The following information is derived in part from: www.cdc.gov/smallpox.

The basic message here is that there is a risk from smallpox vaccination, to the recipient who falls into certain categories of medical problems - and also to those who may have contact with the recipient during the three weeks following the vaccination.  Therefore, everyone should be aware of his or her risk factors and of those around him, before a decision is made about having the vaccination.

• The vaccine which will be used is Wyeth “Dryvax”.  This product contains the following  ingredients, in addition to the live vaccine, which could be an added problem and thus provide at least a relative contraindication to anyone known to be sensitive to any of these products: polymyxin B; streptomycin; tetracycline; neomycin; phenol.
• A new vaccine, still pending approval, is “Acambis” vaccine.
• From vaccination to total resolution (scab falls off) = 19 - 21 days.  During that time, the vaccination is shedding live virus and thus is a source of contagion by contact.
• The vaccination site requires a special occlusive dressing during the entire period, with a further plastic occlusive cover used during showering.
• Some people may react allergically at the site to the special dressing.  Such reactions must not be treated with any steroid creams or ointments.
• Hand hygiene is vital on the part of the person vaccinated, in addition to paying careful attention to towels and clothes used.  Hot water cleaning is recommended.  Especially great care must be taken with the site dressing.
• Any person who may be - for whatever reason - immunosuppressed ( HIV positive, post-cancer chemotherapy, post-transplantation, post-prolonged steroid use, ...) should not receive smallpox vaccination. Nor should any person who lives or has close contact with an individual so affected.
• In addition, the following persons should not receive the smallpox vaccine:
Pregnant person or pregnant household contact;
A breast-feeding mother;
Contact with an infant less than one year old;
Those with a present or past history of eczema,  or a close contact with such a person;
During an acute illness.
• The typical response to a smallpox vaccination is as follows:
Day 2-5...local vesicle (blister);
Day 7-10...pustule;
Day 8-10...maximal erythema (local redness);
Day 14......scar
Day 19-21...scar desquamates (falls off);
During the entire period there may be varying degrees of site pain, swelling, erythema (local and / or regional),  regional adenopathy (lymph node swelling); fever; systemic symptoms (36% miss some work); possible satellite lesions; possible secondary infection with Staph. or Gp. A beta hemolytic strep.
There are more symptoms and complications with primary vaccination.
There are more problems in young children.
• Treatment of problem reactions may include:
cidofovir (an anti-viral agent);
Vaccine-Immune-Globulin (VIG), except in patients with allergy to thiomerosal or who have IgA deficiency.
• Federal compensation for Vaccine Reactions is provided for under the Homeland Security Act, Sec. 304.

GS