Questions & Answers
Smallpox - Vaccine Safety
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Questions

Safety

  1. Is smallpox vaccine safe?
  2. Why should I take this vaccine?
  3. What are the temporary side effects after smallpox vaccination?
  4. Is it okay to take multiple vaccines at the same time?
  5. Can someone vaccinated against smallpox infect someone else?
  6. Is it safe to have surgery soon after I get the smallpox vaccine?
  7. Is it safe to go swimming after my smallpox vaccination?
  8. Can I get smallpox disease from smallpox vaccine?
  9. What laboratory tests should I order if I suspect a contact transmission of the vaccinia virus?

Rare but Serious Side Effects After Vaccination

  1. What are the rare but serious side effects after smallpox vaccination?

Long Term Safety

  1. What are the long-term effects of the smallpox vaccine?

Risks vs Benefit

  1. What are the risks of being vaccinated versus not being vaccinated with smallpox vaccine?

Reproductive Health

  1. Should pregnant women receive the smallpox vaccine?
  2. Should women or men defer conceiving a child after receiving the smallpox vaccine?
  3. Does the vaccine cause sterility?
  4. Is smallpox vaccine safe for women who are breastfeeding?
  5. Is it safe for a woman to breastfeed her baby if a close contact received the smallpox vaccine?
  6. If a breastfeeding mother who has close contact with a recently vaccinated person develops a rash, should she stop nursing?
  7. Is smallpox vaccination or close contact with a recently vaccinated person during pregnancy a reason to consider pregnancy termination?
  8. Are pregnant women who receive the smallpox vaccine more likely than other pregnant women to have a miscarriage?
  9. Are there any other special risks after birth for children who are born to mothers who received smallpox vaccine during pregnancy?
  10. Are there special considerations at the time of delivery for women exposed to smallpox vaccine during pregnancy?
  11. What is being done to learn more about the effects of smallpox vaccine on pregnant women and their babies?

Vaccination Site Care

  1. Are there precautions I can take as a healthcare provider to help my patients avoid spreading smallpox vaccine virus to others?
  2. How should I care for the vaccination site?
  3. Does everybody need one of those big bandages I saw on the clinic workers?
  4. How long should the dressing or bandage or Band-Aid stay in place, before being replaced by a new one?
  5. Who should change the dressing or bandage?
  6. What should I do if the bandage over my smallpox vaccination site gets wet?
  7. How long does it take for the smallpox vaccination site to heal?
  8. I want to get a tattoo placed on my smallpox vaccination site. How long should I wait?
  9. What should I do if I bump the smallpox scab and it falls off?
  10. What should I do if my smallpox vaccination site touched the shower wall?
  11. My dog came in contact with my used smallpox dressing. What should I do?
  12. Is it true that the smallpox vaccine virus can be spread to others?
  13. I got a smallpox vaccination about a week ago. Now my armpit hurts and there is redness and swelling around the vaccination site. What should I do?

Eligibility Criteria

  1. Are there any medical conditions that would exempt me from taking the smallpox vaccine?
  2. Should people with lupus get vaccinated?
  3. Can I get smallpox vaccine if I don't have a spleen?
  4. What other medical conditions should I inform the medical staff about?
  5. Will family members be allowed to get the smallpox vaccine?
  6. Is it okay to go to my dentist after I receive the smallpox vaccine?
  7. How long does the vaccination site remain contagious?
  8. If vaccinia gets on a dressing or bandage, how long will it stay alive and capable of being spread to someone else who touches it?
  9. What should I do if I'm going to be around at-risk people (e.g. small children, eczema sufferers)?
  10. Can I give blood after a smallpox vaccination?
  11. Does the vaccine get into my blood stream?
  12. Could people be exposed to the vaccine virus (vaccinia) if I cut myself?
  13. Can I travel after receiving the smallpox vaccine?
  14. I have recently had surgery, is it safe to get the smallpox vaccine?
  15. Is it safe to get a smallpox vaccination if I have herpes?
  16. I have a condition that requires me to use steroid eye drops. Should I receive the smallpox vaccination?
Answers

Safety

  1. Is smallpox vaccine safe?
    The smallpox vaccine is the best protection you can get if you are exposed to the smallpox virus. Most people experience mild, reactions, such as sore arm, fever, headache, body ache, and fatigue. These symptoms may peak 8 to 12 days after vaccination.

