What the WHO is saying in plain English is Let's cook up a virus that selectively destroys the T-cell system of man, an acquired immune deficiency. Help page Diagnosis page services. The possibility should be looked into that the immune response to the virus itself may be impaired if the infecting virus damages, more or less selectively, the cell responding to the virus.
He blames "the virologists of the world, the sorcerers who brought us this ghastly plague, and have formed a united front in denying that the virus was laboratory-made from known, lethal animal viruses. Post-vaccinial encephalitis is a rare adverse event that frequently leads to death, especially in infants and young children.
Generalized vaccinia results from blood-borne dissemination of vaccinia virus. VIG can be administered to speed recovery. Persons with atopic dermatitis or eczema, irrespective of disease severity or activity, are at risk of developing eczema vaccinatum and should not receive pre-exposure smallpox vaccination. Persons with incompetent immune systems are at risk of complications following smallpox vaccination.
This group includes persons who are immunocompromised due to a specific illness e. Infants less than one year of age should not be vaccinated because several studies have demonstrated that they are at increased risk of death and other complications. Vaccinia virus may be spread from person-to-person, which means that people who have close contact with recent vaccinees may be exposed to the virus and may be at risk of developing complications. For this reason, pre-exposure smallpox vaccination is contraindicated in persons who have close contact with individuals who have some of the risk factors described above.
Individuals should not be vaccinated if they have close contact with pregnant women or infants. Close contacts include both household members and sexual partners. Eczema vaccinatum and inadvertent inoculation are the most frequently reported conditions in contacts of recent vaccinees.
Twenty percent of the eczema vaccinatum and inadvertent inoculation cases reported in a study occurred in contacts of vaccinees. Most cases of contact vaccinia occur through direct person-to-person transfer of virus. The Advisory Committee on Immunization Practices ACIP began serious discussions about the risks and benefits of pre-event smallpox vaccination in At that time, the committee concluded that the risks of vaccination outweighed the benefits in the current pre-event setting except for a very small number of individuals.
However, the ACIP did recommend vaccination for the following groups: persons pre-designated by the appropriate public health authorities to conduct investigation and follow-up of cases; and selected personnel in facilities pre-designated to serve as referral centers to provide care for the initial cases of smallpox. The ACIP then changed its recommendation again after further discussions with state health agencies and bioterrorism experts.
In October , the group stated that suspected smallpox patients are likely to present to hospitals and facilities that provide their usual care, rather than the pre-designated smallpox response facilities. Recommendations published in February state that each acute care hospital should identify a group of health care workers who can be vaccinated and trained to provide care for the first suspected smallpox cases.
The ACIP recommendations also state that previously vaccinated health care workers should be vaccinated whenever possible to decrease the risk of vaccine complications. The current ACIP guidelines provide detailed and useful recommendations regarding the composition of smallpox health care teams, vaccination procedures, prevention of contact transmission and contraindications to pre-event vaccination.
The concept of limited pre-event vaccination is supported by a recently published policy model that evaluated the impact of different smallpox attack scenarios. The models suggest that pre-event vaccination of health care workers will yield a net reduction in fatalities unless the risk of an attack is very low. If the model assumptions are valid, pre-event vaccination of health care workers would save lives if the probability of attack is greater than.
The federal government has indicated that voluntary vaccination of the general public may be approved after health care workers and first responders have been vaccinated.
Increasing the number of vaccinated persons will inevitably lead to increases in morbidity and mortality due to vaccinia, and current evidence suggests net harm would result if smallpox vaccine were made available to the general public on a voluntary basis. If this complex public health decision is delegated to individual citizens, some individuals will be unable to weigh the risks and benefits for true informed consent.
The title of this article refers to the good, bad and ugly of smallpox vaccine. We hope that our great-grandchildren will be oblivious to this concern after many years have passed without the reemergence of this deadly disease. Edward A. Allison L. National Center for Biotechnology Information , U.
Journal List Clin Med Res v. Clin Med Res. Belongia , MD and Allison L. Naleway , PhD. Author information Article notes Copyright and License information Disclaimer. Received Feb 6; Accepted Mar 4. This article has been cited by other articles in PMC. Abstract Smallpox inarguably shaped the course of human history by killing countless millions in both the Old World and the New World. Keywords: Smallpox, Vaccine, Vaccinia, Adverse events. Risk factors Persons with atopic dermatitis or eczema, irrespective of disease severity or activity, are at risk of developing eczema vaccinatum and should not receive pre-exposure smallpox vaccination.
Transmission to Contacts Vaccinia virus may be spread from person-to-person, which means that people who have close contact with recent vaccinees may be exposed to the virus and may be at risk of developing complications. Contributor Information Edward A. References 1. McNeill W. Plagues and Peoples. New York: Doubleday; Lane J, Goldstein J. Evaluation of 21st-century risks of smallpox vaccination and policy options. Ann Intern Med. Smallpox as a biological weapon: medical and public health management.
Working Group on Civilian Biodefense. The myth of the medical breakthrough: smallpox, vaccination, and Jenner reconsidered. Int J Infect Dis. Radetsky M. Smallpox: a history of its rise and fall. Pediatr Infect Dis J. Preston R. The Demon in the Freezer House. New York: Random; Henderson DA. The eradication of smallpox. Sci Am. Weinstein and his colleagues propose that vaccination may confer protection against HIV by producing long term alterations in the immune system, possibly including the expression of a certain receptor, CCR5, on the surface of a person's white blood cells which is exploited by both viruses.
Speaking about the results, Weinstein said, "While these results are very interesting and hopefully may lead to a new weapon against the HIV pandemic, they are very preliminary and it is far too soon to recommend the general use of vaccinia immunization for fighting HIV.
Materials provided by BioMed Central. Note: Content may be edited for style and length. Science News. BMC Immunology , ; in press [ abstract ]. ScienceDaily, 18 May BioMed Central.
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