Quick Guide to Preexposure Smallpox Vaccination

Current National Smallpox Vaccination Policy
Current Recommendations for Vaccination of Healthcare Workers
—Smallpox Response Teams and Healthcare Worker Teams
—Management of the Vaccination Site
—When to Recommend Administrative Leave for Vaccinated Healthcare Workers
—Contraindications for Vaccination of Healthcare Workers
—Administration of Other Vaccines and PPD Testing
Smallpox Vaccine
Vaccine Distribution and Storage
Vaccine Administration
Local Reaction to Vaccination
Contraindications and Precautions
Documented Adverse Reactions
Treatment of Adverse Reactions
Smallpox Vaccination Clinic Implementation
Liability Issues Following Smallpox Vaccine Administration
Resources Available Through CDC

Note: This document deals with current policies related to preexposure vaccination only and is intended to provide practical information to clinicians and public health practitioners. For detailed information on other aspects of smallpox and smallpox vaccines and for the latest news items, click here.

Current National Smallpox Vaccination Policy

On December 13, 2002, President Bush announced the following US policy:

Smallpox vaccinations are required for military personnel. According to the Department of Health and Human Services, approximately 500,000 military personnel will be vaccinated.
Smallpox vaccinations are recommended for smallpox response teams comprised of public health staff and healthcare workers likely to be involved in the initial care of any patients with smallpox.
Smallpox vaccinations also are being offered to other healthcare workers and to first-responders (including police officers, firefighters, and emergency medical technicians).
Under current circumstances, with limited availability of licensed vaccine supplies, vaccination of the general population is not recommended, because the potential benefits of vaccination do not outweigh the risk of vaccine complications.
Smallpox vaccinations may be made available to the general public on a voluntary basis at some point in the future.

Current Recommendations for Vaccination of Healthcare Workers

In October 2002, the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) made the following recommendations for use of smallpox vaccine in the pre-event setting (see CDC: Recommendations for use of smallpox vaccine in a pre-event smallpox vaccination program):

Smallpox Response Teams and Healthcare Worker Teams

Smallpox vaccination is recommended for persons designated by the appropriate bioterrorism and public health authorities to conduct investigation and follow-up of initial smallpox cases (ie, smallpox response teams). These teams might include medical team leaders, public health advisors, medical epidemiologists, disease investigators, diagnostic laboratory scientists, nurses, personnel who would administer smallpox vaccines, and security/law enforcement personnel.
Each acute-care hospital should identify a group of healthcare workers (ie, smallpox healthcare teams) who should be vaccinated and trained to provide direct medical care for the first few smallpox patients requiring hospital admission and to evaluate and manage patients who present to the emergency department with suspected smallpox. These teams should have a wide range of expertise and should include emergency room physicians and nurses, intensive care unit staff, general medical unit staff, primary care house staff, medical subspecialists (including infectious disease specialists, medical consultants with smallpox experience, dermatologists, ophthalmologists, pathologists, surgeons, and anesthesiologists), infection control professionals, respiratory therapists, radiology technicians, security personnel, and housekeeping staff. Ideally, each hospital should have enough vaccinated personnel from each occupational category to assure continuity of care.

Management of the Vaccination Site

Vaccinated healthcare workers who are involved in direct patient care should keep the vaccination site covered with gauze or similar absorbent material. This dressing should then, in turn, be covered with a semipermeable dressing to provide a barrier for containment of vaccinia virus to minimize the risk of transmission. Alternatively, products combining an absorbent base with an overlying semipermeable layer can be used to cover the site. The vaccination site should be covered with gauze, a semipermeable dressing, and a layer of clothing during direct patient care until the scab separates.
Vaccinated healthcare workers should be reminded that consistent hand hygiene with antimicrobial soap and water or an approved alcohol-based hand rub is critical for preventing contact transmission.

When to Recommend Administrative Leave for Vaccinated Healthcare Workers

Vaccinated healthcare workers do not need to be placed on administrative leave unless they: (1) are physically unable to work because of systemic signs and symptoms of illness, (2) have extensive skin lesions that cannot be adequately covered, or (3) are unable to adhere to the recommended infection control precautions.

