Vaccination of Transplant Recipients Against Smallpox?
Should high-risk transplant recipients be vaccinated against smallpox?

Smallpox vaccine may cause severe complications, including eczema vaccinatum, progressive vaccinia, and postvaccinal encephalitis with life-threatening consequences in patients with depressed cell-mediated immunity. Organ transplant recipients are included in this category. The more depressed their immunity, the higher is the chance of developing a severe case of variola major with complications, such as progressive vaccinia with local necrosis and dissemination. Therefore, transplant recipients, even if they are considered "high-risk," should not receive the smallpox vaccine. The exception would be a documented exposure to a smallpox virus, such as in the setting of a bioterrorism attack.