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Smallpox Vaccination Followup: IOM Suggests Changes, Widespread Civilian Vaccinations to Begin

By John S. James

December 27, 2002

January 21, 2003: The first phase of voluntary civilian smallpox vaccinations -- for about 500,000 persons who will serve in first-response teams in case of a smallpox attack -- is expected to start in a few days; later, "phase II" will recommend voluntary vaccination for up to 10,000,000 healthcare workers and others. On January 17 the prestigious Institute of Medicine released a number of recommendations for changes in the program. The IOM report, which had been requested by the U.S. Centers for Disease Control and Prevention (CDC), is available at, along with a press release summarizing important concerns and recommendations.

People with HIV must not be vaccinated against smallpox (unless there is a smallpox attack, in which case the risks and benefits would have to be reconsidered -- or unless a safer vaccine is developed, which will take years). Many others should not be vaccinated as well. In fact, about 30 percent of the U.S. population is believed to have one or more contraindications, and should not be vaccinated. And since this vaccine contains a live virus, persons with HIV or other contraindications need to avoid close contact (especially household contact) with those who have been vaccinated recently, probably for two to three weeks.

Here are some of the concerns reflected in the IOM report that our readers should know about:

Note: Healthcare Workers Vaccination, HIV Testing and Disclosure

On January 15 Lambda Legal, amfAR, and the Gay and Lesbian Medical Association issued a joint statement on HIV testing and disclosure during the vaccination program. It is available at:

ISSN # 1052-4207

Copyright 2002 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.

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