contact with infants less than 1 year of age until the scab (from the vaccination site) falls off," he said. The department's policy also recommends washing hands when feeding and changing diapers and ensuring the vaccination site is covered with a bandage, he added. It advises alternative caretaking arrangements be made or not vaccinating until the military person is deployed or is able to take a 21-day isolation period.

The committee recommended people with inflammatory eye disease requiring corticosteroid drops not receive the vaccination due to the risk of touching the vaccination site and infecting the eye with the vaccine virus. In some cases, this could lead to complications that could result in blindness. Although experts think there is a possibility of this occurring, there are no data to indicate how often it might occur.

John Gravenstein, from the Army Surgeon General's Office, noted Defense Department eye specialists have advised the military to "defer vaccination in people who have had (vision-correcting) PKR or LASIK surgery" until their eyes have healed.

"It certainly makes sense ... and goes with everything else we are being cautious about," said John Modlin, chair of the committee and professor of pediatrics and medicine at Dartmouth Medical School.

(Reported by Steve Mitchell, UPI Medical Correspondent, in Washington)