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In Reply: In response to Dr Fulginiti, reintroduction of smallpox vaccination in the United States has generated many important questions about its safety. Many of these have been answered through critical and scientific review of data from recent trials as well as the civilian and military vaccination experience by experts in the field, as is in the recent review on transmission of vaccinia by Fulginiti and Lane.¹ As more concerns arise about smallpox vaccination, answering these questions in a controlled, hypothesis-driven manner is vital to ensure this vaccine's appropriate use in the event further vaccination will be needed.

Thomas R. Talbot, MD, MPH
Department of Medicine

Kathryn M. Edwards, MD
Department of Pediatrics
Vanderbilt University School of Medicine
Nashville, Tenn

1. Fulginiti VA, Lane MJ. Transmission of vaccinia virus and rationale for measures of prevention. Clin Infect Dis. 2003;37:281-284. PUBMED

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:1452.

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Risks of Smallpox Vaccination
Vincent A. Fulginiti
JAMA. 2003;290(11):1452.
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