Which factors are contraindications to smallpox vaccination?

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The main concept here is that the smallpox vaccine uses a live, replicating vaccinia virus, so it can cause serious adverse events in people with certain conditions. Eczema increases risk because disrupted skin barriers can allow the vaccinia virus to spread beyond the vaccination site, leading to eczema vaccinatum, which can be severe. Immunodeficiency means the body can’t control the contagious virus, raising the chance of disseminated vaccinia and systemic illness. Pregnancy is a concern because vaccinia can infect the fetus and cause fetal vaccinia or miscarriage. Because all three scenarios raise substantial safety concerns with the vaccine, they are all contraindications.