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.
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