Contraindications detailed in smallpox immunization plan. (Atopic Dermatitis, Pregnancy, HIV).

ATLANTA -- Up to 30% of hospital-based individuals targeted for smallpox vaccination could be excluded because of dermatologic conditions, pregnancy or HIV infection, according to guidelines laid out by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

ACIP's guidelines would cover the administration of smallpox vaccine to about 510,000 health care workers at U.S. hospitals. (See story, p. 1). The guidelines are likely to be published in a joint statement by ACIP and the Hospital Infection Control Practices Advisory Committee.

Among the issues tackled in the draft guidelines:

* Administrative leave/site care. Vaccinated workers could continue caring for patients unless they develop severe systemic signs or reactions to the vaccine. They would be required to keep the vaccination site covered with a single semi-permeable dressing (such as Opsite or Tegaderm) over gauze. Dressings must be changed every 3-5 days or when purulent.

The goal is to minimize disruption of health care and avoid further exacerbation of nursing shortages. Data suggest that vaccinia transmission in health care settings was rare during the smallpox vaccine era (JAMA 288[15]:1901-04, 2002).

* Contraindications. Atopic dermatitis affects about 2%-5% of people aged 18 and older. Data suggest that only this group--and not those with eczema--is at increased risk for eczema vaccinatum. But the two conditions are often confused, so ACIP voted to err on the side of caution and exclude anyone who had ever received a diagnosis of either condition or who is a household contact or family member of such an individual. Also excluded are individuals who have ever had an "itchy red, scaly rash that lasts more than 2 weeks and often comes and goes," and their household contacts.

People with other acute, chronic, or exfoliative skin conditions--such as burns, impetigo, varicella zoster, herpes, severe ...