Contraindications for Vaccination of Healthcare Workers

Healthcare workers should not be vaccinated if they or their family members have a history of eczema or atopic dermatitis. Persons with other acute, chronic, or exfoliative skin conditions (eg, burns, impetigo, varicella zoster, herpes, severe acne, or psoriasis) also should not be vaccinated until the condition resolves.
Healthcare workers should not be vaccinated if they have HIV infection or other immunosuppressive conditions. Persons who are taking or have taken high-dose corticosteroids should not be vaccinated within 1 month of completing therapy, and persons treated with other immunosuppressive drugs within the past 3 months should not be vaccinated. While the ACIP does not support mandatory HIV testing prior to smallpox vaccination, the Committee recommends that HIV testing be readily available to all persons considering smallpox vaccination.
Healthcare workers with physician-diagnosed cardiac disease, with or without symptoms, should not be vaccinated. CDC made this recommendation on March 25, 2003 after reports of several cases of myopericarditis, angina, and myocardial infarction in recent vaccinees. An investigation is in progress. On March 28, the recommendation was extended to include workers with three or more major risk factors for cardiac disease (hypertension, diabetes, hypercholesterolemia, heart disease at age 50 years in a first-degree relative, smoking). See CDC: Supplemental recommendations on adverse events following smallpox vaccine in the pre-event vaccination program.
Pre-event vaccinations should not be administered to women who are pregnant or who are trying to become pregnant. Before vaccination, women of childbearing age should be asked if they are pregnant or intend to become pregnant in the next 4 weeks; women who respond positively should not be vaccinated. Women who receive the vaccine should be told not to become pregnant for at least 4 weeks after vaccination. Routine pregnancy testing before vaccination is not recommended. According to the product labeling, smallpox vaccination is not recommended for women who are breast-feeding.

Administration of Other Vaccines and PPD Testing

Smallpox vaccine may be administered at the same time as any inactivated vaccine and at the same time as other live-virus vaccines except varicella vaccine (varicella vaccine and vaccinia vaccine should be administered at least 4 weeks apart). Parenterally administered live vaccines not administered on the same day as smallpox vaccine should be administered 4 or more weeks later.
Healthcare workers who are due to receive an annual PPD skin test should not receive the test until 1 month after smallpox vaccination.

Smallpox Vaccine

The only smallpox vaccine that is currently available for use is the Dryvax vaccine. This vaccine was produced in the 1970s, and an estimated 15.4 million doses are stockpiled. Because of changes to the diluent of the vaccine, it was relicensed by the Food and Drug Administration (FDA) in late 2002 (see related news story on this site). Because the vaccine is a licensed product, it can be given without an Investigational New Drug (IND) protocol.

The vaccine contains the antibiotics polymyxin B, streptomycin, tetracycline, and neomycin.
The diluent used to reconstitute the vaccine is 50% glycerin and a small amount of phenol as a preservative.
The vaccine vial stopper contains dry natural rubber that may cause hypersensitivity reactions for those who handle or receive the vaccine.

Other vaccines either are in production (the Acambis vaccine) or being held for possible emergency use (the Aventis vaccine). More details about these vaccines can be found in the Smallpox Overview on this site.

Vaccine Distribution and Storage

Smallpox vaccine is available from CDC through state or local health departments to the appropriate clinic sites. Key points for consideration include the following (see CDC: Smallpox preparedness: information to support public health and clinical personnel planning for smallpox vaccination):

Each vaccine kit contains the necessary supplies to vaccinate 100 persons, including a vial of vaccine, diluent, and 100 bifurcated needles.
The vaccine vial will hold 100 doses of vaccine after reconstitution; the vial is about 1.5 inches tall and about 5/8 inches in diameter.
If additional bifurcated needles are needed, they may be obtained through the Strategic National Stockpile at the number provided in the shipping instructions.
Both unreconstituted and reconstituted vaccine should be stored at between 2° and 8°C when not in use. Vaccine may be kept at normal room temperature during the course of a clinic session and then placed back into refrigeration.
The vaccine is good for 30 days after being reconstituted and may be taken in and out of refrigeration as many times as needed during the course of those 30 days.
The vaccine is not light-sensitive, so no special measures are needed to protect against light exposure.
The CDC policy on unused smallpox vaccine is available on the CDC smallpox Web site (see CDC: Policy on unused smallpox vaccine).

Vaccine Administration

The vaccine is administered using a droplet of the vaccine applied to a bifurcated needle in the following manner. This procedure is detailed in the following resources available through the CDC Web site: Smallpox Response Plan and Guidelines: Guide B/Part 2, Smallpox Fact Sheet: Smallpox Vaccination Method, and Smallpox Vaccine Administration Video.

