Smallpox - Frequently Asked Questions

If the bandage over your smallpox vaccination site gets wet, you need to change it. It is important to keep your vaccination site clean and dry. The first step when changing the dressing is to wash your hands. Then replace the wet bandage with a new clean bandage. Put the old bandage in a plastic bag with a small amount of bleach, and throw the bag away. Then wash your hands again. For more information about taking care of your vaccination site, go to the MILVAX website and read the Smallpox Tri-fold Brochure.

Always keep your clothes and towels separate from those of your family and other people. Wear clothing that you can wash in the washing machine. Do not share clothes, towels, or toiletries with anyone. If clothes or towels touch your smallpox vaccination site, wash them in hot water with detergent and/or bleach to kill the virus. For more information about taking care of your vaccination site, go to the MILVAX website and read the Smallpox Tri-fold Brochure and the Smallpox Vaccine Household Contacts Brochure.

If you have recently had surgery, ask your healthcare provider whether it is safe for you to get the smallpox vaccine. You may need to wait until your surgical wound heals before you get the vaccine. This is to prevent the smallpox vaccine virus from infecting your surgical wound. Eye surgery, for example Lasik surgery, is a special contraindication to receiving smallpox vaccine. Smallpox vaccination must be postponed until after your eye has healed. Please contact the VHC if you have questions or concerns.

If you must have surgery, inform your surgeon that you have just received smallpox vaccine. Elective or nonurgent surgery is not recommended within 30 days after smallpox vaccination. This allows time for the vaccination site to heal completely, so that it cannot spread smallpox vaccine virus to your surgical wound. Eye surgery, for example Lasik eye surgery, is a special contraindication to receiving smallpox vaccine. Eye surgery should be delayed until after the smallpox vaccination site has healed completely. Please contact the VHC if you have questions or concerns.

An experienced healthcare provider should have determined whether you have had a successful smallpox vaccination by evaluating the vaccination site for a reaction. If this was your first vaccine in which there was no reaction, a second attempt to vaccinate should be made using a different vaccine lot and using a different vaccination site. This site may need to be checked more carefully and more often for a take reaction.

If after your second smallpox vaccination there is still no evidence of a take reaction, you are considered immune to smallpox for military-related requirements, including deployment. Please contact the VHC if you have additional questions or concerns.

It takes on average 30 to 60 days for the smallpox vaccination site to heal. Keep in mind that everyone heals at a different rate, some faster than average and others slower than average.

Before getting a tattoo, wait until the smallpox vaccination site has fully healed, the scab has fallen off, and the skin is intact and dry. It may take longer than the average 30 to 60 days after your vaccination before the skin is ready for tattooing. Please contact the VHC if you have additional questions.

Do not swim in pools, hot tubs or whirlpools until your smallpox vaccination site has healed. There is a theoretical risk of spreading the virus to others. Also, the chemicals used in pool water could make your vaccination less effective.

Yes, you may visit with other people after your smallpox vaccination, but keep your vaccination site covered with both a bandage and a shirt sleeve. Also, wash your hands if you touch your smallpox vaccination site. There are some individuals who you need to be especially careful around. These individuals include those for whom the vaccine is contraindicated: pregnant females, elderly, and those with chronic medical conditions, cancer, immune deficiency diseases, and those on immunosuppressive medications.

Having a history of herpes (either oral or genital) is not a contraindication to receiving the smallpox vaccine. However, if you are having an active herpes outbreak, do not get a smallpox vaccination until your skin lesions have healed. If you have questions or concerns, you may contact a VHC healthcare provider or send us an email message using our Ask VHC secure messaging system.

If the scab falls off, put it in a plastic bag with a small amount of bleach and throw the bag away. Wash your hands thoroughly. Replace the old bandage with a new clean bandage, and then wash your hands again. For more information on proper care of your vaccination site, go to the MILVAX website for the Smallpox Tri-fold Brochure.

Keep your smallpox vaccination site covered with a bandage while you shower. If the bandage gets wet, after your shower put it in a plastic bag with a small amount of bleach, discard it, and then wash your hands. Then put on a new bandage. If your vaccination site does touch a surface, such as the shower wall, clean the surface with a household disinfectant. This will help to make sure that no smallpox vaccine virus remains on that surface.

If you are in close contact or live with a baby who is younger than one year old, a medical provider will usually recommend deferment of the smallpox vaccination until you report to your mobility/deployment assignment. However, if your commander decides that your vaccination is mission essential prior to deployment, he or she can authorize and arrange separate quarters for you.

Wash the part of the dog that came in contact with your used dressing. Then wash your hands well. Keep an eye on your pet, and if any rash or sore develops, contact your veterinarian. Remember to continue good hand washing, keep your vaccination site covered, and dispose of used dressings in a plastic bag with disinfectant. For more information on proper care of your vaccination site, go to the MILVAX website for the Smallpox Vaccine Pets Brochure.

