Clinical guidance for smallpox vaccine use in a postevent vaccination program

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Vaccinology

Background:

• Smallpox poses a significant threat following intentional or accidental release.
• The U.S. Strategic National Stockpile maintains three smallpox vaccines: ACAM2000, Aventis Pasteur Smallpox Vaccine (APSV), and Imvamune.
• Clinical guidance is crucial for effective post-event vaccination programs.

Purpose of the Study:

• To outline recommendations for the clinical use of U.S. Strategic National Stockpile smallpox vaccines.
• To guide vaccination strategies for individuals exposed to or at high risk of smallpox infection.
• To address contraindications and risk-benefit considerations for smallpox vaccination.

Main Methods:

• Review of clinical data and risk-benefit assessments for smallpox vaccines.
• Development of recommendations based on exposure risk, contraindications, and vaccine properties.
• Consideration of specific medical conditions and immune statuses.

Main Results:

• No absolute contraindications for smallpox vaccination in a post-event setting.
• Replication-competent vaccines (ACAM2000, APSV) are recommended for exposed individuals unless severely immunodeficient.
• Imvamune is recommended for severely immunodeficient individuals or those with relative contraindications, when available.

Conclusions:

• Vaccination with ACAM2000, APSV, or Imvamune is critical for smallpox control.
• Careful screening for contraindications ensures safe and effective vaccine administration.
• Recommendations will be updated with emerging data on vaccines and antivirals.