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Contraindications

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Contraindications to Vaccination
(in potential vaccinee or their household or other close physical contacts)

Potential vaccinees must be screened for contraindications to smallpox vaccination. For details refer to specific adverse events.

Anyone with whom the potential vaccinee has contact and who has a susceptibility to complications must be identified to:

•  Avoid accidental transplantation to that individual by the vaccinee
•  Ensure that the vaccinee breaks contact with the individual until scar formation, generally in 2-3 weeks, indicating lack of infectivity

Non-Emergency vs. Emergency

The vaccinia vaccine should not be administered for non-emergency indications if any of the conditions in the accompanying table are present or if the vaccinee lives with or has similar close physical contact (e.g. persons with prolonged intimate contact with the potential vaccinee, including the potential for direct contact with the vaccination site) with someone who has one of these conditions. Vaccine component allergy, concurrent illness, or active eye disease requiring steroid treatment, are contraindications only for the person being offered vaccination and do not apply to other close physical contacts.

Note, however, that in the event of a smallpox outbreak if exposure to smallpox virus has occurred or there is a high risk of exposure to a patient, these contraindications would not apply. In these situations, the benefit of vaccination would outweigh the risks. For further information, please visit the Prevention section of the Progressive Vaccinia page.

Allergies to Vaccine Components

Each Dryvax vaccine lot contains antibiotics and preservatives. Specific allergies to these products may occur. 

Appropriate history of such allergies should be obtained and may negate vaccine administration when smallpox is not present. 

If smallpox is present and the risk of contact great, the vaccine should be administered with subsequent use of an appropriate antihistamine or other medication. 

Current Dryvax contains:

•  Polymyxin B sulfate
•  Streptomycin sulfate
•  Chlortetracycline hydrochloride
•  Neomycin sulfate
•  Pregnancy
Do not administer if pregnant and advise not to become pregnant for 1 month following vaccination.

• 

Immunodeficiency
Includes any disease with immunodeficiency (congenital or acquired) as a component, e.g.:
  •  HIV Infection
  •  AIDS
  •  Many cancers

• 

Immunosuppressive therapy(*)
  •  Cancer treatments
  •  Some treatments for autoimmune diseases
  •  Organ/transplant maintenance
  •  Steroid therapy(†)
  •  Topical steroids for a skin disease

• 

Eczema or Atopic Dermatitis
  •  History or presence of eczema or atopic dermatitis(§)

• 

Skin Disorders(Ά)
Disruptive or eruptive, e.g.:
  •  Severe acne
  •  Burns
  •  Impetigo
  •  Contact dermatitis or Psoriasis
  •  Chickenpox

 

The following contraindications and precautions apply to the vaccinee only:

• 

Vaccine component allergy
  •  Polymyxin B sulfate
  •  Streptomycin sulfate
  •  Chlortetracycline hydrochloride
  •  Neomycin sulfate

• 

Active eye disease of the conjunctiva or cornea (**)
  •  Inflammatory eye disease requiring steroid treatment

• 

Moderately or severely ill at the time of vaccination –
should usually wait until they recover before getting vaccinated

Breastfeeding mothers(††)


* Immunosuppression from some medications may last for up to 3 months after discontinuation
† Equivalent to 2 mg/kg or greater of prednisone daily, or 20 mg/day, if given for 14 days or longer.
§ Even patients with “healed” eczema or atopic dermatitis may manifest complications. They should not be vaccinated and they should avoid contact with a recent vaccinee.
Ά The size and extent of the non-eczema/atopic skin disorder may be sufficiently small that vaccination can be safely performed. However, all such patients must be counseled to take great care to avoid any transfer from the primary site to the affected skin. Persons with conditions or injuries that cause extensive breaks in the skin should not be vaccinated until the condition resolves.
** Persons with inflammatory eye diseases may be at increased risk for inadvertent inoculation due to touching or rubbing of the eye. The Advisory Committee for Immunization Practices (ACIP) recommends that persons with inflammatory eye diseases requiring steroid treatment defer vaccination until the condition resolves and the course of therapy is complete.
†† Unknown if virus transmitted in breastmilk. Close contact may also increase chance of transmission to infant.


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