TABLE 3-1 Number of Reported Cases of Selected Adverse Events Associated with Smallpox Vaccination Among Civilians, by Type, United States, January 24-December 31, 2003

Adverse Events

Number of Casesa




Eczema vaccinatum

Fetal vaccinia

Generalized vaccinia



Inadvertent inoculation, nonocular



Ocular vaccinia



Progressive vaccinia

Erythema multiforme major (Stevens-Johnson syndrome)




Postvaccinial encephalitis or encephalomyelitis


Pyogenic infection of vaccination site

SOURCE: CDC (2004d).

a “Adverse events that have been associated with smallpox vaccination are classified on the basis of evidence supporting the reported diagnoses. Cases verified by virologic testing are classified as confirmed. Cases are classified as probable if possible alternative etiologies are investigated and excluded and supportive information for the diagnosis is found. Cases are classified as suspected if they have clinical features compatible with the diagnosis, but either further investigation is required or investigation of the case did not provide supporting evidence for the diagnosis” (CDC, 2003m).

The War in Iraq

Military action in Iraq began on March 19, 2003. Both the events leading up to the war and the period after the declared end of major combat may have influenced public opinion and attitudes about and participation in the smallpox vaccination program. President Bush declared an end to major hostilities in Iraq in April 2003 (although military action continued).

As described in Chapter 2, the smallpox vaccination policy grew out of a series of discussions among top government officials about the possible existence of smallpox virus outside the two known repositories in Russia and the United States and about the threat of deliberate release of smallpox virus. The scope and content of intelligence considered in decision-making were not made known to the public until the publication of the Senate Intelligence Committee’s Report on the U.S. Intelligence Community’s Pre-

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