Bulletin No. 10
May 25, 1979
Smallpox Immunizations For Travelers -- An Unnecessary Risk

Some countries continue to require smallpox certificates for entry although naturally occurring smallpox has not been reported anywhere in the world since October, 1977, and despite the Global Commission for the Certification of Smallpox Eradication's recommendation that: "Since there is no smallpox infected country anywhere in the world, smallpox vaccination certificates should not be required for international travel" (1). Furthermore in the opinion of the Section of Communicable Disease Control, smallpox vaccination poses a greater risk to the traveler than the risk of smallpox. For these reasons we are following the lead of other states (2,3) in recommending smallpox vaccinations only for travelers to Ethiopia and Somalia. For travelers to all other countries we recommend instead of vaccination that the physician provide a "smallpox vaccination waiver letter" stating that smallpox vaccination "was contraindicated for health reasons." The CDC and other State Health Departments have found it to be rare for this procedure to cause difficulties for travelers. Nevertheless the traveler should weigh the risk of vaccination against the risk of travel difficulties the "waiver letter" could cause.

To summarize, we believe a "smallpox vaccination waiver letter" is preferable to an unnecessary smallpox vaccination and suggest physicians consider providing such a letter to their patients who travel abroad. The patient must consider the risk of the vaccination against the risk of travel difficulties this procedure could cause.

Please also note that smallpox vaccine SHOULD NOT be used in the prevention or treatment of recurrent herpes simplex, herpes zoster, or warts. By doing so patients are exposed to potentially serious and costly complications from a product with no proven value when used in this way.

1. WHO Weekly Epidemiologic Record, 54(5):33-40, 1979
2. California Morbidity, Number 33, August 25, 1978
3. Oregon Communicable Disease Summary, Vol. 28, No. 18, May 5, 1979