Fears about biological terrorism in the United States have led to health workers currently being offered vaccination against smallpox. The main hazard is eczema vaccinatum, a possibly life threatening reaction to the vaccine in people with a history of atopic dermatitis or eczema. Self reporting has led to only a third of the expected numbers giving a history of skin disease, but the good news is that not one case of eczema vaccinatum has occurred in the first 31 000 health workers who have been vaccinated (Annals of Internal Medicine 2003;139: 1-7)

A 16 year old girl with Turcot's syndrome presented with a radiation recall reaction onthe forehead after starting capecitabine chemotherapy for metastatic carcinoma of the sigmoid colon. Ten months earlier she had received a radical postoperative course of radiotherapy to the rightfrontal lobe after excision of a grade 3 astrocytoma. Radiation recall is an inflammatory reactionoccurring in a previously irradiated area when the patient is exposed to certain drugs.

Ahmed M El-Modir, specialist registrar, David Spooner,consultant oncologist, Daniel Ford, specialist registrar, Cancer Centre, University Hospital, Birmingham B15 2TH

If and when the whole population is urged to be vaccinated, some sort of compact (a contract oragreement) should be offered, says Clinical Infectious Diseases (2003;36: 1547-51).This agreement between …