Interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication era

For any vaccination, the risk from disease must be weighed against the risk from of adverse effects from vaccination.
The groups described in paragraphs 4 to 7 below are more susceptible to complications of vaccination. In the absence of exposure to smallpox they would not be offered vaccine.
If these individuals require vaccination following exposure to smallpox infection, depending on supplies, they may be given VaIG (see Appendix 13) to prevent vaccine complications. Adverse effects may be treated with cidofuvir - see Appendix 14.

Eczema

Cases of severe eczema may suffer from overwhelming eczema vaccinatum (see Appendix 10.) This means not only individuals with active eczema, but also those with any present disruption of skin surface or a medical history of eczema. In the past, 10% of eczema vaccinatum cases did not have active clinical disease prior to vaccination.
Other acute or chronic skin conditions may also predispose to complications:

Immunosuppression

This includes those with diseases or conditions which cause immuno-deficiencies: leukaemia, lymphoma, generalised malignancy, hypo-gammaglobulinaemia (defined as <5% of the normal distribution) chronic neutropenia, granulocytopenia.
It also includes those on therapy with immunosuppressive drugs such as cyclophosphamide, methotrexate and oral steroids (eg prednisolone).
HIV positive individuals can be vaccinated without VaIG if their CD4 count is above 200, but should be given VaIG if their CD4 count is below 50. Those in between should be assessed according to their HIV disease state.

Other contraindications

Pregnancy or women planning pregnancy in the near future.
Neurological illness including encephalitis or history of encephalitis.
Blood products/ immune globulins received in the last 6 months.
A vaccination in the last 60 days with a live vaccine.
Allergy to any constituent of the antibiotic content of the vaccine (eg. gentamicin etc).

Screening of vaccinees

This applies to healthcare, emergency, laboratory and other essential personnel (see Section VIII). If any contraindications to vaccination are detected, they should not be vaccinated and should not be involved in any aspects of the smallpox response.
A medical history and brief physical examination should first be taken to screen for any contraindications to vaccination.
The following blood tests should be carried out to screen for additional unrecognised medical problems.

All healthcare workers should have been tested for, or immunised against, hepatitis B and this should be confirmed prior to vaccination.
All of these vaccinees should be placed on a central register so that a list of immune individuals is maintained.

The Scottish Government