Poxvirus Dilemmas

Abstract

In their Sounding Board article, Breman and Henderson (Aug. 20 issue)¹ promote a traditional, decades-old “contain and vaccinate” strategy of controlling smallpox that requires refinement to remain viable. The human immunodeficiency virus (HIV) emerged after the eradication of smallpox and poses new ethical and operational challenges to the control of poxviruses. Although vaccination against smallpox will preserve public health during an outbreak, it may cause fatal side effects in the HIV-infected population. A high rate of severe vaccine-related complications (generalized and progressive vaccinia and eczema vaccinatum) will make emergency control of poxviruses in regions with a high frequency of HIV difficult and reflect poorly on organizations that coordinate the response to outbreaks.