Risks of serious complications and death from smallpox vaccination: A systematic review of the United States experience, 1963–1968

Aragón, Tomás J; Ulrich, Skylar; Fernyak, Susan; Rutherford, George W

doi:10.1186/1471-2458-3-26

Table 4 Risk of eczema vaccinatum (E.V.) and death from primary smallpox vaccinations, Stratified by age and study, 1963–1968

From: Risks of serious complications and death from smallpox vaccination: A systematic review of the United States experience, 1963–1968

Age group and studies	Number vaccinated	E.V. No.	Deaths No.	Risk of complication per million (95% C.I.)^a		Risk of death per million (95% C.I.)^a		Case fatality risk per hundred (95% C.I.)^a
Age <1
Neff 1967a	654,000	16	0	24.5	(14.0, 39.7)	0.0	(0.0, 5.6)	0.0	(0.0, 20.6)
Neff 1967b	31,000	3	0	96.8	(20.0, 283)	0.0	(0.0, 119)	0.0	(0.0, 70.8)
Lane 1969	614,000	5	0	8.1	(2.6, 19.0)	0.0	(0.0, 6.0)	0.0	(0.0, 52.2)
Lane 1970	17,000	1	0	58.8	(1.5, 328)	0.0	(0.0, 217)	0.0	(0.0, 97.5)
Ratner 1970	1	0	0	n/c	n/c	n/c	n/c	n/a	n/a
Neff 1972	32	0	0	n/c	n/c	n/c	n/c	n/a	n/a
Summary	1,316,033	25	0	19.0	(12.3, 28.0)	0.0	(0.0, 2.8)	0.0	(0.0, 13.7)
Age 1 to 4
Neff 1967a	2,973,000	22	0	7.4	(4.6, 11.2)	0.0	(0.0, 1.2)	0.0	(0.0, 15.4)
Neff 1967b	142,000	9	0	63.4	(29.0, 120)	0.0	(0.0, 26.0)	0.0	(0.0, 33.6)
Lane 1969	2,733,000	31	0	11.3	(7.7, 16.1)	0.0	(0.0, 1.3)	0.0	(0.0, 11.2)
Lane 1970	317,000	14	0	44.2	(24.1, 74.1)	0.0	(0.0, 11.6)	0.0	(0.0, 23.2)
Ratner 1970	68,002	0	0	0.0	(0.0, 54.2)	0.0	(0.0, 54.2)	n/a	n/a
Neff 1972	517	0	0	0.0	(0.0, 7110)	0.0	(0.0, 7110)	n/a	n/a
Summary	6,233,519	76	0	12.2	(9.6, 15.3)	0.0	(0.0, 0.6)	0.0	(0.0, 4.7)
Age 5 to 19
Neff 1967a	2,295,000	15	0	6.5	(3.7, 10.8)	0.0	(0.3, 1.6)	0.0	(0.0, 21.8)
Neff 1967b	110,000	8	0	72.7	(31.4, 143)	0.0	(0.3, 33.5)	0.0	(0.0, 36.9)
Lane 1969	1,959,000	14	0	7.1	(3.9, 12.0)	0.0	(0.3, 1.9)	0.0	(0.0, 23.2)
Lane 1970	229,000	8	0	34.9	(15.1, 68.8)	0.0	(0.3, 16.1)	0.0	(0.0, 36.9)
Ratner 1970^b	193,721	3	0	15.5	(3.2, 45.3)	0.0	(0.3, 19.0)	0.0	(0.0, 70.8)
Summary	4,786,721	48	0	10.0	(7.4, 13.3)	0.0	(0.0, 0.8)	0.0	(0.0, 7.4)
Age 20 +
Neff 1967a	317,000	1	0	3.2	(0.1, 17.6)	0.0	(0.3, 11.6)	0.0	(0.0, 97.5)
Neff 1967b	15,000	1	0	66.7	(1.7, 371)	0.0	(0.3, 246	0.0	(0.0, 97.5)
Lane 1969	288,000	7	0	24.3	(9.8, 50.1)	0.0	(0.3, 12.8)	0.0	(0.0, 41.0)
Lane 1970	33,000	1	0	30.3	(0.8, 169)	0.0	(0.3, 112	0.0	(0.0, 97.5)
Ratner 1970^b	107,822	0	0	0.0	(0.0, 34.2)	0.0	(0.3, 34.2)	n/a	n/a
Summary	760,822	10	0	13.1	(6.3, 24.2)	0.0	(0.0, 4.8)	0.0	(0.0, 30.8)
All ages^c
Neff 1967a	6,239,000	54	0	8.6	(6.5, 11.3)	0.0	(0.0, 0.6)	0.0	(0.0, 6.6)
Neff 1967b	298,000	24	0	80.5	(51.6, 120)	0.0	(0.0, 12.4)	0.0	(0.0, 14.2)
Lane 1969	5,594,000	58	0	10.4	(7.9, 13.4)	0.0	(0.0, 0.7)	0.0	(0.0, 6.2)
Lane 1970	596,000	25	0	41.9	(27.1, 61.9)	0.0	(0.0, 6.2)	0.0	(0.0, 13.7)
Mellin 1970	109,000	5	0	45.9	(14.9, 107)	0.0	(0.0, 33.8)	0.0	(0.0, 52.2)
Ratner 1970	369,546	3	0	8.1	(1.7, 23.7)	0.0	(0.0, 10.0)	0.0	(0.0, 70.8)
Neff 1972	549	0	0	0.0	(0.0, 6697)	0.0	(0.0, 6697)	n/a	n/a
Summary	13,206,095	169	0	12.8	(10.9, 14.9)	0.0	(0.0, 0.3)	0.0	(0.0, 2.2)

n/c = not calculated, n/a = not assessable ^aRisk and confidence intervals not calculated (n/c) for less that 100 vaccinations. Exact confidence intervals based on the binomial distribution. ^bThe Ratner study age groups, "Age 5 to 14" and "Age 15+", were counted in the Table age groups "Age 5 to 19" and "Age 20+", respectively. ^cAll ages group includes subjects whose age was unknown

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