Yes, the smallpox vaccine virus can possibly be spread anytime there is direct contact with the uncovered vaccination site or contact with fluid from the site. This spread is called "contact transmission." To prevent contact transmission, follow these three simple steps: wash your hands, keep the vaccination site covered, and properly dispose of vaccination dressings.

You can sleep in the same bed and continue intimate relationships as long as you make sure the vaccination site is covered and neither of you touch it. Some people have medical conditions that make them more likely to have serious complications if they are infected with the smallpox vaccine virus. In this case, special precautions might be necessary. If you have a question or concern about this, please contact the VHC.

What you are describing sounds like a typical reaction that occurs after the smallpox vaccination known as a "robust take." A "robust take" occurs when your body has a vigorous response to the vaccine. This response is a normal variation and usually goes away on its own; over-the-counter pain relievers may be useful. If you have questions or concerns you may contact a VHC healthcare provider or send us a photo of the reaction via our Ask VHC secure messaging system.

Rashes can sometimes occur after smallpox vaccination. They can range from mild to severe. We recommend that you have your symptoms evaluated by a healthcare provider. You may contact a VHC healthcare provider or send us a photo of the rash via our Ask VHC secure messaging.

The smallpox vaccine is made from vaccinia virus, which is a live virus similar to smallpox virus. Vaccinia virus cannot cause smallpox disease.

You should not receive smallpox vaccine if you will have close contact with a pregnant woman because of the small risk of spreading the vaccine virus to the woman. Fetuses of pregnant women who inadvertently receive the vaccine or receive a contact transmission of the vaccine are at risk for a rare complication called fetal vaccinia. The military offers options for military personnel in these circumstances such as temporary exemption or alternative housing. For further questions, see our pregnancy page or contact the VHC.

You should not receive smallpox vaccine if you have close contact with someone who has an atypical skin condition. This is because the virus can spread through direct contact with the vaccination site or fluids, and persons with a history of chronic skin conditions or active skin lesions have higher risks for developing serious health problems related to the smallpox vaccine.

If you have specific questions or concerns, please contact the VHC for help.

You should not be vaccinated while you are using steroid eye drops. Steroid eye drops decrease your resistance to eye infections. It is a serious problem if your eye becomes infected with the smallpox vaccine virus. This exposure can happen when you touch your eye when the vaccine virus is on your finger. If you have had refractive eye surgery and are using steroid eye drops you should not be vaccinated until after the prescribed period. If you are planning to have refractive eye surgery, you must wait at least 30 to 60 days after your smallpox vaccination or until the scab has fallen off your vaccination site, whichever is longer. Please contact the VHC if you have any questions.

When a pregnant woman receives smallpox vaccine, there is a very rare but serious complication that can occur in the fetus called "fetal vaccinia." It is so rare that according to CDC there have been fewer than 50 cases ever reported in the world. Because fetal vaccinia is so rare, smallpox vaccination during pregnancy should not be a reason to consider termination of the pregnancy. Smallpox vaccination of pregnant women has not been linked with prematurity, low birth weight, or other serious birth problems.

As with any pregnancy, make sure you receive regular prenatal care and inform your healthcare provider about the vaccination.

You may also contact the Naval Health Research Center for information about the DoD Birth and Infant Health Registry.

Identify infectious agents through scraping or aspiration of lesion content: herpes simplex (HSV) and varicella are most common etiologies and can be rapidly assessed with DFA (direct fluorescent antibody screening slide) followed by culture. These diagnoses are more common than vaccinia. Bacterial cultures may be indicated. If DFA is negative for HSV, varicella, then obtain vaccinia PCR and culture.

1. PCR (polymerase chain reaction assay for vaccinia) is available through military or state regional laboratories participating in Emergency Response Lab Network. If unable to obtain prompt local support for PCR and culture, contact the Vaccine Healthcare Centers Network by email or telephone. After hours, Call DOD Vaccine Call Center: 1-866-210-6469.
2. Information on obtaining viral PCR and culture specimens is available on the CDC website: www.bt.cdc.gov/agent/smallpox/vaccination/vaccinia-specimen-collection.asp

An individual (a) born before 1972, or (b) employed as a health care worker before 1977, or (c) who travelled internationally before 1983, or (d) who was on active duty before 1991 or after 2002, or (e) who has a Jennerian scar and who does not have a cutaneous response ('major reaction' or 'take') following Smallpox vaccination is presumed to have been previously vaccinated and therefore, in accordance with the ACAM2000 package insert, does not require a second vaccination attempt to try to elicit a cutaneous response. The patient is considered adequately protected against smallpox (immune) and is fit for all military-related assignments, including deployment. No further diagnostic evaluation is required.

A smallpox vaccinee not meeting the presumptive prior-vaccination criteria (above) who fails to demonstrate a cutaneous response ('major reaction' or 'take') after receiving 15 jabs with ACAM2000 requires a second vaccination attempt in accordance with current policy (reference?). If after a second attempt there is still no evidence of a cutaneous reaction the individual is considered adequately protected against smallpox (immune) for all military-related assignments, including deployment. No further diagnostic evaluation is required.