Choose the site for vaccination; the deltoid area on the upper arm is preferred
No skin preparation is required. Under no circumstances should alcohol be applied to the skin prior to vaccination, as it has been shown to inactivate the vaccine virus.
Dip the needle into the vaccine vial and withdraw. The same needle should never be dipped into the vaccine vial more than once, in order to avoid contamination of the vial.
Hold the needle perpendicular to the site of insertion.
For primary vaccinations, make three insertions (perpendicular strokes) of the needle rapidly in an area about 5 mm in diameter; for revaccinations, make 15 insertions of the needle (see CDC: Recommendations for use of smallpox vaccine in a pre-event smallpox vaccination program). The strokes should be sufficiently vigorous so that a trace of blood appears at the vaccination site after 15 to 30 seconds. If no blood is visible, an additional three insertions should be made using the same bifurcated needle without reinserting the needle into the vaccine vial.
Discard the bifurcated needle in an appropriate biohazard container immediately after vaccinating a patient.
Absorb the excess vaccine and blood from the site with sterile gauze and discard in a safe manner (usually in an infection control receptacle).
Cover the site with a sterile gauze dressing (or similar absorbent material) loosely secured by tape. This dressing should be covered with a semipermeable dressing. Products that combine an absorbent base with an overlying semipermeable layer also can be used to cover the vaccination site.
Educate the vaccinee about caring for the site (see section Smallpox Vaccination Clinic Implementation below and see CDC: Smallpox Fact Sheet: Caring for the Smallpox Vaccination Site).
Record the following information: vaccine used, diluent used, lot number, and any adverse health events.

Local Reaction to Vaccination

See CDC: Smallpox Vaccination and Adverse Events Training Module and CDC: Smallpox vaccination and adverse reactions: guidance for clinicians.

Upon primary vaccination, all recipients experience a local reaction to the vaccine. A typical reaction occurs in the following sequence:

At 3 to 5 days after vaccination, a red papule appears at the vaccination site.
By day 5 to 8, the papule becomes vesicular, then pustular, and reaches its maximum size at 8 to 10 days. The jennerian pustule, which contains turbid fluid, is whitish, umbilicated, multilocular, and surrounded by an erythematous areola.
The pustule eventually dries, leaving a dark crust that normally separates 14 to 21 days after vaccination.
A pitted scar usually remains after the scab separates.
Regional lymphadenopathy and fever are common.
Response to the vaccination should be evaluated 6 to 8 days after vaccination to assure that a typical reaction has occurred (ie, a "take").

Cutaneous reactions to subsequent vaccinations are weaker and manifest a range of the local reactions above. For a revaccination to be considered successful, palpable inflammation or a pustule must be present. With revaccination, the less intense the jennerian pustule, the greater the likelihood of some degree of residual immunity. Vaccinated persons in whom a typical reaction to the vaccine develops are considered to be protected against smallpox, since more than 95% of such persons have been shown to have increased antibody titers following vaccination. No reaction to revaccination indicates inadequate technique or insufficient virus in the inoculation.

Contraindications and Precautions

See CDC: Smallpox Fact Sheet: Smallpox (Vaccinia) Vaccine Contraindications. Vaccinia vaccine for pre-exposure use is contraindicated for the following groups (see Recommendations for use of smallpox vaccine in a pre-event smallpox vaccination program):

Persons who have ever been diagnosed with eczema or atopic dermatitis (even if the condition is mild or not presently active), because the risk of eczema vaccinatum is increased
Persons with other acute or chronic exfoliative skin conditions (eg, burns, impetigo, chicken pox, contact dermatitis, shingles, herpes, severe acne, psoriasis), until the condition resolves
Persons with conditions causing immunodeficiency (eg, HIV infection, leukemia, lymphoma, generalized malignancy, solid organ or stem cell transplant, agammaglobulinemia or other hereditary immunodeficiency, autoimmune disease); for more information on smallpox vaccination and patients with organ transplantation, see Dropulic 2003
Persons receiving treatments that cause immunodeficiency (eg, alkylating agents, antimetabolites, radiation, corticosteroids, chemotherapy agents, organ transplant medications); persons who are taking or have taken high-dose corticosteroids should not be vaccinated within 1 month of completing therapy, and persons treated with other immunosuppressive drugs within the last 3 months should not be vaccinated
Pregnant women, because vaccination may result 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 4 weeks—those who respond positively should not be vaccinated (for more information on smallpox vaccine and pregnancy, see CDC: Smallpox Fact Sheet: Smallpox Vaccination Information for Women Who Are Pregnant or Breastfeeding)
According to the product labeling, smallpox vaccination is not recommended for women who are breast-feeding
Persons with hypersensitivity reactions to vaccine components, including polymyxin B sulfate, streptomycin sulfate, chlortetracycline hydrochloride, and neomycin sulfate
Persons under 18 years of age in nonemergency situations
Persons with household contacts who are immunodeficient, who have a history of eczema or atopic dermatitis (even if the condition is not currently active), or who have an acute, chronic, or exfoliative skin condition
Persons with physician-diagnosed cardiac disease, with or without symptoms and persons with three or more risk factors for coronary artery disease (see CDC: Supplemental recommendations on adverse events following smallpox vaccine in the pre-event vaccination program)

