Recall of Skin Diseases That Disqualify People from Preexposure Smallpox Vaccination

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The summary below is from the full report titled "Eczematous Skin Disease and Recall of Past Diagnoses: Implications for Smallpox Vaccination." It is in the 1 July 2003 issue of Annals of Internal Medicine (volume 139, pages 1-7). The authors are A.L. Naleway, E.A. Belongia, R.T. Greenlee, B.A. Kieke Jr., R.T. Chen, and D.K. Shay.

What is the problem and what is known about it so far?

Smallpox vaccine prevents the serious disease smallpox. Until 30 years ago, smallpox vaccine was a recommended part of regular health care. Vaccine was effective and eliminated the disease. The smallpox virus now exists only in a few high-security research laboratories. Recently, because of worry about smallpox as a possible weapon in bioterrorism or war, the U.S. Surgeon General recommended that American health care workers get preexposure smallpox vaccine (that is, receive the vaccine even though no cases of the disease exist). Smallpox vaccine has serious side effects, including death. The vaccine may also cause sores all over the body. People with atopic dermatitis or eczema, which are common, nonserious skin conditions, are at higher risk for this side effect than people without these conditions. Atopic dermatitis and eczema cause red, itchy patches on the skin that come and go over time. People who have (or have ever had) these skin conditions themselves or have lived with someone who has one of these conditions should not get smallpox vaccine unless they are actually exposed to smallpox.

Why did the researchers do this particular study?

To see whether people remember if they or someone they live with has (or had ever had) atopic dermatitis or eczema.

Who was studied?

Using medical records, the researchers identified people who had been diagnosed with atopic dermatitis or eczema at the Marshfield Clinic between 1979 and 2001. The Marshfield Clinic is a large health care system that provides care at 40 locations in central Wisconsin.

How was the study done?

The researchers contacted a parent or guardian of each of 228 children with atopic dermatitis or eczema, 94 adults who themselves had atopic dermatitis or eczema, and 133 people who lived with an adult who had the condition. The researchers asked whether the person answering the survey or a household contact ever had atopic dermatitis, eczema, or "an itchy rash that was coming and going for at least 6 months." They then calculated how often these people remembered that they or someone they live with had these skin conditions.

What did the researchers find?

Only 55 of the 94 (59%) adults who themselves had the skin condition reported that they had the condition. Only 79 of the 133 (60%) household contacts correctly reported that a person in their household had the skin condition. Among the 177 parents of a child with the skin condition, only 123 (70%) recalled that their child had it.

What were the limitations of the study?

Recall of the skin conditions might be better if people were really considering smallpox vaccination. This study cannot say how often people who did not have the conditions themselves or whose household contacts did not have the condition would incorrectly report that they did.

What are the implications of the study?

Many people who have atopic dermatitis or eczema themselves or live with someone who has one of these conditions do not remember the diagnosis. Just asking about these conditions before preexposure smallpox vaccine might result in vaccination of people who should not be vaccinated.