Dermatological

“Case 1. In early May 2003, a service member received his primary smallpox vaccination. Approximately 6-8 days after vaccination, he experienced a major reaction (i.e., an event that indicates a successful take; is characterized by a papule, vesicle, ulcer, or crusted lesion, surrounded by an area of induration; and usually results in a scar) (4). The vaccinee reported no substantial pruritus. He slept in the same bed as his wife and kept the vaccination site covered with bandages. After bathing, he reportedly dried the vaccination site with tissue, which he discarded into a trash receptacle. He also used separate towels to dry himself, rolled them so the area that dried his arm was inside, and placed them in a laundry container. His wife handled bed linen, soiled clothing, and towels; she reported that she did not see any obvious drainage on clothing or linen and had no direct contact with the vaccination site.

In mid-May, the wife had vesicular skin lesions on each breast near the areola but continued to breastfeed. Approximately 2 weeks later, she was examined at a local hospital, treated for mastitis, and continued to breastfeed. The same day, the infant had a vesicular lesion on the upper lip, followed by another lesion on the left cheek (5). Three days later, the infant was examined by a pediatrician, when another lesion was noted on her tongue. Because of possible early atopic dermatitis lesions on the infant’s cheeks, contact vaccinia infection with increased risk for eczema vaccinatum was considered. The infant was transferred to a military referral medical center for further evaluation. On examination, the infant had seborrheic dermatitis and no ocular involvement. Skin lesion specimens from the mother and infant tested positive for vaccinia by viral culture and PCR at the Alaska Health Department Laboratory and at Madigan Army Medical Center. Because both patients were stable clinically and the lesions were healing without risk for more serious complications, vaccinia immune globulin was not administered. Neither patient had systemic complications from the infection.

Case 2. In July 2003, a service member who had been vaccinated was wrestling with an unvaccinated service member at a military recreational function when the bandages covering the vaccination site fell off. The unvaccinated service member subsequently wrestled with another unvaccinated service member. Six days later, both unvaccinated service members had lesions on their forearms, neck, and face. Skin lesion specimens from both men tested positive for vaccinia virus by PCR and viral culture at Tripler Army Medical Center’s microbiology laboratory.”

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https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a3.htm

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Severe eczema vaccinatum in a household contact of a smallpox vaccinee.