  2. Why should I take this vaccine?

    People in many countries are concerned about the potential use of smallpox as a bioterrorism agent. The U.S. government has been preparing for some time for the remote possibility of an outbreak of smallpox as an act of terror. Those preparations quickened after September 11, 2001.

    The likelihood that smallpox would be used as a bioweapon is unknown. About 30 percent of people who contract smallpox die; about 70% survive.

    Vaccination prevents almost all cases of smallpox. If symptoms of smallpox do appear, they are generally milder than in unvaccinated people.



  3. What are the temporary side effects after smallpox vaccination?

    Mild reactions include swelling and tender lymph nodes that can last two to four weeks after the blister heals. Most people develop itching, headache, fatigue, muscle aches, pain, or chills after smallpox vaccination, usually about eight to 12 days later. Some individuals may have rashes that last two to four days. These side effects are usually temporary and self-limiting, meaning they go away on their own or with minimal medical treatment, for example aspirin and rest.

    If the vaccination is successful, a red and itchy bump develops at the vaccine site in three or four days. Then, in the first week, the bump becomes a large blister and fills with pus. During the second week, the blister begins to dry up and a scab forms. The scab falls off in the third or fourth week, leaving a small scar. People who are being vaccinated for the first time have a stronger reaction than those who are being revaccinated.

    If someone does not get the expected vaccination site response, they need to be revaccinated. If someone has a question or concern about the smallpox vaccination site they should contact their primary-care manager, medical department representative or their healthcare provider.



  4. Is it okay to take multiple vaccines at the same time?
    Multiple inoculations do not weaken or overwhelm the immune system. The immune system has an enormous capacity to respond to immune stimuli from vaccines. Far from weakening an immune system, vaccines actually strengthen the body's natural defenses against serious and potentially fatal infections. Even infants are capable of generating protective immune responses to multiple vaccines given at the same time.

  5. Can someone vaccinated against smallpox infect someone else?
    Yes. However, infection of this kind can be prevented with covering the site and frequent hand washing. Adverse reactions, sometimes severe, can also occur in people who come in contact with a vaccinated person. These problems result from touching the vaccination site and transferring the vaccine virus to another person.

  6. Is it safe to have surgery soon after I get the smallpox vaccine?
    If you must have surgery, inform your surgeon that you have just received smallpox vaccine. Elective or nonurgent surgery is not recommended within 30 days after smallpox vaccination. This allows time for the vaccination site to heal completely, so that it cannot spread smallpox vaccine virus to your surgical wound. Eye surgery, for example Lasik eye surgery, is a special contraindication to receiving smallpox vaccine. Eye surgery should be delayed until after the smallpox vaccination site has healed completely. Please contact the IHB if you have questions or concerns.

  7. Is it safe to go swimming after my smallpox vaccination?
    Do not swim in pools, hot tubs or whirlpools until your smallpox vaccination site has healed. There is a theoretical risk of spreading the virus to others. Also, the chemicals used in pool water could make your vaccination less effective.

  8. Can I get smallpox disease from smallpox vaccine?
    The smallpox vaccine is made from vaccinia virus, which is a live virus similar to smallpox virus. Vaccinia virus cannot cause smallpox disease.

  9. What laboratory tests should I order if I suspect a contact transmission of the vaccinia virus?
    Identify infectious agents through scraping or aspiration of lesion content: herpes simplex (HSV) and varicella are most common etiologies and can be rapidly assessed with DFA (direct fluorescent antibody screening slide) followed by culture. These diagnoses are more common than vaccinia. Bacterial cultures may be indicated. If DFA is negative for HSV, varicella, then obtain vaccinia PCR and culture.

