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Contact Spread of Vaccinia from a Recently Vaccinated Marine -- Louisiana

On December 27, 1983, a 20-year-old woman was admitted to a suburban New Orleans hospital with vesicular lesions on her face, thighs, buttocks, and labia. The patient had noted labial and inguinal pain and swelling beginning on December 24, and on December 25, clear vesicles on her face, thighs, and buttocks.

On admission, the patient had a fever of 38.0 C (100.4 F) and seven lesions ranging from clear vesicles to pustular-umbilicated lesions on her nose and chin and along her left cheek and malar areas. There was tender, firm submental, submandibular, and anterior cervical lymphadenopathy on the left. Additional lesions were noted on the right thigh and left buttock. A pelvic examination showed similar lesions on her labia majora and minora and posterior fourchette area and along the right lateral vaginal wall and anterior cervix. Marked inguinal and femoral lymphadenopathy was present. On December 28, pox virus was confirmed by electron microscope, and the patient received 0.3 ml/kg of vaccinia immune globulin (VIG).

On December 29, the patient developed a new clear vesicular lesion on the right wrist and a satellite lesion adjacent to a vesicle at the angle of the mandible. A second dose of VIG was given; by December 30, these lesions had not developed further. The size and pain of the mandibular nodes decreased, and the patient noted a marked decrease in pain. Her remaining hospital course was uneventful.

The patient's fiance, an officer in the U.S. Marine Corps, had received his first smallpox vaccination while completing a training session on December 16, 1983. He went on leave on December 17, and he and the patient spent December 17-25 together. The patient had never received a smallpox vaccination.

Cultures for herpes simplex 2 and serologic studies for chlamydia and herpes 2 were negative. Vaccinia virus was cultured from the patient's vaginal and facial lesions. No other cases among her large extended family occurred. Reported by WL Willliams, MD, HT Cook, MD, Slidell, CT Caraway, DVM, State Epidemiologist, Louisiana Dept of Health and Human Resources; Viral Infections and Herpes Br, Div of Viral Diseases, Center for Infectious Diseases, International Health Program Office, CDC.

Editorial Note

Editorial Note: This episode resembles a 1981 vaccinia outbreak in Canada (1) and demonstrates the potential for contact spread of vaccinia from recently vaccinated persons. It is unusual because of the culture-proven intravaginal lesions.

The Department of Defense routinely vaccinates all active duty, National Guard, and Reserve personnel against smallpox on entry into service and at 5-year intervals. In general, these vaccinations are performed at the start of basic training, summer camps, or other settings that minimize contact between recently vaccinated military personnel and the general public. The present case illustrates the potential for serious complications by accidental spread of vaccinia to unvaccinated individuals. Accidental spread to individuals at high risk, such as children under 1 year of age and individuals with eczema or immunodeficiencies, could be more serious.

Reference

  1. CDC. Vaccinia outbreak--Newfoundland. MMWR 1981;30:453-5.

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