COMPLICATIONS OF SMALLPOX VACCINATION: SURVEILLANCE DURING AN ISLAND-WIDE PROGRAM IN PUERTO RICO, 1967–19681

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Abstract
Ratner, L H. (Memorial Hospital for Cancer and Allied Diseases, New York, N. Y. 10021), J. M. Lane and C. N. Vicéns. Complications of smallpox vaccination: surveillance during an island-wide program in Puerto Rico, 1967–1968. Amer. J. Epid., 1970, 91: 278–285.—In 1967–1968, the Health Department of the Commonwealth of Puerto Rico carried out an island-wide smallpox vaccination program, utilizing jet injectors. Approximately one-third of the population (835, 471) was vaccinated against smallpox; 369, 545 (44.2%) were primary vaccinations and 465, 926 (55.8%) were revacdnations. A surveillance system for vaccination complications, using printed notification cards, was established, and incidence rates for vaccination complications, by vaccination status and age, were compiled. Eighty-five complications were noted, 74 in primary vaccinees, 6 in revacdnees, and 5 in patients whose vaccination status was unknown. Twenty-two patients were personally examined by one of the authors (LH.R.) and photographed. The over-all complication rate was 100 per million; the rate in primary vaccinees was 201 per million. No vaccinia necrosum was reported, but one death due to probable postvaccinial encephalitis was detected. Twenty-seven cases of generalized vaccinia, 14 cases of accidental infection, 20 cases of erythema multiforme, and 3 cases of eczema vaccinatum were detected. Twenty cases of generalized skin eruptions, many of which were difficult to classify as generalized vaccinia or erythema multiforme, were noted. Careful screening for contraindications to vaccination may account for the lack of more life-threatening preventable complications.

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