Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

To the Editor—We appreciate the thoughtful comments of Nishiura and Eichner [1] about our article [2]. They suggested that skin lesions after smallpox vaccination are not useful in the evaluation of vaccine-induced immunity. However, smallpox vaccination has been used as an immunization procedure and as a test of existing immunity since Jenner’s time [3]. Since the early 1900s, the descriptive terms “vaccinia” (or “primary reaction,” seen in those who have completely lost effective immunity), “vaccinoid” (or “accelerated reaction,” seen in those who retain only partial immunity), and “immune reaction” have come into more general use [4, 5]. Later, the use of the term “immune reaction” was discontinued, and “immediate reaction” was used to describe the peak of the reaction within 3 days after vaccination [6]. As Nishiura and Eichner’s review of the historical literature suggests, the interpretation of skin reactions gave rise to debates among the early vaccinators, especially regarding the “immediate reaction” and the absence of skin reactions. During the global eradication campaign, the expert committee of World Health Organization recommended that the former 2 types of skin reaction be combined as “major reactions” and all other reactions as “equivocal reactions” [7]. This recommendation was made to ensure that every vaccination was truly effective, because equivocal reactions can be caused by suboptimal inoculation technique, the use of subpotent vaccine, and residual immunity in previously vaccinated individuals. This approach was retained in the recent classification system by the Centers for Disease Control and Prevention [8]

Issue Section:
Correspondence
You do not currently have access to this article.
Download all slides