The federal plan for vaccination of certain individuals against smallpox has raised many questions among immunosupppressed patients, including transplanted persons. Late last year the Centers for Disease Control (CDC) recommended that smallpox vaccinations be administered to a limited number of health care workers in hospitals and “first responders” (i.e., emergency response workers, such as fire and police personnel). Johns Hopkins Hospital, as well as other medical facilities in the region, has begun to inoculate some staff against acquiring smallpox.
In January, Edward K. Kasper, M.D., Associate Professor of Medicine, and Co-Director, Cardiac Transplant Program, offered guidance for cardiac transplant patients. “The infectious disease staff at the Johns Hopkins Hospital has reviewed the information provided by the CDC, and have written recommendations which will help guide care for the organ transplant patients.”
He explained that, “The smallpox vaccine is made from a virus called vaccinia which is a “pox” type virus related to smallpox. The smallpox vaccine contains the ‘live’ vaccinia virus – not dead virus like many other vaccines. Secondary spread of the vaccinia virus could occur even through a sealed bandage therefore putting organ transplant patients at risk for developing vaccinia. In an immunosuppressed patient such as an organ transplant recipient, complications of the vaccinia virus could be dangerous.”
Dr. Kasper advised that: 1. Transplant patients should not be preventively vaccinated for smallpox. 2. Family members of transplant patients should not be preventatively vaccinated for smallpox. 3. If a family member is required to receive the smallpox vaccine (i.e., military personnel, first responder medical personnel), the patient should have no household contact with the person for three weeks. |
Nevertheless, patients who are immunosuppressed before or after transplant may on occasion require visiting a medical facility for treatment. At Hopkins, all employees who are vaccinated must not have any patient care, nor be in a position to be accidentally in contact with patients. Such staff will be reassigned to administrative and non-clinical areas for a period of time so as not to infect patients, according to Gabor D. Kelen, M.D., Professor and Chair of the Department of Emergency Medicine.
For those patients who are receiving some of their care at other medical facilities, the advice is to inquire how the facility is handling potential contact with those who have been vaccinated. Patient questions should be directed to Hopkins transplant medical personnel.
