Journal Article

Smallpox Vaccination and Patients with Human Immunodeficiency Virus Infection or Acquired Immunodeficiency Syndrome

Donald A. Henderson, Thomas V. Inglesby, Tara O'Toole Inglesby and John G. Bartlett

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 36, issue 4, pages 468-471
Published in print February 2003 | ISSN: 1058-4838
Published online February 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/368093
Smallpox Vaccination and Patients with Human Immunodeficiency Virus Infection or Acquired Immunodeficiency Syndrome

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Smallpox vaccination strategies are evolving rapidly and have important implications for human immunodeficiency virus (HIV)–infected persons. Cell-mediated immunity is important for controlling both smallpox and vaccinia. For smallpox, the concern is a substantial increase in the associated mortality rate, which is 30% among healthy persons. For smallpox vaccination, the concern is progressive vaccinia, which is usually lethal but relatively uncommon. The risks associated with both smallpox and vaccinia viruses probably correlate with CD4 cell count, and, as a corollary, the best protection against infection with each is presumably immune reconstitution. It appears that all vaccinations will be voluntary, with 2 recommendations: (1) HIV-infected persons will be advised to decline preemptive vaccination, and (2) in the event of a bioterrorism attack involving smallpox, HIV-infected patients with exposures will be advised to receive vaccine.

Journal Article.  2497 words. 

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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