Rare but Serious Side Effects After Vaccination

  1. What are the rare but serious side effects after smallpox vaccination?

    Smallpox vaccination is generally a safe and effective means of preventing smallpox. However, in a number of individuals, smallpox vaccination can result in untoward effects and adverse reactions. Most are totally benign, but may be alarming in appearance. Some are serious, but treatable. A few, which rarely occur, are serious, life threatening and can be fatal. Severe adverse reactions are more common in persons receiving primary vaccination compared to those being revaccinated.

    Local Reactions

    • Progressive vaccina. Progressive vaccinia is one of the most severe complications of smallpox vaccination. It is almost always life threatening (primary vaccination site fails to heal dies and turns black. This necrosis then spreads to surrounding tissue, often affecting major portions of the body).

    Systemic Reactions

    • Generalized Vaccinia (systemic spread of the vaccinia virus from the vaccination site)
    • Erythema Multiforme ( a hypersensitivity/allergic reaction to vaccination resulting in lesions erupting in multiple areas of the body)
    • Progressive Vaccinia (primary vaccination site fails to heal dies and turns black. This necrosis then spreads to surrounding tissue, often affecting major portions of the body).
    • Eczema Vaccinatum (extensive vaccinial lesions developing either through direct inoculation of the virus onto diseased skin or possibly viremic spread if they were recently vaccinated)
    • Occular Vaccinia (eye infection resulting from transfer of the vaccinia virus to the eye)
    • Fetal Vaccinia (vaccinia virus infects the unborn baby, usually resulting in stillbirth)
    • Post Vaccinial Encephalitis(inflammation of the brain occurring shortly after vaccination), Ecephalopathy (infection of the brain), Encephalomyelitis (inflammation of the brain and spinal cord)
    • Myocarditis (inflammation of the heart muscle)
    • Pericarditis (inflammation of the sac surrounding the heart)
    In the past, about 1,000 people for every 1,000,000 vaccinated people experienced reactions that were serious, but not life-threatening. Most involved the spread of virus elsewhere on the body.

     

    In the past, between 14 and 52 people out of 1,000,000 vaccinated for the first time experienced potentially life-threatening reactions. These reactions included serious skin reactions and inflammation of the brain (encephalitis).

    From past experience, one or two people per 1 million who received smallpox vaccine died as a result of vaccination side effects. Serious side effects generally are rarer after revaccination, compared to first time vaccinations. Careful screening of potential vaccine recipients is essential to ensure that those at increased risk for serious side effects do not receive the vaccine.

    These side effect rates are based on data collected in the United States during the 1960s, when about 300,000 adults got their first smallpox vaccination and over 4,000,000 adults got repeat smallpox vaccinations (revaccinations).

    A few heart attacks, some fatal, have been reported after smallpox vaccination. After reviewing these cases, the rate of heart attacks in smallpox vaccinated and unvaccinated people is the same and there is no evidence of a cause-and-effect link between smallpox vaccine and heart attacks. Even so, DoD medically exempts people with heart conditions.

    We try to reduce the risk of side effects by exempting people who should not receive this vaccine.

    For more information about side effects of the smallpox vaccine please visit http://emergency.cdc.gov/agent/smallpox/vaccination/reactions-vacc-clinic.asp



Long Term Safety

  1. What are the long-term effects of the smallpox vaccine?
    Smallpox vaccine was given to millions of Americans over many decades and used in the eradication of smallpox around the world. No long-term side effects were ever found to be due to smallpox vaccination.

Risks vs Benefit

  1. What are the risks of being vaccinated versus not being vaccinated with smallpox vaccine?
    The risk of smallpox vaccination is associated with potential side effects listed in the package insert, which are usually mild and temporary. The benefit of being vaccinated is the avoidance of contracting actual smallpox disease from a known or unknown exposure to the smallpox virus. The odds that smallpox would be used as a bio-weapon cannot be known with certainty.

