A CBBS member wonders what her institution should do if a recently vaccinated individual requests to bank their own autologous blood during the time that they would otherwise be deferred under the Dec. 2002 FDA recommendations regarding deferral of blood donation following smallpox vaccination.

The following response was received.

ADDENDA Jan. 3, 2003

1. A transfusion medicine physician in New York is of the opinion that since viruses would not be expected to proliferate in stored blood (unlike some bacteria under some circumstances), he can think of no biologic reason why someone who has received an attenuated viral vaccine shouldn't be allowed to donate autologous blood.

Editor's Note: It is strongly advised that those deciding whether to encourage autologous donation by a recently vaccinated patient read the article by Kent Sepkowitz entitled 'How Contagious is Vaccinia?'(to be published in the Jan 30, 2003 issue of the NEJM). Then decide if you want to encourage recently vaccinated individuals to visit a donor center where they may come into contact with other autologous donor-patients, some of whom might be immunocompromised.

ADDENDA Jan. 6, 2003

2. A blood banker from the East Coast of the US wrote that in his opinion, individuals who have a routine vaccinia vaccination (one uncomplicated set of vesicles under a single, occlusive dressing) appear to have little risk of secondary transmission. Further, in his opinion, the risk-benefit ratio appears to be at least as good as the acceptance of routine homologous donors with sniffles but no fever or myalgia (one rare individual may have early stage influenza but the risk appears to be tolerably low). Such donors would be handled by routine autologous procedures (separation by time and/or space from all other donors and meticulous handwashing by staff after contact). The occlusive dressing must stay in place over the vaccinia site at all times during the autologous blood donation process. Any complication of variolization (vaccinia necrosum, etc.) may be associated with more detectable viremia and an apparently increased risk of secondary transmission. Such patients should be deferred (discouraged) from autologous donation to avoid reinfusion of vaccinia prior to having established immunity and to avoid secondary transmission to others at the donor center.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator