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Infectious Diseases

mass smallpox vaccination risk factor

09/27/2002

Question:

in the event of mass inncoulations for small pox, would I have to stop taking immune-suppressive meds that have kept my MG in check? I am healthy now; but work with the general public & wonder if this "live virus" would present a risk? (I am 50 yrs old & have been in "remission" about 5 years)

Answer:

You ask a very important and difficult question. I don`t have a perfect answer for you, because there are many unknowns. When people are vaccinated against smallpox, they are infected with vaccinia virus. Vaccinia is related to smallpox but causes a much milder illness. Vaccinia, although safe for the vast majority of people, causes serious or even fatal illness in some people, particularly people with eczema, people with impaired immunity, or children younger than 1 year. People infected with vaccinia virus (i.e., vaccinated against smallpox) can infect others with vaccinia. How great this risk is, or how often it would happen in a mass vaccination campaign, is not known. Right now, there is no reason to change your medicines. But next time you see your doctor, you should discuss your concerns. You and s/he should discuss what would happen if you were to stop your immunosuppressive medicines for a short period of time, and you should have a way to contact your doctor if a mass vaccination occurred. Furthermore, people vaccinated against smallpox are generally advised to stay away from anyone at risk of serious illness from the vaccine. If there were a mass vaccination, you should let people know that you are one of those at-risk people. Lastly, if you were ever exposed to bona fide smallpox, you should get the vaccine. Vaccinia is still safer than smallpox itself.

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Response by:

Amy Beth Kressel, MD
Associate Professor of Clinical Medicine
College of Medicine
University of Cincinnati