Reproductive Health

  1. Should pregnant women receive the smallpox vaccine?

    No. Pregnant women should not receive the smallpox vaccine, unless they have been exposed to smallpox. Most of the time, when pregnant women get smallpox vaccine, the pregnancy goes well. In an outbreak, personal benefit from vaccination may outweigh the risks of vaccination. Women who are pregnant or planning to become pregnant within 4 weeks after vaccination should NOT get the smallpox vaccine. In addition, anyone who has a close contact who is pregnant should not get the vaccine. Close contacts include anyone living in your household and anyone you have close, physical contact with such as a sex partner or someone you share a bed with.

    Smallpox vaccine can cause a very rare but serious complication in the fetus called fetal vaccinia. Less than 50 cases of fetal vaccinia have ever occurred. Most babies born to women who got smallpox vaccine will be fine. If a woman is vaccinated, she should avoid pregnancy for a month. She should wait until the vaccination site has completely healed and the scab has fallen off before trying to become pregnant after vaccination. Until that time, effective measures should be taken to prevent pregnancy, such as abstinence, birth control pills, injections, implants, or IUDs. Other methods of birth control, such as condoms, diaphragms, spermicide, and natural family planning are less effective than abstinence.

    Women uncertain about whether or not they are pregnant should get a medical evaluation. Clinics should display warning signs about asking women if they are pregnant. Urine or blood tests can help women find out if they are pregnant before immunization.



  2. Should women or men defer conceiving a child after receiving the smallpox vaccine?

    Women receiving a smallpox vaccination should wait until the scab has fallen off and the vaccination site has completely healed before trying to become pregnant after vaccination. Generally, this means vaccinated women should wait four weeks after their smallpox vaccination. Until that time, effective measures should be taken to prevent pregnancy, such as abstinence, birth control pills, injections, implants, or IUDs. Other methods of birth control, such as condoms, diaphragms, spermicide, and natural family planning are less effective than abstinence.

    Vaccinated men may wish to wait a similar amount of time before fathering a child. Until the vaccination site has completely healed, they can be the source of spreading vaccinia to a close contact (such as a sex partner). Covering the vaccination site is very important for both men and women.



  3. Does the vaccine cause sterility?
    No formal studies have ever been performed on sterility rates after smallpox vaccination. Smallpox vaccine has been given to billions of people around the globe over many decades and no effects on sterility have ever been found.

  4. Is smallpox vaccine safe for women who are breastfeeding?

    Women who are breastfeeding should not get the smallpox vaccine. Breastfeeding places the baby close to the vaccination site on a woman's arm. This advice is true even if women are pumping and then bottle-feeding breast milk. It is unknown whether the vaccine virus or antibodies pass on to the baby through breast milk. A woman who desires to maintain her milk supply may continue to pump breast milk, but the milk should be discarded until the vaccination site has completely healed and not be given to the baby.



  5. Is it safe for a woman to breastfeed her baby if a close contact received the smallpox vaccine?

    Yes, if clothing is not contaminated and proper hand washing is used. Anyone who receives the smallpox vaccine should remember to wash their hands with soap and warm water after direct contact with the vaccination site, or anything that has touched the vaccination site (bandages, clothing, towels, bedding, etc.). This is will help prevent the spread of vaccinia virus to contacts, including young babies.



  6. If a breastfeeding mother who has close contact with a recently vaccinated person develops a rash, should she stop nursing?

    First, she should check with her healthcare provider to determine if the rash is related to the smallpox vaccine. If she has a vaccine-related rash, breastfeeding should not take place until all scabs from the rash have fallen off and the skin is completely healed. A woman who desires to maintain her milk supply may continue to pump breast milk, but the milk should be discarded until her scabs fully separate and the skin is completely healed.



  7. Is smallpox vaccination or close contact with a recently vaccinated person during pregnancy a reason to consider pregnancy termination?

    There have been less than 50 cases of fetal vaccinia ever reported in the world. Because fetal vaccinia is so rare, smallpox vaccination during pregnancy should not be a reason to consider termination of pregnancy.



  8. Are pregnant women who receive the smallpox vaccine more likely than other pregnant women to have a miscarriage?

    Smallpox vaccine has not been associated with an increased risk of miscarriage. There is no evidence that smallpox vaccine causes spontaneous abortion (miscarriage).



