Routine Childhood Vaccination against Smallpox Reconsidered

Abstract The United States can expect 210 deaths caused by smallpox vaccination between now and the end of the century if present policies, emphasizing routine childhood vaccination, persist. The risk of importation of smallpox is extremely low. Only two out of every three importations have resulted in spread, and only eight deaths on the average have occurred in each outbreak. To outweigh the health hazards of routine vaccination, the United States would have to have a smallpox importation nearly every year. The benefits of routine childhood smallpox vaccination no longer outweigh its risks, and consideration should be given to its discontinuance.