In the US, most of primary care physicians will be asked to be vaccinated against Smallpox over the next 12 months. One may ask: why should one be so serious?

When I went to medical school, I learned that the last case of Smallpox was found in the planet earth in 1977, thanking mainly to the effective vaccination combined with quick identification and isolation of Smallpox patients. This is the first infectious disease considered eradicating from human kind, remarkable for a disease that routinely caused a fatality rate of 20-30%. Routine vaccination in the US stopped in 1972 for children and 1976 for health care workers. So several generations grew up without any vaccination. Now after the Anthrax scare of 2001, there is credible threat of usage of Smallpox virus (variola virus) to spread this deadly disease among the US population. As a biological weapon, Smallpox can easily spread from person to person, usually transported through the air in tiny saliva droplets by coughing, sneezing, or breathing. An infected person’s urine and eye secretions also carry the virus, as can personal items and linens.

However, there is no treatment for the virus. This poses serious threat to not only those who had never been vaccinated but also those who had been vaccinated in the past. Low titre of antibodies can be found if vaccinated in the past, but those usually provide protection for about five to ten years and probably will not provide sufficient protection against re-infection.

What are potential side effects from vaccination? The worse fear is the development of Smallpox itself because in some unlucky persons, the weakened live Smallpox virus can cause full blown Smallpox. Fortunately, this only happens in approximately 1 in one million people vaccinated. Other adverse reactions include tenderness and erythema at the injection site, systemic reactions (fever, malaise, muscle pain, local glands swelling) and generalized skin rashes. People who are over age of 30, who have been vaccinated before, appear to suffer fewer reactions to the vaccine.

Some people should not receive vaccination if they have not exposed to Smallpox virus. Those include people diagnosed with eczema, atopic dermatitis, or HIV. However, in case of actual attack, those with eczema or atopic dermatitis should be considered for vaccination. Those with impetigo, chicken pox, contact dermatitis, shingles, herpes, severe acne, psoriasis should not receive the vaccine until the condition resolves. Pregnant women should not be vaccinated because potential adverse effect on fetuses. If women intend to be pregnant within the next four weeks, then they should not be vaccinated either.

Public is split on the best policy to protect against smallpox bioterror attack. A recent poll showed that 42% favors offer vaccine now to everyone eligible. 18% don’t want to vaccinate now, but prepare to do so. Another 18% think that vaccines should be offer to ER and hospital workers, plus paramedics, firefighters and police. 5% only flavors vaccination of ER and hospital workers. Those physicians like me who are potential first targets of smallpox exposure may take comfort in the fact the we may suffer few side effects when being revaccinated. In return, we may be able to help the patients who have become victim of smallpox exposure much more effectively. Those who may want to be safe at the future potential attack may want to weight risks and benefits of vaccination before proceeding. Others may want to be ready for vaccination when public announcement comes, after knowing fully the potential side effects of Smallpox vaccination. After all, a stitch in time saves nine.