This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Today's increased threat of bioterrorism has caused renewed concern about smallpox. Large-scale vaccination or re-vaccination of the civilian population as a prophylactic measure against possible bioterrorist attack is currently an important public health concern. However, the smallpox vaccine is not without risk. The live-virus vaccine, composed of the smallpox-related virus vaccinia, has the highest rate of adverse reactions among all vaccines. Most serious is eczema vaccinatum (EV), a potentially life-threatening condition in which the virus spreads unchecked throughout the skin. When untreated, EV causes severe systemic symptoms resembling septic shock leading to death in 40% of cases. Mortality rates are higher in children under 2 years of age. Individuals particularly at risk include those with a history of atopic dermatitis (AD). AD is most common in children and young adults and the global prevalence of AD and other atopic disorders has been on the rise. Recent studies suggest that more than 10% of children are affected by AD. The increased threat of bioterrorism and the possibility of the smallpox virus for use as a biological weapon, coupled with the lack of natural or vaccine-induced immunity among the general population, have understandably led to discussion about reinstating routine smallpox vaccination. It cannot be predicted who will get EV, although, since 40% of the U.S. population is immunologically na ve to vaccinia and immuno-compromising factors (skin diseases such as AD) are more prevalent today than in the past, the rate of EV would most likely be higher than during the era when smallpox vaccination was routine. These risks must be carefully considered in any public health discussion regarding smallpox vaccination.
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