  9. Are there any other special risks after birth for children who are born to mothers who received smallpox vaccine during pregnancy?

    Except for the rare case of fetal vaccinia, smallpox vaccination of pregnant women has not been linked with premature birth, low birth weight, or other serious birth problems.



  10. Are there special considerations at the time of delivery for women exposed to smallpox vaccine during pregnancy?

    Most women who receive smallpox vaccine during pregnancy will deliver normal babies, and standard delivery procedures should be followed. All pregnant women who have received the smallpox vaccine during pregnancy should let their healthcare provider and their baby's healthcare provider know about their vaccination. Their providers should contact the registry by calling 619.553.9255 or e-mailing NHRC-birthregistry@med.navy.mil.



  11. What is being done to learn more about the effects of smallpox vaccine on pregnant women and their babies?

    DoD works with the CDC in operating the National Smallpox Vaccine in Pregnancy Registry. This registry is used to monitor the outcomes of pregnant women who received the smallpox vaccine. This will help us better understand the risks of smallpox vaccine in pregnancy. The registry has already provided important information, which is generally reassuring to women in these circumstances.

    Pregnant women who received the smallpox vaccine, or pregnant women whose close contacts received the smallpox vaccine, may contact their healthcare provider or their state health department for help in enrolling in the registry. Health-care providers and staff from state health departments (see http://emergency.cdc.gov/agent/smallpox/faq/pregnancy.asp) are encouraged to report all exposed pregnant women to the registry by calling 619.553.9255 or e-mailing NHRC-birthregistry@med.navy.mil. To learn more, click here: www.smallpox.mil/pregnancy



Vaccination Site Care

  1. Are there precautions I can take as a healthcare provider to help my patients avoid spreading smallpox vaccine virus to others?

    You should follow the same instructions on "How should I care for the vaccination site?" and read the following:

    Even patients vaccinated in the past may be at increased risk due to current immunodeficiency. If contact with unvaccinated patients is essential and unavoidable, healthcare workers can continue to have contact with patients, including those with immune deficiencies, as long as the vaccination site is well-covered and thorough hand-hygiene is maintained. In this setting, a more occlusive dressing might be appropriate. Semi-permeable polyurethane dressings (e.g., Opsite®, Tegaderm®) are effective barriers to vaccinia and recombinant vaccinia viruses.

    However, exudate may accumulate beneath the dressing, and care must be taken to prevent viral contamination when the dressing is removed. In addition, accumulation of fluid beneath the dressing may increase the maceration of the vaccination site. To prevent accumulation of exudates, cover the vaccination site with dry gauze, and then apply the dressing over the gauze. The dressing should also be changed daily or every few days (according to type of bandaging and amount of exudate), such as at the start or end of a duty shift.

    Military treatment facilities will develop plans for site-care stations, to monitor workers' vaccination sites, promote effective bandaging, and encourage scrupulous hand hygiene. Wearing long-sleeve clothing can further reduce the risk for contact transfer. The most critical measure in preventing inadvertent contact spread is thorough hand-hygiene after changing the bandage or after any other contact with the vaccination site.

  2. How should I care for the vaccination site?

    Three Key Points:

    1. Don't touch your vaccination site.

    2. If you touch it by accident, wash your hands right away.

    3. Don't let others touch your vaccination site or materials that touched it.

    Vaccinia virus is present at the vaccination site for 30 days and until the vaccination site is completely healed. This means other people can get infected if they come in contact with virus from your arm.

    Most vaccination sites can be left unbandaged, when not in close contact with other persons. Airing the site will speed healing. Wear sleeves covering the site and/or use an absorbent bandage to make a touch-resistant barrier when around others. Dispose of bandages in sealed or double plastic bags. You may carefully add a little bleach, if desired.

    Keep the site dry. Do not use creams or ointments; they will delay healing. Long-sleeve clothing worn during the day and at night can protect the site from dirt. Launder clothing and linens that touch the site in hot water with soap or bleach.

