News reports of a soldier’s child who is ill from his father’s smallpox vaccine shows the reason that we no longer vaccinate everyone.

Years ago, when we used the vaccine, we saw a lot of complications, but in those days when you could catch smallpox and when lawyers weren’t as active, it was viewed as a risk you took.

Smallpox vaccine uses a mild varient of the disease. Originally it was cowpox, but over the last 200 years it has become a different virus, called vaccinia. For most people, it would cause a sore– an open sore with a pus pocket or pustule–and leave a scar. You would have complete immunity for 7 to ten years, but if you might be in contact with smallpox, you just got it repeated. I had several: one as a child, one when I started medical school, one when I went to Africa.

However, because it is a live virus, it can make you sick.

The most common complication that we used to see from the vaccine was eczema vaccinatum, That happened when a child with ecsema–dry allergic itchy rash of the skin–got the virus on his hand and scratched it into his skin. He would end up with not one but dozens of pustules. It was rarely fatal, but it made the kids very sick. From the news reports that’s what happened to this kid. There is an anti viral antibiotic that they are using on this kid.

However, there is a much more dangerous complication of smallpox vaccine that occurs with people whose immune systems are weak from cancer, chemotherapy, or HIV. That is generalized vaccinia. When we used to vaccinate kids, we always had to check if grandmom or other adults in contact with the kid had cancer. And if an adult needed the vaccine for travel, you were supposed to make sure he or she didn’t have any mild problems. When we were in medical school, they told us of a famous author who had chronic leukemia but didn’t know it and who went to a doc for his routine travel immunizations, and ended up dying of it.

I see the USArmy is again using smallpox on their soldiers. That means someone is worried about Biological warfare.
Back in the  1980’s, when HIV started, as soon as there was testing for HIV everyone, including myself, got tested for HIV. But there was a question if that meant retirement, and back then the decision was merely to keep you in the USA and not let you go to war for two reasons: one was reactions to live vaccines, and the other was because in emergencies, you transfuse using “walking donors” blood.

I think what finally stopped the smallpox immunizations back then was that before th etest was available, a man with early HIV enlisted, got his smallpox vaccine, and got generalized vaccinia. The rumor was that they depleted the CDC’s entire stock of antibody globulin but he survived.

However, 9-11 changed all of that.

And other problems with the vaccine, including a few heart attacks in vulnerable people, stopped the enthusiasm to vaccinate civilians.

They are working on a vaccine with fewer side effects, but like everything, there is a “cost benefit ratio” that has to be considered. Soldiers will still probably get the old fashioned time proven vaccine for awhile.

After all, with the news that measles vaccine has to be repeated, and last week’s news that Chicken pox vaccine wears off in a few years, there is an argument not to risk the lives of soldiers with an unproven vaccine if another vaccine is available.

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Nancy Reyes is a retired physician living in the Philippines. Her webpage is Finest Kind Clinic and fishmarket and she posts medical essays on Hey Doc Xanga BLog

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