Goldstein J A, Neff J M, Lane J M, Koplan J P
Pediatrics. 1975 Mar;55(3):342-7.
Smallpox vaccination in the United States is a routine public health measure which has been under intensive review during the last decade. The most frequently occurring adverse reactions to vaccination are benign and require little or no systemic therapy. These reactions include accidental infection, erythematous and urticarial rash, and generalized vaccinia. Chickenpox occurring concurrently with vaccination presents no problem unless vaccinia has widely superinfected the chickenpox lesions. There is no risk to the pregnant woman who is vaccinated, but there is a slight risk that the fetus will develop fetal vaccinia. The vaccinia does not cause congenital malformations. Vaccinia hyperimmune globulin (VIG) in prophylactic dosage may be given to a pregnant woman who is traveling to a smallpox infected or endemic area in order to prevent fetal vaccinia. Vaccinia necrosum and eczema vaccinatum require vigorous systemic therapy with VIG, and often thiosemicarbazone. Post-vaccinial encephalitis, while frequently serious, has not been shown to be ameliorated by VIG therapy, although there are data which suggest VIG has some value in prophylaxis for encephalitis. Prophylaxis, prompt recognition, and proper therapy may reduce the fatality rates of these complications. Revaccination of patients who have suffered a complication is a frequent clinical problem. Revaccination of an individual who has had post-vaccinial encephalitis or vaccinia necrosum is contraindicated unless the risk of contracting smallpox outweighs the risk of the above two diseases. Revaccination of children who have had eczema vaccinatum is not contraindicated. Revaccination of children with a history of accidental infection or erythematous or urticarial rash presents no known or theoretically increased risk.
在美国，天花疫苗接种是一项常规公共卫生措施，在过去十年中受到了深入审查。接种疫苗最常见的不良反应是良性的，几乎不需要或根本不需要全身治疗。这些反应包括意外感染、红斑和荨麻疹皮疹以及全身性牛痘。接种疫苗时同时出现水痘一般没有问题，除非牛痘广泛感染了水痘病灶。接种疫苗的孕妇没有风险，但胎儿有轻微风险会患上胎儿牛痘。牛痘不会导致先天性畸形。对于前往天花感染地区或流行地区的孕妇，可以给予预防剂量的牛痘超免疫球蛋白（VIG），以预防胎儿牛痘。坏死性牛痘和牛痘性湿疹需要用VIG进行积极的全身治疗，通常还需要使用氨硫脲。接种后脑炎虽然通常很严重，但尚未证明VIG治疗能改善病情，不过有数据表明VIG在预防脑炎方面有一定价值。预防、及时识别和适当治疗可以降低这些并发症的死亡率。对出现并发症的患者进行再次接种是一个常见的临床问题。曾患接种后脑炎或坏死性牛痘的个体禁忌再次接种，除非感染天花的风险超过上述两种疾病的风险。曾患牛痘性湿疹的儿童再次接种并无禁忌。有意外感染或红斑或荨麻疹皮疹病史的儿童再次接种没有已知的或理论上增加的风险。
