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To the Editor: The last case of smallpox occurred in 1977, and the world was declared free of the disease in 1980.¹ In the United States, recommendations for smallpox vaccination were withdrawn in 1971 for the general public, 1976 for health care workers, 1982 for international travelers, and 1990 for military personnel.² Due to an increased threat of biowarfare and bioterrorism, immunization against smallpox has now resumed for certain health care workers and military personnel. First-time vaccinees are considered protected after a "major reaction" (papule, pustule, scab, scar) at the immunization site.² In a nonimmune person who is not immunosuppressed, the expected response to primary vaccination is the development of a papule at the site of vaccination 2 to 5 days after percutaneous administration of vaccinia vaccine. The papule becomes vesicular, then pustular, and reaches its maximum size in 8 to 10 days. The pustule dries and forms a . . . [Full Text of this Article]

Report of a Case

John M. Kelso, MD
jmkelso@nmcsd.med.navy.mil
Division of Allergy
Naval Medical Center
San Diego, Calif

Kevin M. Kuhn, MD
Explosive Ordnance Disposal Mobile Unit 3
Naval Amphibious Base
Coronado, Calif

Frances K. Newman, MS
Division of Infectious Diseases and Immunology
Saint Louis University School of Medicine
St Louis, Mo

Jeffrey S. Kennedy, MD
Center for Infectious Disease and Vaccine Research
University of Massachusetts Medical School
Worcester

Sharon E. Frey, MD
Division of Infectious Diseases and Immunology
Saint Louis University School of Medicine
St Louis, Mo