    Normal bathing can continue. Dry off carefully, so the towel does not rub or spread virus elsewhere. Don't allow others to use that towel until laundered. Don't use public towels, unless laundry workers are aware of special handling precautions. Use a waterproof adhesive bandage if you exercise enough to cause a sweat. Avoid swimming pools and spas until the site is completely healed.

    Take good care of your vaccination site.



  3. Does everybody need one of those big bandages I saw on the clinic workers?
    No. Health care workers will get large bandages so they can stay on the job in a healthcare center without taking time off. Regular Band-Aids are sufficient for covering the vaccination site for most people.

  4. How long should the dressing or bandage or Band-Aid stay in place, before being replaced by a new one?
    The dressing or bandage should be kept in place until a change is needed. A change would be necessary when there is enough drainage from the vaccination site to soak the pad. It can be changed more often, if the person wants. Always wash your hands, before and after changing a bandage.

  5. Who should change the dressing or bandage?
    You can change the dressing or bandage yourself if you carefully dispose of it and wash your hands in soapy water before and afterwards. Some healthcare facilities have bandage-changing stations set up for Healthcare workers.

  6. What should I do if the bandage over my smallpox vaccination site gets wet?
    If the bandage over your smallpox vaccination site gets wet, you need to change it. It is important to keep your vaccination site clean and dry. The first step when changing the dressing is to wash your hands. Then replace the wet bandage with a new clean bandage. Put the old bandage in a plastic bag with a small amount of bleach, and throw the bag away. Then wash your hands again. For more information about taking care of your vaccination site, go to the IHB website and read the Smallpox Tri-fold Brochure.

  7. How long does it take for the smallpox vaccination site to heal?
    It takes on average 30 to 60 days for the smallpox vaccination site to heal. Keep in mind that everyone heals at a different rate, some faster than average and others slower than average.

  8. I want to get a tattoo placed on my smallpox vaccination site. How long should I wait?
    Before getting a tattoo, wait until the smallpox vaccination site has fully healed, the scab has fallen off, and the skin is intact and dry. It may take longer than the average 30 to 60 days after your vaccination before the skin is ready for tattooing. Please contact the IHB if you have additional questions.

  9. What should I do if I bump the smallpox scab and it falls off?
    If the scab falls off, put it in a plastic bag with a small amount of bleach and throw the bag away. Wash your hands thoroughly. Replace the old bandage with a new clean bandage, and then wash your hands again. For more information on proper care of your vaccination site, go to the IHB website for the Smallpox Tri-fold Brochure.

  10. What should I do if my smallpox vaccination site touched the shower wall?
    Keep your smallpox vaccination site covered with a bandage while you shower. If the bandage gets wet, after your shower put it in a plastic bag with a small amount of bleach, discard it, and then wash your hands. Then put on a new bandage. If your vaccination site does touch a surface, such as the shower wall, clean the surface with a household disinfectant. This will help to make sure that no smallpox vaccine virus remains on that surface.

  11. My dog came in contact with my used smallpox dressing. What should I do?
    Wash the part of the dog that came in contact with your used dressing. Then wash your hands well. Keep an eye on your pet, and if any rash or sore develops, contact your veterinarian. Remember to continue good hand washing, keep your vaccination site covered, and dispose of used dressings in a plastic bag with disinfectant. For more information on proper care of your vaccination site, go to the IHB website for the Smallpox Vaccine Pets Brochure.

  12. Is it true that the smallpox vaccine virus can be spread to others?
    Yes, the smallpox vaccine virus can possibly be spread anytime there is direct contact with the uncovered vaccination site or contact with fluid from the site. This spread is called "contact transmission." To prevent contact transmission, follow these three simple steps: wash your hands, keep the vaccination site covered, and properly dispose of vaccination dressings.

  13. I got a smallpox vaccination about a week ago. Now my armpit hurts and there is redness and swelling around the vaccination site. What should I do?
    What you are describing sounds like a typical reaction that occurs after the smallpox vaccination known as a "robust take." A "robust take" occurs when your body has a vigorous response to the vaccine. This response is a normal variation and usually goes away on its own; over-the-counter pain relievers may be useful. If you have questions or concerns you may contact a IHB healthcare provider or send us a photo of the reaction via our Ask VHC secure messaging system.

