29: Smallpox and vaccinia
Notifiable

Introduction

In December 1979, the Global Commission for the Certification of Smallpox Eradication declared the world free of smallpox and this declaration was ratified by the World Health Assembly in May 1980.
In response to the threat of a bioterrorist release of smallpox, in 2003 the Department of Health published Guidelines for smallpox response and management in the post-eradication era (smallpox plan) available at www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4070830&chk=XRWF7m
This outlines the vaccination of response teams who could safely manage and diagnose suspected cases of smallpox. In 2003–04 more than 300 healthcare and ambulance workers were vaccinated, along with a small number of staff in laboratories designated to receive specimens from suspected cases.
An information pack entitled Smallpox vaccination of Regional Response Groups: information for health care workers administering or receiving the smallpox vaccine has been developed specifically for non-emergency vaccination of such first responders. It includes information on administration and types of vaccine. It also has guidance on pre-vaccination screening and exclusion criteria and on work restrictions following vaccination. It is available at www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4009816&chk=InmH7S
Outside the context of this plan there is no indication for smallpox vaccination for any individual with the exception of some laboratory staff and specific workers at identifiable risk.

Recommendations

Workers in laboratories where pox viruses (such as monkeypox or genetically modified vaccinia) are handled, and others whose work involves an identifiable risk of exposure to pox virus, should be advised of the possible risk and vaccination should be considered. Detailed guidance for laboratory staff has been prepared (Advisory Committee on Dangerous Pathogens and the Advisory Committee on Genetic Modification, 1990). Further advice on the need for vaccination and on contraindications should be obtained from the Health Protection Agency (HPA) Virus Reference Department (Tel: 020 8200 4400); if vaccination is considered desirable, vaccine can be obtained through HPA on this number. In Scotland, advice can be obtained from Health Protection Scotland (Tel: 0141 300 1100).
Vaccination is not recommended for people exhuming bodies in crypts, since the theoretical risk involved poses less risk than the vaccination.

Reference

Advisory Committee on Dangerous Pathogens and Advisory Committee on Genetic Modification (1990) Vaccination of laboratory workers handling vaccinia and related pox viruses in infectious situations for humans. London: TSO.
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