hi Normal reactions to smallpox vaccination include erythema, edema, regional lymphadenopathy, fever, malaise, and urticaria. These reactions require only observation and symptomatic treatment. In clinical trial settings, up to one third of vaccinees may be ill enough to miss work or have difficulty sleeping.Historically, approximately 21 percent of first-time vaccinees consulted a physician because of bothersome reactions. In contrast, recent data on military hospital workers demonstrated a 3 percent sick-leave rate. Approximately 10 percent of first-time vaccinees have “robust takes.” These reactions include large areas of erythema and extensive lymphadenopathy or lymphadenitis . It may be difficult to distinguish robust takes from bacterial infections. Robust takes occur eight to 10 days after vaccination and resolve spontaneously within 72 hours. No treatment is necessary. take care