Documented Adverse Reactions

See CDC: Smallpox Fact Sheet: Adverse Reactions Following Smallpox Vaccination; CDC: Smallpox vaccination and adverse reactions: guidance for clinicians; CDC: Smallpox Vaccination and Adverse Events Training Module, and CDC: Smallpox Vaccine: Adverse Event Rates, 1968.

Well-documented adverse reactions include the following:

Tenderness, erythema at the injection site and other localized reactions (including allergic reactions to tape adhesives), and secondary bacterial infections; local reactions greater than 10 cm in size are referred to as "robust takes"
Systemic reactions: fever of at least 100°F, malaise, myalgias, local lymphadenopathy, generalized skin rashes, including erythema multiforme and Stevens Johnson syndrome
Focal and generalized suppurative folliculitis (without evidence of viral infection; may be mistaken for generalized vaccinia (see Talbot 2003)
Inadvertent autoinoculation of another body site: 25.4 to 529.2 cases per million primary vaccinees
Generalized vaccinia (GV): vesicles or pustules appearing on normal skin distant from the vaccination site; 23.4 to 241.5 cases per million primary vaccinees
Eczema vaccinatum (EV): localized or systemic spread of vaccinia virus; may be severe and can be fatal; 10.4 to 38.5 cases per million primary vaccinees
Vaccinia keratitis
Progressive vaccinia (PV): progressive necrosis in the area of vaccination, often with metastatic lesions at other sites; can be severe and fatal; 0.9 to 1.5 cases per million primary vaccinees)
Postvaccinial encephalitis (PVEM): 2.9 to 12.3 cases per million primary vaccinees
Fetal vaccinia: occurs after primary inoculation of the mother during pregnancy; usually results in stillbirth or death of the infant soon after birth
Death: 1.1 deaths per million primary vaccinees

On March 28, 2003, CDC reported several cases of possible cardiac adverse events among civilian healthcare and public health workers who had received smallpox vaccine between January 24 and March 21, 2003 (see CDC: Cardiac adverse events following smallpox vaccination—United States, 2003). Additional cases have been reported since that time (see CDC: Adverse events following smallpox vaccination—United States, 2003; CDC: Cardiac and other adverse events following civilian smallpox vaccination—United States, 2003). Key points include the following:

The events included myocardial infarction, angina, myopericarditis, and dilated cardiomyopathy (DCM).
Although myocarditis and pericarditis had been reported following smallpox vaccination in the past, these are not well-recognized complications following vaccination with the strain of vaccinia used in the United States.
A causal relationship between these cardiac events and smallpox vaccination has not yet been established; however, persons receiving smallpox vaccine should be informed that myopericarditis might be associated with smallpox vaccination, and recently vaccinated persons should seek medical attention if they experience chest pain, shortness of breath, or other symptoms of cardiac disease.
CDC currently is recommending that persons with known cardiac disease (with or without symptoms) and persons with three or more major risk factors for cardiac disease be excluded from smallpox vaccination (see CDC: Supplemental recommendations on adverse events following smallpox vaccine in the pre-event vaccination program).

Cases of myopericarditis following smallpox vaccination also have been recognized among vaccinia-naive military personnel. According to a recent report, 18 cases of probable myopericarditis following smallpox vaccination were identified among 230,734 primary vaccinees who were vaccinated between December 2002 and March 2003, yielding an incidence of 7.8 cases per 100,000 primary vaccinees over 30 days (see Halsell 2003).

Studies conducted in the United States in the 1960s demonstrated that the overall rater for serious life-threatening reactions (ie, progressive vaccinia, eczema vaccinatur, postvaccinial encephalitis) is 14.2 to 52.3 cases per million primary vaccinees.

Contact vaccinia (ie, spread from a vaccinated person to an exposed contact) can occur; both household and nosocomial transmission have been documented (see January 30, 2003, New England Journal of Medicine article "How Contagious is Vaccinia?")