Eligibility Criteria

  1. Are there any medical conditions that would exempt me from taking the smallpox vaccine?

    Some people should not get the smallpox vaccine unless under emergency situations:

    • People whose immune system is not working fully (due to disease, medication, or radiation), such as HIV/AIDS, cancer, transplant, immune deficiency
    • People diagnosed with eczema or atopic dermatitis, now or earlier in life
    • People with current skin conditions, such as burns, impetigo, contact dermatitis, chickenpox, shingles, psoriasis, or uncontrolled acne, until the condition clears up
    • Pregnant women
    • People with a household contact who meets any of the conditions above
    • People with serious heart or vessel conditions (such as angina, heart attack, artery disease, congestive heart failure, stroke, other cardiac problem)
    • People with 3 cardiac risk factors (smoking, high blood pressure, high cholesterol, diabetes, family history of heart disease before age 50)
    • People taking steroid eye drops or ointment
    • Breastfeeding mothers
    • Anyone who had problems after previous doses or is allergic to the vaccine or any component

    In a smallpox outbreak, even people with exemptions to vaccination should be vaccinated if exposed to smallpox, unless extremely immunosuppressed.



  2. Should people with lupus get vaccinated?
    People who have been diagnosed with lupus should talk with their physician about whether or not they should be vaccinated, considering the state of their disease, the medications they take, and their personal risk for specific infections. Several medical studies have shown that people with lupus can be safely and effectively vaccinated against influenza, hepatitis B, pneumococcal disease, and other diseases that would pose a significant risk if they were infected. For military personnel with lupus, providers are authorized to grant medical exemptions according to the patient's specific situation. Medical specialists can advise how to get the best benefit from vaccination in such circumstances.

  3. Can I get smallpox vaccine if I don't have a spleen?

    You should discuss your concerns and your individual situation with your medical provider to be sure.

    Certain medical conditions, such as the absence of a working spleen (asplenia) may increase a person's risk for certain infections. Some vaccines, particularly pneumococcal, meningococcal, and Haemophilus vaccines, are specifically recommended for people without a spleen. People with asplenia are generally not considered immunosuppressed for the purposes of vaccination and should receive routine vaccinations with both live and inactivated vaccines according to the usual schedules.



  4. What other medical conditions should I inform the medical staff about?

    You should inform your Health Care Provider if you have heart disease, with or without symptoms, or if you have three or more known major cardiac risk factors (i.e., hypertension, diabetes, hypercholesterolemia, heart disease at age 50 years in a first-degree relative, and smoking).

    Other contraindications include:

    • Current or a history of skin conditions,
    • Positive for HIV or otherwise immunocompromised or immunosuppressed
    • Pregnant or planning to become pregnant
    • Allergies to vaccine components,
    • Recent or scheduled eye surgery
    • Breastfeeding
    • Contact with children 12 months of age or younger
    • Close contact with any of the above

    Also if you have had a serious reaction to polymyxin B, neomycin, latex or a previous dose of smallpox vaccine it may be a contraindication for you to receive smallpox vaccine at this time. If you have concerns, please consult with your health care provider before vaccination.

    Careful prevaccination screening will help determine any risk issues you may have.

    The standardized DoD smallpox screening form can be viewed at the IHB website at www.smallpox.mil/screeningform



  5. Will family members be allowed to get the smallpox vaccine?
    Family members and non-essential civilian personnel in designated high-threat areas overseas (e.g., Korea) are authorized to receive smallpox vaccine on a voluntary basis. Our procedures will be consistent with FDA guidelines for use of the vaccine and our need to protect mission critical capabilities of the Department of Defense. It remains the Department's policy to evacuate non-emergency essential civilians and family members from threat areas in crisis situations.

  6. Is it okay to go to my dentist after I receive the smallpox vaccine?
    Yes, if you are careful. Inform your dentist that you have been recently vaccinated. Be sure to cover your vaccination site with a bandage and/or long-sleeve clothing to provide a barrier to protect your dentist.

