Diary from a week in practice.

Publication: American Family Physician

Publication Date: 15-MAR-03

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COPYRIGHT 2003 American Academy of Family Physicians

Monday

Lately, I'm fielding questions about the smallpox vaccine. Misinformation abounds. Some believe that they retain immunity to smallpox no matter how long it has been since they were originally vaccinated. Others fear that the rate of serious adverse reactions from the vaccine is 50 percent, rather than the actual estimate of complications in first-time recipients of less than 50 persons per 1 million. "What do you think about the smallpox vaccine?" Catherine quizzed me as we were concluding the elderly woman's visit for her diabetes and neuropathy. "Do I really need one? You know I had a vaccination years ago." I sensed the answer Catherine desired was "No," and she appeared more distressed than interested by the question, so I probed a little deeper. "In 1940, my 13-year-old sister died of encephalitis after receiving a smallpox vaccination. How safe is it for me to be revaccinated?" We spent some time chatting--Catherine shared memories of her sister with me, and I shared what I knew about smallpox with her. "If and when a time comes that mass vaccination is recommended, I believe you'll be safe in getting another one," I summed things up for her. Doctors may not have all the answers, but that does not stop...

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