Smallpox Vaccine Clinic

About a week and a half ago (hey, I'm a little proud of myself for only being a week and a half behind), I arrived early at Ft. Meade to attend smallpox vaccine clinic. Since smallpox vaccine isn't exactly routine, there's quite a lot of screening and education that goes along with it.

The education begins at 0630, with a CDC video about why we vaccinate against smallpox (since it's been, you know, eradicated and whatnot), how to vaccinate, and some of the risks. Quite frankly, I thought it was a bit too technical for the average audience (medical information for patients should be below the eighth grade level) and quite boring. It wouldn't be a bad video for doctors, nurses, and the techs who are administering the vaccine, but they need something better for the vaccinees. And something made in this century.

That took about 45 minutes, and then it was into the exam room to screen patients for vaccination. It's a very risk-averse environment, and there a lot of contraindications. Overall, the risk of infection is only theoretical--terrorists might have smallpox, but we have no proof of that. So if someone has a slightly increased risk of having an adverse effect from the vaccine, we're not going to give it. Some of the contraindications of vaccinating are skin problems (eczema, psoriasis, severe acne, etc) or skin problems in any close contacts (family members). This is why:

This is eczema vaccinatum and the result of someone with eczema being in contact with the vaccinia virus. People with intact skin will only get vaccinia at the sit of innoculation (the hands of milkmaids in the good old days, the right deltoids of vaccinees today), but people with such skin problems can get cowpox (vaccinia) everywhere. And it's quite serious.

Anyway, other contraindications of smallpox vaccination are dry eyes (because people with dry eyes rub them, and getting vaccinia in the eyes would be bad), immunosuppression (from HIV or certain medications), close contact with infants younger than 12 months, having another live virus vaccination within the last four weeks (such as FluMist), and certain heart problems, since smallpox vaccination can cause heart problems in even healthy people. Of the three people in vaccination clinic when I was there, only got vaccinated. Of the other two, one had FluMist the week before, and the other had both close contact with an infant and severe acne. Interestingly, the one who did get vaccinated was born outside the United States and had a BCG vaccination at birth (to protect against TB) and scar from that. Little known fact: according to the WHO, the BCG vaccine is given in the left deltoid, and the smallpox vaccine on the right, because they leave identical scars. By having it standardized back in the days when many people got both, you could tell who had had what.

I did watch the tech do the vaccination (he made me stand on the other side of the room, since I haven't been vaccinated). It looks kinda like this:

This is the only vaccine that uses a bifurcated needle. How it's done is that the needle is dipped into the vaccine so it leaves a small drop between the two prongs. Then, using the hand technique demonstrated here, the arm is stabbed with the needle fifteen times quickly, deep enough to leave a drop of blood. The site is then covered with a piece of gauze and the vaccinee is given instructions on how to care for the vaccination site. If everything goes right, the site should look like this:

And then it leaves a small, permanent scar. Quite enjoyable. Can't wait for mine (sarcasm).