  7. How long does the vaccination site remain contagious?
    The vaccinia is present at the vaccination site for up to 30 days after vaccination and until the site is completely healed. Other people can get infected through contact with the vaccinia from your vaccination site

  8. If vaccinia gets on a dressing or bandage, how long will it stay alive and capable of being spread to someone else who touches it?

    Vaccinia virus can survive in the environment for about 24 hours. It might survive longer if it stays moist and in the dark. If the bandage dries out, the virus is still present, but less able to spread.

    No matter the time, it is always best to carefully dispose of used dressings or bandages in sealed or double plastic bags. Always wash your hands after handling dressings or bandages.



  9. What should I do if I'm going to be around at-risk people (e.g. small children, eczema sufferers)?

    In a household, people have much more intimate or close contact than in work sites or other social settings (e.g., church, malls). As usual, the key here is to not move the virus from your vaccination site to another person. So be careful when around others and follow the standard precautions (band-aids, long-sleeves, hand-washing).

    Regarding household members with contraindications:
    You shouldn't be vaccinated if you have household members with contraindications to the smallpox vaccine, unless you can be separated from them until your scab falls off (about 14 to 28 days).

    Regarding children under 1 year of age:
    "Minimizing close physical contact with infants less than one year of age is prudent until the scab falls off. If unable to avoid infant contact, wash hands before handling an infant (e.g., feeding, changing diapers) and ensure that the vaccination site is covered with a porous bandage [e.g., Band-Aid, or gauze] and clothing. It is preferable to have someone else handle the infant." This quote comes from the October 2002 recommendations of the Advisory Committee on Immunization Practices.



  10. Can I give blood after a smallpox vaccination?
    People who receive the smallpox vaccine and have no complications will be deferred from donating blood for 4 weeks. Individuals with vaccine complications will be deferred until 14 days after all vaccine complications have completely resolved. Consult your blood-donor center for details.

  11. Does the vaccine get into my blood stream?
    Usually not. Experts believe it is very uncommon for vaccinia virus to move from your vaccination site into your blood stream.

  12. Could people be exposed to the vaccine virus (vaccinia) if I cut myself?
    Spreading the vaccinia virus by cutting yourself is highly unlikely. But you would want to clean up any blood spills to protect people against other blood borne pathogens.

  13. Can I travel after receiving the smallpox vaccine?
    Traveling is permitted after smallpox vaccination. Remember to use Band-Aids or long-sleeved clothing to prevent your vaccination site from touching other people. Wash your hands at appropriate intervals.

  14. I have recently had surgery, is it safe to get the smallpox vaccine?
    If you have recently had surgery, ask your healthcare provider whether it is safe for you to get the smallpox vaccine. You may need to wait until your surgical wound heals before you get the vaccine. This is to prevent the smallpox vaccine virus from infecting your surgical wound. Eye surgery, for example Lasik surgery, is a special contraindication to receiving smallpox vaccine. Smallpox vaccination must be postponed until after your eye has healed. Please contact the IHB if you have questions or concerns.

  15. Is it safe to get a smallpox vaccination if I have herpes?
    Having a history of herpes (either oral or genital) is not a contraindication to receiving the smallpox vaccine. However, if you are having an active herpes outbreak, do not get a smallpox vaccination until your skin lesions have healed. If you have questions or concerns, you may contact a IHB healthcare provider or send us an email message using our Ask VHC secure messaging system.

  16. I have a condition that requires me to use steroid eye drops. Should I receive the smallpox vaccination?
    You should not be vaccinated while you are using steroid eye drops. Steroid eye drops decrease your resistance to eye infections. It is a serious problem if your eye becomes infected with the smallpox vaccine virus. This exposure can happen when you touch your eye when the vaccine virus is on your finger. If you have had refractive eye surgery and are using steroid eye drops you should not be vaccinated until after the prescribed period. If you are planning to have refractive eye surgery, you must wait at least 30 to 60 days after your smallpox vaccination or until the scab has fallen off your vaccination site, whichever is longer. Please contact the IHB if you have any questions.