Prior to being mobilized to Iraq, National Guard members were given smallpox vaccinations. The soldiers who were old enough to have previously received smallpox vaccinations as children did not seem to have any of the typical transient symptoms (i.e., pain, erythema, axillary lymphadenopathy, low-grade fever, and localized edema at the injection site). Am I correct to assume that this was a result of previous vaccination, or do these individuals need to receive the vaccination again to confer immunity?
—ShawnT. Buller, PA-C, MPH, MAJ/USAR, Charlotte, N.C.

First-time vaccinees are more likely to have the normal reactions to smallpox vaccination as described. However, both primary vaccinees and revaccinees should have the “take” response to vaccination. This involves a progression from papule to pustule to scab at the vaccination site. If the take response does not occur, regardless of prior vaccination status, the response is said to be “equivocal,” and vaccination should be repeated with 15 punctures. One cause of equivocal response is immunity. A revaccinee should be considered immune if no take occurs after two attempts. A primary vaccinee with two “no takes” should be referred for immunologic evaluation. For more information, refer to MMWR Recomm Rep. 2001;50(RR-10):1-25.
—Jo Ann Deasy, PA-C, MPH (114-18)

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