Page 130 - JSOM Fall 2022

TABLE 1 Contraindications to ACAM2000 Smallpox Vaccine
Primary Household
Contraindication Vaccinees Revaccinees Contacts
History or presence of atopic dermatitis X X X
Other active exfoliative skin conditions such as:
• Eczema
• Burns
• Impetigo
• Varicella­zoster virus infection X X X
• Herpes simplex virus infection
• Severe acne
• Severe diaper dermatitis with extensive areas of denuded skin
• Psoriasis
• Darier disease (keratosis follicularis)
Conditions associated with immunosuppression such as:
• HIV/AIDS
• Leukemia
X X X
• Lymphoma
• Generalized malignancy
• Solid organ transplant
Persons undergoing therapy with:
• Alkylating agents
• Antimetabolites
• Radiation X X X
• Tumor necrosis factor (TNF) inhibitors
• High­dose corticosteroids (≥2 mg/kg body weight or ≥20 mg/day of prednisone
or its equivalent for ≥2 weeks)
Persons who are hematopoietic stem cell transplant recipients <24 months post­
transplant OR ≥24 months, but who have graft­versus­host disease or disease relapse X X X
Persons with autoimmune disease (e.g., systemic lupus erythematosus) with X X X
immunodeficiency as a clinical component
Pregnancy X X X
Aged <1 year X X X
Breastfeeding X X
Serious vaccine component allergy X X
Known underlying heart disease (e.g., coronary artery disease or cardiomyopathy) X X
Three or more known cardiac risk factors:
• Hypertension
• Diabetes X X
• Hypercholesterolemia
• Heart disease at age 50 years in a first degree relative
• Smoking
Adapted from CDC. Smallpox. https://www.cdc.gov/smallpox/clinicians/index.html. Accessed 16 July 2022.

fully healed. 2,9,30,31 Revaccination must occur every 10 years
to maintain immunity. Data from the eradication era sug­
30
gest that postexposure vaccination within 3 days is effective at
FIGURE 2 Day 7 – First- preventing disease. 11,24 Postexposure vaccination beyond that
time vaccinee successful time may not prevent infection but may still decrease mor­
“take.” tality. Implementation of a vaccination program should be
24
Source: Adapted from done in accordance with unit and combatant command poli­
CDC. Comparison of
reactions for first­time cies – further guidance on the specifics of implementation and
vaccinees and revaccinees. a comprehensive list of DoD­specific resources are available at
https://www.cdc.gov/ www.health.mil/smallpox.
smallpox/clinicians/
comparison­vaccinees­ Adverse effects caused by smallpox vaccination can be mild
images.html#2. and self­limited but also life­threatening (Table 2). The most
31
Accessed 16 July 2022. 38
severe reactions generally include eczema vaccinatum (EV),
which occurs in patients with preexisting skin conditions,
and progressive vaccinia (PV), also known as disseminated

126 | JSOM Volume 22, Edition 3 / Fall 2022