Epidemiologic Notes and Reports
Disseminated Vaccinia Infection in a College Student -- Tennessee
On October 12, 1982, the University of Tennessee Student Health
Service notified the Tennessee Department of Public Health that a
19-year-old male undergraduate had been hospitalized that day for
disseminated vaccinia infection.
The student was vaccinated for the first time in his life at an
Air National Guard meeting in Nashville on October 3, 1982. A
primary
"take" appeared at the vaccination site on October 5, after his
return
to the university in Knoxville. On October 9, multiple pustules
developed on his face. On October 12, the patient's right upper
arm
was swollen and erythematous, with a 2-3 cm vaccinial lesion and
exquisitely tender right axillary nodes. He had numerous confluent
facial lesions compatible with vaccinia on both cheeks in areas of
active acne. He also had anterior cervical and submandibular
lymphadenopathy. The patient appeared acutely ill with chills and
a
temperature of 38.7 C (101.7 F). Laboratory studies were
unremarkable. Vaccinia immune globulin (VIG) was obtained from
CDC,
and 25 ml, half the indicated dose, was administered
intramuscularly
that evening. By morning, the patient appeared much improved; he
was
afebrile, and axillary tenderness was markedly decreased. No
additional VIG was given. The patient continued to improve over
the
next 5 days and returned to class on October 18. No secondary
cases
were identified.
Reported by J Sweet, MD, L Bushkell, MD, University of Tennessee
Health Svc, RH Hutcheson, Jr, MD, State Epidemiologist, Tennessee
State Dept of Public Health; Field Svcs Div, Epidemiology Program
Office, CDC.
Editorial Note
Editorial Note: This student probably inoculated vaccinia virus
from
the smallpox vaccination site to the acne on his face. Normal skin
is
rarely infected by vaccinia virus shed from smallpox vaccination.
Abnormal skin such as atopic dermatitis is more susceptible to
infection by inoculation.
Because of concern about the possible use of variola as a
biological weapon, all U.S. military personnel continue to be
routinely vaccinated against smallpox. Active duty military
personnel
and members of the reserves and National Guard are vaccinated on
entry
into service and every 5 years thereafter. Person-to-person spread
of
vaccinia from vaccinated military personnel to civilian contacts
has
been reported in England and Canada (1).
Smallpox vaccination of civilians is recommended only for
laboratory workers exposed to variola or other orthopox viruses
(e.g.
monkeypox, vaccinia) (2). Even so, smallpox vaccine continues to
be
misused in attempts to treat illnesses, particularly herpes (both
"cold sores" and genital herpes). A case of severe vaccinia
necrosum
resulting from an attempt to treat genital herpes was recently
reported from Michigan (3). In November 1982, after three
hospitalizations and 7 months of treatment with a wide variety of
antiviral agents (including VIG, interferon, Marboran,
thiosemicarbazone, thymosin), the Michigan patient still has large,
unhealed, vaccinia-positive ulcers at the vaccination site and on
the
thigh.
CDC. Vaccinia necrosum after smallpox vaccination--Michigan.
MMWR
1982;31:501-2
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