|
In the absence of smallpox, patients with T-cell abnormalities should not
receive smallpox vaccine. Not all patients suffering from immune defects, cancer, HIV or receiving
immunosuppressive therapy are T-cell deficient. Consultation with an immunologist is advised for
patients in these categories, but prudence would dictate they not receive vaccine in non-emergent
situations. Patients in these categories should also be cautioned not to come in contact with vaccinated
individuals.
If a smallpox outbreak occurs, the ACIP and CDC have recommended that all patients in these
categories that have been exposed to smallpox be vaccinated. That recommendation is likely to be
reviewed as deliberations about smallpox vaccine policy continue. For further information, please
visit the Advisory Committee on Immunization Practice
(ACIP) web site and the CDC Public
Health Emergency Preparedness & Response Smallpox web site.
An appropriate history suggestive of T-cell immunodeficiency, either on a congenital basis or
secondary to some other disease or treatment identifies a person as potentially susceptible to Progressive Vaccinia.
The following areas should be explored with the potential vaccinee. These potential susceptibilities apply to the:
| • |
Vaccinee |
| • |
His/her contacts |
| Potential Susceptibilities |
Condition
|
Notes
|
Immunodeficiency, congenital or
acquired |
Is there a known immunodeficiency, congenital or acquired?
| • |
Family history |
| • |
History of prior infections compatible with CMI deficiency |
|
Disease
associated with immunodeficiency |
| • |
HIV |
| • |
AIDS |
| • |
Many cancers |
|
Immunosuppressive therapy |
Is the patient or the contact receiving any immunosuppressive therapy?
| • |
For cancer |
| • |
For maintenance of an organ or other transplant
|
| • |
Steroid therapy equivalent to 2 mgm per kg of prednisone daily
|
| • |
For any disorder that requires the use of immunosuppressive therapy, especially that which
reduces T-cell immune function |
|
|
