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Am Fam Physician. 2003;67(8):1839-1840

Smallpox Vaccine in Persons with Eczema

The National Eczema Association for Science and Education has released a statement urging anyone who has eczema or atopic dermatitis not to receive the smallpox vaccine unless they have been exposed to smallpox because of a heightened risk of life-threatening reactions.

The association cautioned that the smallpox vaccine contains a live virus that can be harmful or even fatal to those with eczema or atopic dermatitis. Family members of those persons with eczema should not take the vaccine unless they have been exposed to smallpox, because the live virus in the vaccine can harm the family member with eczema on contact.

Persons with eczema who have come in contact with another's vaccine site or believe they have come in contact with the live virus should immediately and thoroughly wash with soap and warm water and alert their physician.

Eczema and atopic dermatitis, which affect an estimated 17 million persons in the United States, cause an itchy red, scaly rash that often comes and goes. If the live virus from the vaccine site gets into broken skin, it can cause a rash in that area. Most people will recover from the rash with treatment, but people with eczema may experience a severe rash, sometimes leading to scarring or even death.

Exposures include touching the vaccination site before it has healed or coming into contact with the live virus in any way, including contact with towels, clothing, washcloths, or bandages used by a person who has received the vaccine. The danger period of transmission lasts from three weeks to one month.

FDA Statement on Counterfeit Procrit

The U.S. Food and Drug Administration (FDA) is alerting health care providers and patients to the existence of three lots of counterfeit product labeled as Procrit (epoetin alfa):

  • P007645: 40,000 units per mL, expiration October 2004

  • P004677: 40,000 units per mL, expiration February 2004

  • P004839: 40,000 units per mL, expiration February 2004

This counterfeit Procrit has been found to be contaminated with bacteria and therefore represents a significant potential hazard to consumers. In addition, FDA testing has demonstrated that some counterfeit product contains no active ingredient. Procrit is used to stimulate the production of red blood cells in humans to treat severe anemia.

The FDA urges health care professionals and patients to check the packaging and vials before using the product. Counterfeit product should be quarantined and not used. The FDA's Center for Biologics Evaluation and Research should be contacted at 800-835-4709 (prompt 1, then prompt 5), and Ortho Biotech at 800-325-7504 (prompt 2).

Additional information concerning the counterfeit product is available on the manufacturer's Web site at

CDC Report on Pregnancy-Related Mortality

Black women have three to four times the risk of a pregnancy-related death compared with white women, according to a report from the Centers for Disease Control and Prevention (CDC). “Pregnancy-Related Mortality Surveillance—United States, 1991–1999” is available online at

The pregnancy-related mortality ratio for all women for the years 1991 through 1998 was 11.8 deaths per 100,000 live births. The risk of death from complications related to pregnancy remains higher than the nation's Healthy People 2010 objective: no more than 3.3 maternal deaths per 100,000 live births.

Pregnancy-related deaths are rare; 525 occurred in 1999. However, significant racial disparities persist. During the nine-year study period, the pregnancy-related mortality ratio for black women was 30.0 deaths per 100,000 live births, compared with 8.1 for white women. This is the largest racial gap of any indicator in the field of maternal and child health and has persisted for more than 60 years.

The CDC report also found a greater risk of pregnancy-related deaths among older women and those who received no prenatal care. The risk for pregnancy-related death increased sharply for women age 35 and older, and the risk for women 40 and older was four times the risk for women age 30 to 34. For each age category, black women were at a higher risk of death than white women. Among all age groups, women who received no prenatal care were three to four times more likely to die of pregnancy-related causes than women who received any care; this risk was even higher for black women.

Data published in the report are from the CDC's Pregnancy Mortality Surveillance System, which collects data on pregnancy-related deaths through state health departments, maternal mortality review committees, the media, and individual providers. Improved identification of pregnancy-related deaths in recent years has likely led to the reported increase in the pregnancy-related mortality ratio. However, the authors of the report say that pregnancy-related deaths are still underreported and that the number of deaths related to pregnancy may increase significantly with more active surveillance.

The CDC is responding to the problem of complications and deaths related to pregnancy by collaborating with the Safe Motherhood Initiative, a broad coalition of agencies, organizations, and professionals, to address research and policy issues on this topic. More information on the Safe Motherhood Initiative is available online at

AAP Statement on Emergency Care of Children

Appropriate medical care for a child or adolescent with an urgent or emergent condition should never be withheld or delayed because of problems with obtaining consent, according to a policy statement issued by the Committee on Pediatric Emergency Medicine of the American Academy of Pediatrics (AAP). “Consent for Emergency Medical Services for Children and Adolescents” appears in the March 2003 issue of Pediatrics.

USP Consumer Guide on Safe Use of Medications

The U.S. Pharmacopeia (USP) is offering a free consumer brochure on how to safely use prescription and over-the-counter (OTC) medications. “Think It Through: A Guide to Managing the Benefits and Risks of Medicines” is available by calling 888-878-8256 (ask for department 73) and online at

The eight-page brochure offers information on the following five steps in making informed decisions and safely using medications:

  1. Talk with your physician, pharmacist, or other health care professional. Keep an up-to-date list of medicines and dietary supplements you use, and always ask questions about any concerns or thoughts you may have.

  2. Know your medicines, both prescription and OTC. Be aware of when, how, and how long to use them, what to do if you miss a dose, and whether or not there are any side effects.

  3. Read the label and follow directions. Always double-check that you have the right medicine, and never combine medicines in the same bottle. Make sure you understand the directions; if you have any questions or concerns, ask.

  4. Avoid interactions. Before starting any new medicine or dietary supplement, ask if there are possible interactions with products you are currently using. Whenever possible, use the same pharmacy for all your medication needs.

  5. Monitor your medicine's effects and the effects of other medications or supplements you use. Pay attention to how you are feeling; write down the changes so that you can remember to tell your physician or pharmacist.

Children and adolescents frequently seek medical treatment in emergency departments (ED) unaccompanied by a legal guardian. Current state and federal laws and medical ethics recommendations support the ED treatment of these persons with an identified emergency medical condition, regardless of consent issues. The AAP believes financial reimbursement should not limit the patient's access to emergency medical care or result in a breach of patient confidentiality.

Health care professionals should be familiar with federal and state regulations regarding consent for treatment of children. In addition, the AAP recommends all clinics, office practices, and EDs develop written policies for treatment of unaccompanied children and adolescents, and document all discussions related to obtaining consent.

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