After smallpox was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer needed. However, because of concern that variola virus might be used as an agent of bioterrorism, the U. If you need long-term protection, you may need to get booster vaccinations regularly. To stay protected from smallpox, you should get booster vaccinations every 3 years. If there is a smallpox outbreak, public health officials will say who else should get the vaccine.
CDC works with federal, state, and local officials to prepare for a smallpox outbreak. The smallpox vaccine is given by a special technique. It is given using a two-pronged bifurcated needle that is dipped into the vaccine solution. When removed, the needle holds a droplet of the vaccine. This has led to concerns that smallpox could someday be used as a biological warfare agent.
No cure or treatment for smallpox exists. A vaccine can prevent smallpox, but the risk of the vaccine's side effects is too high to justify routine vaccination for people at low risk of exposure to the smallpox virus.
These are smallpox lesions on the skin of the trunk. This photograph was taken in Bangladesh in The first symptoms of smallpox usually appear 10 to 14 days after you're infected. During the incubation period of seven to 17 days, you look and feel healthy and can't infect others. Following the incubation period, a sudden onset of flu-like signs and symptoms occurs. These include:. A few days later, flat, red spots appear first on your face, hands and forearms, and later on your trunk.
Within a day or two, many of these lesions turn into small blisters filled with clear fluid, which then turns into pus. Scabs begin to form eight to nine days later and eventually fall off, leaving deep, pitted scars. Lesions also develop in the mucous membranes of your nose and mouth and quickly turn into sores that break open.
Most people who get smallpox survive. However, a few rare varieties of smallpox are almost always fatal. However, the vaccine does contain another virus called vaccinia which is live in the vaccine. Because the virus is alive, it can spread to other parts of the body or to other people from the vaccine site. For that reason, the vaccine site must be carefully monitored.
Vaccinia is spread by touching a vaccination site before it has healed or by touching bandages or clothing that have become contaminated with live virus from the vaccination site.
Vaccinia is not spread through airborne contagion. The vaccinia virus may cause rash, fever, and head and body aches. Vaccinia is not spread through the air. The smallpox vaccine is the best protection you can get if you are exposed to the smallpox virus. Most people experience normal, usually mild reactions that include a sore arm, fever, and body aches. In recent tests, one in three people felt bad enough to miss work, school, or recreational activity or had trouble sleeping after receiving the vaccine.
However, the vaccine does have some more serious risks. In the past, about 1, people for every 1 million people vaccinated experienced reactions that, while not life-threatening, were serious. These reactions include a vigorous toxic or allergic reaction at the site of the vaccination and spread of the vaccinia virus the live virus in the smallpox vaccine to other parts of the body and to other people. These reactions typically do not require medical attention.
Rarely, people have had very bad reactions to the vaccine. In the past, between 14 and 52 people per 1 million vaccinated experienced potentially life-threatening reactions, including eczema vaccinatum, progressive vaccinia or vaccinia necrosum , or postvaccinal encephalitis.
Based on past experience, it is estimated that between 1 and 2 people out of every 1 million people vaccinated will die as a result of life-threatening reactions to the vaccine. Careful screening of potential vaccine recipients is essential to ensure that those at increased risk do not receive the vaccine.
People most likely to have side effects are people who have, or even once had, skin conditions, especially eczema or atopic dermatitis and people with weakened immune systems, such as those who have received a transplant, are HIV positive, or are receiving treatment for cancer.
Anyone who falls within these categories, or lives with someone who falls into one of these categories, should NOT get the smallpox vaccine unless they are exposed to the disease. Pregnant women should not get the vaccine because of the risk it poses to the fetus. Anyone who is allergic to the vaccine or any of its components should not get the vaccine, and anyone under the age of 18 should not get the vaccine unless they are exposed to smallpox. People who should not get the vaccine include anyone who is allergic to the vaccine or any of its components polymyxin B, streptomycin, chlortetracycline, neomycin ; pregnant women; women who are breastfeeding; people who have, or have had, skin conditions especially eczema and atopic dermatitis ; and people with weakened immune systems, such as those who have received a transplant, are HIV positive, are receiving treatment for cancer, are taking medications like steroids that suppress the immune system, or have heart conditions.
Also individuals younger than 12 months of age should not get the vaccine. Additionally, the Advisory Committee on Immunization Practices ACIP advises against non-emergency use of smallpox vaccine in children younger than 18 years of age and the vaccine manufacturer's package insert states that the vaccine is not recommended for use in geriatric populations in non-emergency situations.
The term geriatric generally applies to those people age 65 and above. These people should not receive the vaccine unless they have been exposed to smallpox. Also, people who are using steroid drops in their eyes should wait until they are no longer using the medication to get the vaccine. Careful monitoring of smallpox vaccinations given over recent months has suggested that the vaccine may have caused side effects on the heart.
Experts are exploring this more in depth. As a precaution, if you have been diagnosed by a doctor as having a heart condition with or without symptoms you should NOT get the smallpox vaccine at this time. A second drug, cidofovir, may be used is some situations.
Neither drug is currently licensed for this purpose both administered under investigational new drug IND protocol and they may have side effects of their own. Vaccinated parents of young children need to be careful not to inadvertently spread the virus to their children.
Getting a shot 4 to 7 days after exposure may also help. People who have very close contact with a person who has gotten a smallpox vaccine can get an infection from the virus used in the vaccine. The infection usually causes a minor skin rash and is not smallpox. So the site where the smallpox vaccine was given should be covered until the scab falls off. In the past, when a smallpox infection was diagnosed, infected people were kept away from others to prevent the spread of infection. Everyone who might have been exposed to the virus was then vaccinated.
This practice, called ring vaccination, played a key role in wiping out smallpox. Many experts think it would be better to carry out ring vaccination before mass vaccination if there were a case today.
Because there are risks of a serious reaction from the vaccine, routine smallpox immunization doesn't occur. All children and most adults in the U. Since the September terrorist attacks on the U. The U. The smallpox vaccine is recommended for laboratory workers who handle the vaccinia virus, for members of smallpox response teams, and for certain people in the military. Current as of: September 23, Author: Healthwise Staff. Medical Review: E. This information does not replace the advice of a doctor.
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