| Vaccinia
Necrosum (VN) Cases per 1,000,000 Primary Vaccinations(*)
| Age (yrs) |
1968 National
Survey(†)
|
1968 10-State
Survey(§)
|
| 1-4 |
0.4 |
3.2 |
| 5-19 |
0.9 |
0 |
| >20 |
7.1 |
0 |
| Totals >1 yr |
1.0 |
1.7 |
Cases among young children in 1968 were due to congenital immune deficiency, the condition only being identified when their vaccinial infection failed to heal.
Adults experienced progressive vaccinia almost always as a result of an immunosuppressive disease (e.g. leukemia, lymphoma). Those who experienced progressive vaccinia secondary to immunosuppressive therapy generally had a milder form of the disease, which was often treatable.
| * |
Numbers rounded to the nearest
tenth, total number of vaccinations estimated in both
studies. Observations missing age were distributed according
to the existing age distribution for VN. |
| † |
Case sources include: American
Red Cross Vaccinia Immune Globulin (VIG) distribution
system, Red Cross VIG consultants, State and Territorial
Epidemiologists, Burroughs-Wellcome Thiosemicarbazone
distribution list, smallpox vaccine manufacturers complication
reporting files, state reports to the Encephalitis Surveillance
Unit of the National Communicable Disease Center (NCDC),
and specimen submissions for vaccinia testing to the Viral
Exanthems Unit of NCDC. |
| § |
Case sources include: Physician
reporting via survey in 10 states with active case information
follow-up and chart review for post-vaccinial encephalitis
and vaccinia necrosum reports. |
|
Susceptible individuals today include those with the conditions in the accompanying table:
| Susceptible Populations |
| Condition |
Size of Population |
|
|
Immunodeficiency(¶)
(congenital or acquired) |
Unknown |
|
|
| HIV or AIDS(**) |
900,000 |
|
|
| Cancer(††) |
~ 8 million |
|
|
| Organ transplantation with immunosuppressive therapy |
184,000 (U.S.) |
|
|
| High dose corticosteroid treatment(§§) |
Unknown |
|
|
| Other immunosuppressive therapy (¶¶) |
Unknown |
|
|
| ¶ |
Particularly of cell-mediated immunity; although antibody-deficient individuals may also be at some risk. |
| ** |
It is not known if susceptibility correlates with T-cell counts. |
| †† |
Particularly those that impair cell-mediated immune function such as:
| • |
Lymphomas |
| • |
Leukemia |
| • |
Lymphosarcomas |
|
| §§ |
A variety of diseases are treated with high doses of corticosteroids. |
| ¶¶ |
Patients with a variety of diseases that require immunosuppressive therapy of a type that suppresses cell-mediated immune function. |
|
