CDC fine-tunes smallpox vaccination program. (Guidelines for Lactating Women).

Contact with infants less than 1 year of age, vaccination site care, and autoimmune disease were among the last-minute issues pertaining to smallpox vaccination that were clarified in telephone conference calls held by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

With the nationwide smallpox vaccination program starting in January, the ACIP made final recommendations that month on a few issues left over from its October meeting. They include the following:

* Lactating women. Consistent with the package label, smallpox vaccination is not recommended for women who are breastfeeding, although their household contacts may be vaccinated.

* Adult contacts of infants under 1 year. The presence of an infant in the household is not a contraindication to vaccination for adult contacts because data suggest that the risk of serious complications resulting from adult-to-child transmission is low.

However, some individual state vaccination programs may defer vaccination of adult household contacts, because data suggest that the risk of adverse events among primary vaccinees in this age group is higher than that in older children.

* Number of needle insertions. In primary vaccinees, the Dryvax package ...