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Hiroshi Nishiura, Martin Eichner, Predicting Residual Immunity against Smallpox, The Journal of Infectious Diseases, Volume 195, Issue 1, 1 January 2007, Pages 160–161, https://doi.org/10.1086/509812
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To the Editor —Kim et al. [1] reported that an intradermal skin test using inactivated vaccinia virus would be useful for the evaluation of vaccine-induced immunity against smallpox. They wrote that the skin test is “a simple, rapidly interpretable, and reliable method for prediction of residual immunity to smallpox” (p. 383) and compared the test with those using a neutralizing antibody or a cell-mediated immune reaction. Although it is certainly true that knowing the immunity status of the present population is important, we have serious concerns about the authors’ methods and discussion. Unfortunately, the experimental design is technically flawed
The authors assessed the diagnostic performance of the skin test in predicting the characteristic skin reactions to vaccinia virus [1]. That is, they suggested that sizes of induration and erythema after the intradermal skin test explained the outcome variable (i.e., the presence of the “skin reaction”; p. 379) better than other laboratory immune reactions. Even without the authors’ experiments, it is clear that one type of skin sign at the site of vaccination almost perfectly predicts another type of skin reaction to the same vaccination (i.e., laboratory immune reactions must be far less efficient at predicting the characteristic skin reaction)
