Summary of ACIP Telephone Conference on Supplemental Recommendations for Smallpox Vaccination

This is an unofficial summary. The actual final recommendations will be published after CDC review and approval.

Update: On January 29, 2003, the Advisory Committee on Immunization Practices (ACIP) met by conference call to finalize supplemental recommendations for use of smallpox vaccine. The Committee recommended that smallpox vaccine be given in accordance with the package insert, with 3 insertions of the bifurcated needle for primary vaccination and 15 insertions for revaccination.

Recommendations for Use of Smallpox Vaccine in a Pre-Event Smallpox Vaccination Program is now available.

January 14, 2003

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met via telephone conference call Tuesday, January 14, 2003 to review selected issues related to the Supplemental Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) for Use of Smallpox Vaccine in a Pre-Event Smallpox Vaccination Program. The committee developed these draft recommendations at their regularly scheduled meeting in October, 2002.

The discussion focused on several issues related to pre-event smallpox vaccination including:

1. Whether an adult household contact of a child less than one year of age should be deferred from vaccination until the child is at least one year of age?
2. Should the vaccination method for primary vaccinees remain as written, recommending 15 punctures [on January 29, 2003, ACIP recommended that smallpox vaccine be given in accordance with the package insert, with 3 insertions of the bifurcated needle for primary vaccination and 15 insertions for revaccination]?
3. Is autoimmune disease in the absence of immune-suppressing medication a contraindication for receiving smallpox vaccine?
4. Are inflammatory eye diseases a contraindication for smallpox vaccination?
5. What is appropriate care for vaccination sites?

The committee affirmed that smallpox vaccination is contraindicated for infants less than one year of age. The presence of an infant in the household is not a contraindication to vaccination of other members of the household; data suggest that the risk of serious complications from transmission from an adult to a child is extremely small. The ACIP recognizes some programs may defer vaccination of household contacts of infants less than one year of age because of data suggesting a higher risk of adverse events among primary vaccinees in this age group, compared with that among older children.

The committee affirmed the recommendation that 15 insertions [on January 29, 2003, ACIP recommended that smallpox vaccine be given in accordance with the package insert, with 3 insertions of the bifurcated needle for primary vaccination and 15 insertions for revaccination] of the bifurcated needle be used for both primary vaccination and revaccination. Although the FDA package insert recommends 2 to 3 insertions for primary vaccinations, the committee based its recommendation on experience gained during the global eradication program and recent smallpox vaccine clinical trials.

The sense of the committee was that some individuals with severe autoimmune diseases such as systemic lupus erythematosus, dermatomyositis, and scleroderma may have immune suppression in the absence of disease therapy, although there are no data documenting an increased rate of complications in such persons following smallpox vaccination. Therefore, it may be prudent in a setting without known smallpox transmission and with an uncertain risk of a smallpox attack to not vaccinate these persons at this time.

The committee recommended that persons receiving steroids for eye disease not receive smallpox vaccination until the course of therapy is completed.

The committee affirmed semi-permeable dressings should be used in the health care setting to prevent transmission, especially to immunocompromised patients. Other types of dressings may be used outside of health care settings. When using a semi-permeable dressing, it should be applied over a gauze dressing.

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