After the death of a few patients with significant heart disease following smallpox vaccination, the Advisory Committee on Immunization Practices (ACIP) recommended caution in smallpox vaccination in patients with heart disease or significant risk factors for cardiovascular disease.


Conditions indicating known heart disease:

(1) known coronary artery disease (previous myocardial infarction, angina)

(2) congestive heart failure

(3) cardiomyopathy

(4) history of stroke or transient ischemic attacks (TIA)

(5) chest pain or shortness of breath with exertion

(6) other heart conditions requiring the care of a physician


A person is at risk for atherosclerotic heart disease if 3 or more of the following risk factors are present:

(1) high blood pressure

(2) hypercholesterolemia

(3) diabetes mellitus

(4) current cigarette smoking

(5) first degree relative with a heart attack before the age of 50


A person with known heart disease or at high risk for atherosclerotic heart disease should not receive the smallpox vaccine until the risk/benefit parameters are better understood.


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