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
CDC. Smallpox vaccine available for protection of at risk
laboratory workers. MMWR 1983;32:543.
World Health Organization. Smallpox: post-eradication
surveillance. Vaccination policy. Weekly Epidemiological
Record
1984;59:278.
Laboratory Centre for Disease Control. Vaccinia
outbreak--Newfoundland. Canada Diseases Weekly Report
1981;7:29-30.
CDC. Contact spread of vaccinia from a recently vaccinated
Marine--Louisiana. MMWR 1984;33:37-8.
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