b. Smallpox Vaccine. Smallpox vaccine is a sterile suspension obtained from
cowpox, but used to prevent smallpox. The vaccine is administered by puncturing the
skin with brief stabbing movements, while the vaccine is kept in contact with the
(1) Primary vaccination. Within 6-8 days after a primary vaccination, there
should be an area of active inflammation surrounding a central lesion. On this basis,
the vaccination is recorded as successful or unsuccessful. An unsuccessful primary
vaccination must be repeated until a successful lesion is obtained.
Precautions and contraindications.
(a) Smallpox vaccine is not to be injected, except intradermally with jet
hypodermic injection apparatus.
(b) The vaccine should not be given to anyone who has eczema or
other lesions of the skin, because in such persons there is danger of systemic reaction.
(c) The site of administration should be left open to the air to aid
healing. This is the reason that the arm should be used.
(d) The vaccine should be administered with utmost attention to sterile
technique to prevent secondary infection of the vaccination site. A person who receives
smallpox vaccine is more exposed to infection than is a person who receives a drug by
injection because of the numerous punctures of the skin for smallpox vaccination.
(e) The vial, in which freeze-dried smallpox vaccine is reconstituted,
and the assembly for administration contain live virus. Before these items are discarded,
they should be burned, autoclaved, or boiled to prevent accidental vaccination by
breakage during disposal.
(3) Supply. Smallpox vaccine is supplied as a freeze-dried powder with a
colored sterile diluent to reconstitute the vaccine, in 20-, 25-, and 100-doses. It is
currently available only to military service members from the Center for Disease Control
(CDC) in Atlanta, Georgia. Production of the smallpox vaccine for civilian use was
discontinued in May 1983.
c. Yellow Fever Vaccine. An attenuated strain of yellow fever virus is prepared
from chick embryos and freeze-dried. It should be kept frozen for preservation. Its
period of potency is 12 months. Before administration, it is reconstituted with the diluent
provided. It is injected subcutaneously. It results in solid immunity for 10 years. (The
vaccine should be used with caution in egg-sensitive persons. It should not be
administered concomitantly with smallpox vaccine or to persons ill with other virus