Responses to Smallpox Vaccine

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Abstract
I am alarmed by the high rate of vaccinia-vaccine–associated morbidity (>30 percent) in the study by Frey et al. (April 25 issue).1 In their study, there were three deviations from prior standard procedures for vaccinia vaccination2-5 that may account for the unusually high rate of morbidity as compared with the rate at our clinic.6 First, their use of 15 scratches (part of the investigational-new-drug [IND] protocol for the vaccine) instead of the previously recommended 5 scratches for persons without prior vaccination results in a higher inoculum, which was previously reserved for persons with a prior vaccination.

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