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Epidemiologic Notes and Reports Contact Spread of Vaccinia from a National Guard Vaccinee -- Wisconsin

On January 24, 1985, a 15-year-old female was referred to a dermatologist in a clinic in La Crosse, Wisconsin, for evaluation of an ulcerated lesion on her left upper lip. On examination, the patient had a 2-cm diameter ulcer on her left upper lip, five 4-mm diameter oval vesicles on the arms, and marked conjunctival injection of the left eye. She appeared mildly sick with low-grade fever, fatigue, and tender cervical lymphadenopathy. The patient was otherwise in good health, with no history of eczema, malignancy, or immunologic deficiency.

The patient has a male friend who is a member of the Wisconsin National Guard. He had received a smallpox vaccination in a U.S. Army facility in Wisconsin at the end of December 1984. In early January, the patient assisted her friend in applying compresses to ease the discomfort of a successful smallpox vaccination. As a child, the patient had received a smallpox vaccination but had never developed a reaction. She has no scar compatible with smallpox vaccination.

She was treated with trifluridine in the left eye, oral erythromycin, and topical neosporin for the ulcer on her lip. In addition, she received a total of 30 ml of vaccinia immune globulin (VIG) intramuscularly over 2 days. Vaccinia virus was cultured from the skin lesions. On follow-up visit on February 6, all lesions were healing well, and it appeared that the lesion on the left lip would heal without scarring.

An investigation conducted to determine whether the patient had transmitted disease to her contacts involved five immediate family members and 45 participants in a girls' gymnastics meet on January 21 in which the patient competed. By January 31, none of these 50 individuals had subsequent evidence of vesicular or pustular skin lesions. Reported by JC Baumgaertner, MD, R Hogan, MD, C Born, MD, Gundersen Clinic, LaCrosse, J Berg, JP Davis, MD, State Epidemiologist, Wisconsin Dept of Health and Social Svcs; Div of Viral Diseases, Center for Infectious Diseases, International Health Program Office, CDC.

Editorial Note

Editorial Note: Since the successful global eradication of smallpox, smallpox vaccinations of civilians in the United States have decreased to several hundred a year. Smallpox vaccine is now recommended only for laboratory workers occupationally exposed to orthopox viruses (1).

The U.S. Department of Defense (DOD) routinely vaccinates all active-duty personnel and members of the National Guard and Reserves on entry into military service and every 5 years thereafter. Under current policy guidelines, several hundred thousand DOD personnel are vaccinated against smallpox each year. In line with World Health Organization recommendations (2), the DOD policy recommends vaccination of military personnel in circumstances that would limit the potential contact between recent military vaccinees and potentially unprotected civilian contacts. For example, smallpox vaccinations are given during basic training and, for the National Guard, are recommended at the start of extended training activities, such as 2-week summer training. Contact spread of vaccinia from recently vaccinated military personnel has occurred in Canada (3) and Louisiana (4).

Apparently, this case resulted because of an incomplete application of this policy. The National Guard member was not vaccinated at the start of an extended training period. Although this patient's illness was relatively benign, the potential for serious or fatal complications would have been much greater if she had had eczema or immunologic deficiency because of malignancy or chemotherapy.

References

  1. CDC. Smallpox vaccine available for protection of at risk laboratory workers. MMWR 1983;32:543.

  2. World Health Organization. Smallpox: post-eradication surveillance. Vaccination policy. Weekly Epidemiological Record 1984;59:278.

  3. Laboratory Centre for Disease Control. Vaccinia outbreak--Newfoundland. Canada Diseases Weekly Report 1981;7:29-30.

  4. CDC. Contact spread of vaccinia from a recently vaccinated Marine--Louisiana. MMWR 1984;33:37-8.

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