VIG 'reasonable' approach to curb fetal vaccinia. (Smallpox Vaccination in Pregnancy).

ATLANTA -- A woman who receives the smallpox vaccine without realizing that she is pregnant may benefit from a dose of intravenous vaccinia immune globulin before the time when viremia may occur.

At a meeting of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, the consensus was that it would be reasonable to offer this treatment. The committee declined to formally recommend the use of vaccinia immune globulin (VIG) in pregnancy, however, citing uncertainty about safety and efficacy.

The concern with smallpox vaccination in pregnancy is the possibility of fetal vaccinia, a rare condition in which infection of the fetus is frequently associated with miscarriage and neonatal death, said Dr. Susan Goldstein of the CDC's National Immunization Program smallpox team.

Approximately 47 cases of fetal vaccinia have been reported in case series and case reports, all from developed countries. This is probably an underestimate, because in less developed countries, fetal vaccinia is less likely to be recognized and reported.

Among the cases for which data are available, 10 were associated with primary vaccination, 3 with revaccination, 2 were infected via dose contacts, and in 9 cases, vaccination status was unknown. Outcomes included miscarriage in 11, live birth with neonatal death in 10, and live birth with neonatal survival in 4. In the 13 cases in which placental examinations were carried out, all showed gross pathologic abnormalities and/or positive viral cultures.

"Among 'smallpox gurus,' the frequency of viremia is thought to differ by strain," Dr. Goldstein said. Viremia has been documented with some of the "hot" European strains such as the older ...