Abstract
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As the authors are no doubt aware, the use of traditional replicating smallpox vaccines in individuals with eczema can result in eczema vaccinatum (EV). EV is a severe adverse reaction caused by widespread vaccinia infection of the skin in people with previously diagnosed skin conditions such as eczema or atopic dermatitis, even if the conditions are not active at the time of smallpox vaccination. Historical experience teaches us that EV is often life-threatening.
Based upon this well-recognized and severe, albeit rare, adverse event, the NEA advised individuals with eczema against participating in the 2003 civilian smallpox vaccination program. Because of the risk of accidentally infecting loved ones with live vaccinia virus from the site of inoculation, the NEA further suggested individuals refrain from participating in the vaccination program if they even lived with an individual suffering from eczema. While no instances of EV were reported during this smallpox vaccination program, the Department of Defense's Smallpox Vaccination Program has not been so lucky. In 2007, a 28-month-old child with eczema developed EV after exposure to his father, a member of the US military who had recently received a replicating smallpox vaccine.
The NEA supports investments by the government to develop safer smallpox vaccines that can be used by Americans living with eczema. In fact, the law requires federal agencies responsible for developing medical countermeasures to address the needs of at-risk populations. These populations include children, individuals with compromised immune systems, and, in the case of smallpox preparedness, individuals with eczema.
To support their position, the authors note that the WHO's Strategic Advisory Group of Experts recently reviewed recommendations developed by ad hoc external consultants regarding smallpox vaccines. In addition to failing to disclose that Dr. Henderson participated as one of the consulting experts, it is important to note that none of the experts had dermatological expertise.
Finally, the authors imply that the government has done nothing to develop plans for how to use the different smallpox vaccines maintained in the Strategic National Stockpile. This is incorrect. As part of the government's development of clinical utilization guidance, the NEA was asked to review an early draft and provide suggestions. At last month's 2014 Preparedness Summit, I attended a presentation where government officials from the Centers for Disease Control and Prevention and the Office of the Assistant Secretary for Preparedness and Response described in detail the final utilization guidance for the public health professionals that ultimately would be called upon to put these plans into effect.
Modern science has allowed us to advance research and operational policies that will allow all individuals access to the right kind of smallpox vaccine for them, without causing further harm. We cannot ignore the needs of 30 million Americans.