vertently exposed to smallpox vaccine during pregnancy. It is impossible, however, to detect every pregnancy since pregnancy tests might miss very early pregnancies. Understanding this and recognizing that each woman has the right to decide for herself whether a pregnancy test is appropriate, the committee agrees with the October 2002 recommendation of the ACIP that “Routine pregnancy testing of women of child-bearing age is not recommended” (CDC, 2002d).

CDC has stated that they are considering expanding the questions and advice about pregnancy and intention to become pregnant (included in the Vaccine Information Statement Supplement E) (Mulinare et al., 2003). The committee believes that additional public health interventions to screen for pregnancy and provide advice on avoiding pregnancy could probably be beneficial, if they do not detract from other important screening and programmatic activities. Considering that the rate of inadvertent exposure to smallpox vaccine during pregnancy is lower than expected and it is impossible to detect all pregnancies at the time of vaccination, the committee does not recommend extra pregnancy screening efforts at this time. Data on the rate of pregnancies exposed to smallpox vaccine should be evaluated regularly, with the decision on whether to intensify pregnancy screening efforts also being reevaluated regularly.

On June 11, 2003, CDC recommended smallpox vaccination for persons investigating monkeypox outbreaks, involved in caring for infected individuals or animals, or who have had close or intimate contact with individuals or animals confirmed to have monkeypox (CDC, 2003a). Smallpox vaccination is recommended for persons who have contraindications to vaccination (e.g., pregnancy, eczema) if they have had close or intimate contact with a person with a rash illness, but CDC cautions that it is important to confirm suspected cases of monkeypox before recommending smallpox vaccination for a person with contraindications. Considering that there may be some pregnant women who will be advised to receive a smallpox vaccination because of their close personal contact with a confirmed case of monkeypox, the committee recognizes that it will be important for CDC to describe how such women will be incorporated into the National Smallpox Vaccine in Pregnancy Registry. These women will not have experienced an “inadvertent” smallpox vaccine exposure, because smallpox vaccination will have been recommended due to their contact with a monkeypox case. As these issues begin to be worked out, the committee encourages CDC to describe how data on them will be combined with or separated from the pregnancies exposed to smallpox vaccine stemming from the pre-event smallpox vaccination program, and how followup data on the pregnancies exposed to smallpox vaccine because of contact with monkeypox will contribute to evaluation of the other pregnancies included in the registry.

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