Adverse reactions to smallpox vaccine should be reported through the Vaccine Adverse Event Reporting System (VAERS) (see VAERS Web site).

CDC is monitoring rates of adverse reactions reported during the current pre-event vaccination program. These rates are being updated weekly on the CDC smallpox Web site: Smallpox Vaccination Report: Status of Adverse Events.

Beginning in December 2002, the US military implemented a program of smallpox vaccination for military personnel. Over a 5.5-month period, 450,293 vaccinations were administered (70.5% of recipients were primary vaccinees and 29.5% were revaccinees) (see Grabenstein 2003).

No cases of eczema vaccinatum or progressive vaccinia were reported
Notable adverse events included the following:

1 case of encephalitis (2.2 cases per million vaccinees)
37 cases of acute myopericarditis (82 cases per million vaccinees)
36 cases of generalized vaccinia (80 cases per million vaccinees)
48 cases of inadvertent self-inoculation (107 cases per million vaccinees)

The incidence rates of adverse events identified in this study are generally lower than the historic rates reported from the 1960s. The authors concluded that "mass smallpox vaccinations can be conducted safely with very low rates of serious adverse events." The authors indicate that these low rates can be attributed to careful staff training, contraindication screening, recipient education, and attention to bandaging. The relative health of the military population may also have been a contributing factor.

Treatment of Adverse Reactions

Therapies for adverse reactions to smallpox vaccination include vaccinia immunoglobulin (VIG), cidofovir (a nucleotide analogue of cytosine), and topical ophthalmic antiviral drugs for ocular involvement. Detailed information on use of these agents can be found in CDC: Smallpox vaccination and adverse reactions: guidance for clinicians).

Indications for use of vaccinia immunoglobulin (VIG) are outlined in the table below.

Indications for Use of Vaccinia Immunoglobulin (VIG) for Treatment of Adverse Reactions Associated With Smallpox Vaccination
Adverse Reaction	VIG Indication
Inadvertent inoculation of body sites other than eye	Reaction usually self-limited so VIG generally not required unless reaction considered severe (eg, high number of lesions, toxicity, severe pain)
Inadvertent inoculation involving eye	—VIG should be considered for severe ocular disease (eg, severe blepharitis, blepharoconjunctivitis) when vaccinial keratitis not present —VIG generally contraindicated for vaccinial keratitis because increased scarring may occur; however, VIG should not be withheld if comorbid condition exists that requires it
Generalized vaccinia (GV)	Indicated if patient is toxic or if patient has serious underlying illness
Eczema vaccinatum (EV)	Indicated
Progressive vaccinia PV)	Indicated
Postvaccinial encephalitis (PVEM)	Not effective
Nonspecific skin rashes, erythema multiform, Stevens-Johnson syndrome	Not recommended
See CDC report below for additional details on treatment of ocuar involvement. Adapted from CDC: Smallpox vaccination and adverse reactions: guidance for clinicians.*

Cidofovir may be used under an IND protocol to treat serious smallpox vaccine reactions (see CDC: Smallpox vaccination and adverse reactions: guidance for clinicians). The proposed dose is 5 mg/kg administered intravenously, one time, over a 60-minute period; however, cidofovir should be administered in consultation with experts from CDC or the Department of Defense. CDC will supply cidofovir at no cost for use under the IND. Cidofovir will be released by CDC in the following situations:

A patient fails to respond to VIG
A patient is near death
All inventories of VIG have been exhausted

Off-label use of topical ophthalmic antiviral agents (trifluridine or vidarabine) has been recommended by some ophthalmologists to treat vaccinia infection of the conjunctiva or cornea.

Smallpox Vaccination Clinic Implementation

In general, smallpox vaccine clinics should follow standard operating procedures for administration of other vaccines. CDC has provided information about operating postexposure vaccination clinics (Smallpox Response Plan: Annex 3: Smallpox Vaccination Clinic Guide). Special considerations for smallpox clinics include the following:

Vaccinators

May include those allowed to administer vaccines under state law.
Should receive smallpox vaccine themselves.
Should receive standardized training in administration of smallpox vaccine, including use of bifurcated needles.

Supplies

Vaccine, diluent, and bifurcated needles are available from CDC.
Once a person has received the vaccine, the vaccination site must be covered loosely with a gauze bandage. Each clinic must provide its own bandages; these are not available from CDC.

