What is the thinking about nurses who have been vaccinated for smallpox coming in contact with newborns -- both in postpartum care, NICU, and well-born nursery? Our hospital is allowing nurses to be vaccinated, but our neonatologist organization is strongly recommending against it.
Response From the Expert
Adjunct Assistant Professor, School of Health Sciences, George Washington University, Washington, DC, and Pediatric Nurse Practitioner in a primary care pediatric practice, Columbia, Md.
Good question! Keep in mind that most of the recommendations for use of smallpox (variola) vaccine are based on data collected several decades ago when smallpox vaccine was part of the routine immunization schedule. Based on that data, the Centers for Disease Control's (CDC) Advisory Committee on Immunization Practices (ACIP) states that smallpox vaccine is contraindicated in pregnant or breast-feeding women and may not be administered to infants under the age of 12 months. However, ACIP does state that contacts of infants may be vaccinated.
While smallpox vaccine is not contraindicated in children over the age of 12 months, both ACIP and the American Academy of Pediatrics (AAP) recommends that infants and children not be vaccinated. The AAP supports a program of "ring vaccination" whereby first responders are vaccinated in advance of an actual smallpox outbreak, but worries about the potential for spread of vaccine from vaccinees to unprotected children.
However, the CDC's Clinician's Help Line (personal communication, April 2, 2003) advises that nurses having contact with neonates may be vaccinated against smallpox. These nurses should follow guidelines for care of the vaccination site and should keep the area covered with an occlusive bandage and wear long sleeves until the site is healed. Obviously, they should also follow normal procedures for hand washing. Comprehensive information on care of the vaccine site can be found at: https://www.bt.cdc.gov/agent/smallpox/vaccination/close-contacts.asp.
Despite this recommendation, the ACIP policy states:
The presence of an adolescent or child (including an infant) in the household is not a contraindication to vaccination of adult members of the household; the risk for serious complications from transmission from an adult to a child is limited. Nonetheless, ACIP recognizes that programs might defer vaccination of household contacts of infants aged < 1 year because of data indicating a higher risk for adverse events among primary vaccinees in this age group, compared with that among older children. 
Where this leaves the clinician is a bit unclear. What is clear is that nurses at risk for exposure to smallpox should be vaccinated. However, nurses who have contact with young infants and who are not at high risk may wish to defer vaccination.
It is reasonable to presume that there may be changes in recommendations as the smallpox vaccination program evolves. The CDC, through the Vaccine Adverse Event Reporting System (VAERS), continues to monitor potential adverse reactions. Clinicians who believe that a patient may be experiencing a reaction secondary to smallpox vaccine can report to VAERS. Already, just since the February 2003 policy statement was released, ACIP has suggested a change based on concerns about postvaccine cardiac events, and in March 2003 the guidelines were again modified to recommend that patients with known coronary disease not be vaccinated.
An outstanding source for general information on the vaccine is the CDC's Advisory Committee on Immunization Practices, available on Medscape at https://www.medscape.com/pages/editorial/public/toc-smallpox
Medscape Nurses. 2003;5(1) © 2003 Medscape
Cite this: Marilyn W Edmunds. Can I Care for Newborns if I Get Vaccinated for Smallpox? - Medscape - May 08, 2003.