The Atlanta-based Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) cites the following contraindications for receipt of smallpox vaccine:
Eczema or atopic dermatitis and other acute, chronic, or exfoliative skin conditions
People who have ever been diagnosed with eczema or atopic dermatitis should not be vaccinated, even if the condition is not active currently. These patients are at high risk of developing eczema vaccinatum, a potentially severe and sometimes fatal complication. Additionally, people with household contacts who have a history of eczema or atopic dermatitis, irrespective of disease severity or activity, should not be vaccinated. If the potential vaccinee or any of their household contacts have other acute, chronic, or exfoliative skin conditions (e.g., burns, impetigo, chicken pox, contact dermatitis, shingles, herpes, severe acne, or psoriasis), they are at risk for inadvertent autoinoculation of the affected skin with vaccinia virus and should not be vaccinated until the condition resolves. The literature also reports that people with Darier’s disease can develop eczema vaccinatum and therefore should not be vaccinated.
Diseases or conditions that cause immunodeficiency or immunosuppression
If potential vaccinees or their household contacts have conditions such as HIV/AIDS, solid organ or stem cell transplant, generalized malignancy, leukemia, lymphoma, agammaglobulinemia, or autoimmune disease, they should not be vaccinated. People with these conditions are at greater risk of developing a serious adverse reaction resulting from unchecked replication of the vaccine virus (progressive vaccinia). HIV testing should be readily available to all people considering smallpox vaccination. HIV testing is recommended for those who have any history of a risk factor for HIV infection and who are not sure of their HIV infection status. Anyone who is concerned that they could have HIV infection also should be tested. HIV testing should be available in a confidential or, where permitted by law, anonymous setting with results communicated to the potential vaccinee before the planned date of vaccination. People with a positive test result should be told not to present to the vaccination site for immunization.
Treatments that cause immunodeficiency or immunosuppression
If potential vaccinees or their household contacts are undergoing treatment with radiation, anti-metabolites, alkylating agents, corticosteroids, chemotherapy agents, or organ transplant medications, they should not be vaccinated. People who are receiving these therapies are at greater risk of serious adverse reactions to the smallpox vaccine.
Pregnancy
Live virus vaccines are generally contraindicated during pregnancy. Pregnant women who receive the smallpox vaccine are at risk of fetal vaccinia. Although this is a very rare condition (fewer than 50 cases have ever been reported), it usually results in stillbirth or death of the infant shortly after delivery. Before vaccination, women of childbearing age should be asked if they are pregnant or intend to become pregnant in the next four weeks; women who respond positively should not be vaccinated. In addition, women who are vaccinated should be counseled not to become pregnant during the four weeks after vaccination. Routine pregnancy testing of women of childbearing age is not recommended. Any woman who thinks she could be pregnant or who wants additional assurance that she is not pregnant should perform a urine pregnancy test using a "first morning" void urine on the day scheduled for vaccination. If a pregnant woman is inadvertently vaccinated or if she becomes pregnant within four weeks after vaccinia vaccination, she should be counseled regarding the basis of concern for the fetus. However, vaccination during pregnancy ordinarily should not be a reason to terminate pregnancy.
Previous allergic reaction to smallpox vaccine or any of the vaccine’s components
Vaccinia vaccine (Dryvax) contains small amounts of polymyxin B sulfate, streptomycin sulfate, chlor-tetracycline hydrochloride, neomycin sulfate, and phenol. Anyone who has experienced an anaphylactic reaction to these components should not be vaccinated. In addition, anyone who has experienced a previous allergic reaction to the smallpox vaccine should not be vaccinated.
Moderate or severe acute illness
Moderate or severe acute illness generally is a contraindication to vaccination. Vaccination should be deferred until the acute illness has resolved.
Under 18 years of age
Vaccination of people younger than 18 is not recommended in nonemergency circumstances.
The Centers for Disease Control and Preventions Advisory Committee on Immunization Practices cites these contraindications for receipt of smallpox vaccine.
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