Vaccine recipients

Should be educated about care of the vaccination site to avoid auto-inoculation of vaccinia virus to another body site or contact transmission to others (see Smallpox Fact Sheet: Caring for the Smallpox Vaccination Site). Key points include:

Avoid rubbing or scratching the vaccination site and do not apply ointments or salves to the site.
Keep the site loosely covered with a gauze bandage; do not use a bandage that blocks all air from the vaccination site.
Change the dressing every 1 to 2 days.
Wash hands with soap and water after contact with the vaccination site or contaminated bandages.
Keep the vaccination site dry.
Put contaminated bandages in a sealed plastic bag and throw them away.
Wash clothing or other material that comes in contact with the vaccination site.

Should return to the clinic 7 days after vaccination so that the site can be assessed to determine whether or not the vaccination has been successful.
Should be given information about severe side effects and directions on when medical care should be sought.

Liability Issues Following Smallpox Vaccine Administration

The Homeland Security Act of 2002

The Homeland Security Act of 2002 (Section 304) addresses issues regarding liability following smallpox vaccination. An explanation of Section 304 is available from CDC: Smallpox Questions and Answers: Section 304 of the Homeland Security Act

Section 304 applies to:

Smallpox vaccine manufacturers
Healthcare institutions and public health agencies that distribute vaccine or that administer smallpox vaccination programs
Licensed healthcare providers or other individuals authorized to administer smallpox vaccine or other smallpox countermeasures under state law
Any official, agent, or employee of the above entities

Section 304 states that no claim for liability for injury or death attributable to smallpox countermeasures, including vaccination or other substances used to treat or prevent smallpox, can be brought against the entities or individuals who are covered under the section unless gross negligence, recklessness, illegal conduct, or willful misconduct can be demonstrated.
Section 304 applies to persons who receive the smallpox vaccine and to persons who contract vaccinia infection as a result of exposure to a vaccinated person.
Persons who suffer injury or death from smallpox countermeasures may file a claim with an appropriate agency of the US government within 2 years after the incident.
If the US government makes a payment on a claim under Section 304, and the claim is a result of gross negligence, recklessness, illegal conduct, or willful misconduct by the manufacturer or a healthcare professional or is based on the person's violation of a contract with the United States, then the United States may recover that portion of the payment (with interest and litigation costs).
Similarly, if a claim is based on an act or omission by a manufacturer, healthcare professional, healthcare entity, or other person covered under Section 304, then the United States will not be liable for any damages resulting from that act or omission.
Workers who are covered by state workers' compensation statutes and who suffer work-related injuries from a smallpox vaccination program are not eligible to file a claim with the federal government under Section 304 if those state laws constitute an exclusive remedy.
Section 304 went into effect in January of 2003.

The Smallpox Emergency Personnel Protection Act of 2003

On April 30, 2003, the President signed into law the Smallpox Emergency Personnel Protection Act of 2003. The law establishes a no-fault program to provide benefits and compensation to certain individuals (ie, healthcare workers and emergency responders) who are injured as a result of administration of smallpox vaccination or other smallpox countermeasures. The key points of this law include:

Families of people who are killed by the vaccine and die without dependents are entitled to a lump sum payment of $262,100, an amount based on an existing compensation program for police and firefighters.
Estates of those who are killed and have dependents could choose the lump sum payment or up to $50,000 per year to make up for the deceased's lost wages. The payments would continue until the victim's youngest child reached age 18.
Those who are totally and permanently disabled would get up to $50,000 per year for lost wages until age 65, with no cap.
Those who are permanently but not totally disabled, and those with temporary disability, would get lost wages up to a maximum of $262,100.

As part of the law, the Secretary of the Department of Health and Human Services was required to provide a table identifying adverse effects that shall be presumed to result from the administration of or exposure to smallpox vaccine. This table was published in an interim final rule in the Federal Register on August 27, 2003 (click here).

Resources Available Through CDC

The CDC has provided extensive information on smallpox and smallpox vaccination on their Public Health Preparedness and Emergency Response Web site. Links to key selected items/documents follow:

Smallpox Vaccination Overview for Clinicians
Clinical Evaluation Tools for Smallpox Vaccine Adverse Reactions
Smallpox Vaccination and Adverse Reactions: Guidance for Clinicians (MMWR 2003;52:1-19)
Smallpox Prevaccination Information Packet (for prospective vaccinees to help them in decision making; includes the vaccine information statement)
Smallpox Vaccination Method
Smallpox Images
Webcasts and slide sets
Specimen Collection for Vaccinia Virus
Guidelines for Smallpox Vaccine Packing and Shipping


Home	Mission & Activities	About Us	Center Support	Contact Us