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Smallpox - How To Administer Smallpox Vaccine
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Protective Measures To Follow While Administering Smallpox Vaccine

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  1. Introduction:

    Vaccination has been successfully and safely administered to people of all ages, from birth onward. As with all vaccinations, the smallpox vaccination process should begin with careful individualized assessment of vaccine indications and contraindications.

    The site of vaccination is the upper arm over the insertion of the deltoid muscle. No skin preparation should be performed unless the skin at the intended site of vaccination is obviously dirty, in which case an alcohol swab(s) may be used to clean the area. If alcohol is used, the skin must be allowed to dry thoroughly to prevent inactivation of the live vaccine virus by the alcohol.

    The multiple-puncture technique uses a sterilized bifurcated needle inserted vertically into the vaccine vial, causing a droplet of vaccine to adhere between the needle prongs. The droplet contains the recommended dosage of vaccine. Confirm the presence of the droplet between the prongs visually. Holding the bifurcated needle perpendicular to the skin, make 15 punctures rapidly with strokes vigorous enough to allow a trace of blood to appear after 15 to 20 seconds. Wipe off any remaining vaccine with dry sterile gauze, then dispose of the gauze in a biohazard waste container.

    Cover the site with a bandage to deter touching the site and perhaps transferring virus to other parts of the body.



  2. Should vaccinators wear goggles?
    Smallpox vaccine is a very thick fluid not prone to splashing. Goggles are not necessary during vaccine reconstitution or administration; however, workers may take this extra precaution if they wish.

  3. What should be done when reconstituted or unreconstituted smallpox vaccine is spilled?
    Smallpox vaccine contains a poxvirus called "vaccinia." Unreconstituted or reconstituted, vaccinia is potentially infectious and should be treated using Biosafety Level 2 (BSL2) precautions. The techniques used for Universal Precautions suffice as protection for clean-up. Spilled smallpox vaccine should be cleaned with a solution containing 10% household bleach and 90% water. The solution should be prepared immediately prior to use, as it is less effective if it is more than one day old. For optimal disinfection, use household bleach which has been opened for less than 3 months. Absorb the spill with paper towels and then slowly pour the bleach from the edge of the spill towards the center. Allow absorbed spill to sit for 20 minutes; then clean it up. Wipe the area with towels soaked in the bleach solution, followed by clean water. The area is now disinfected. In clinical settings, the waste should be disposed of as biohazardous or regulated medical waste.