Smallpox: What the Dermatologist Should Know

Phyllis I. Spuls, MD; Jan D. Bos, MD, PhD; Donald Rudikoff, MD


Skinmed. 2004;3(4) 

In This Article

Complications of Vaccination

Vaccination uses live viruses and causes a number of complications.[38,39] According to the CDC, 15 of every 1 million first-time vaccinees may suffer life-threatening reactions including encephalitis, generalized vaccinia, and eczema vaccinatum. For every 1 million people vaccinated, 39 would develop severe eczema vaccinatum, 12 subjects would develop encephalitis, and one would die.

Dryvax vaccine comes in a vial with a rubber stopper, so persons administering or receiving the vaccine who are latex sensitive may potentially develop an allergic reaction. Dryvax should also not be used in persons sensitive to any component of the vaccine, including polymyxin B sulfate, dihydrostreptomycin sulfate, chlortetracycline hydrochloride, and neomycin sulfate. The presence of inflammatory eye disease requiring topical corticosteroid treatment increases the risk of ocular vaccinia as a result of rubbing or touching the eye. In such persons, vaccination should be delayed until the eye condition has completely resolved and corticosteroid therapy is discontinued.

Screening for risk factors like atopic dermatitis, pregnancy, or compromised immunity is mandatory. Vaccination during pregnancy can cause fetal vaccinia. Severe complications can occur in individuals with congenital or acquired immune deficiencies, people with active or quiescent atopic dermatitis or a history of eczema, patients infected with human immunodeficiency virus, organ transplant recipients, and patients who are receiving chemotherapy. In the event of an actual credible smallpox exposure, the danger of overwhelming variola infection outweighs these contraindications.

According to the CDC, during the period January 24-April 18, 2003, 33,444 civilian health care and public health workers received the smallpox vaccine.[40]Ten patients developed myopericarditis and six experienced myocardial infarction. Two cases of ocular vaccinia were reported in contacts of vaccinees as were two cases of nonocular inadvertent inoculation. Of 369 vaccinees who reported nonserious adverse effects, there were 78 instances of fever, 11 instances of pruritus, 69 rashes, and 56 cases of localized pain.

There have been two deaths among military personnel from cardiac-related events.[41] Of these, a 22-year-old female reservist was later determined to have had lupus. She received anthrax and smallpox vaccination.[42] The other, a 55-year-old National Guard member, had underlying coronary artery disease.[43] There were 36 cases of generalized vaccinia.[44] Just under two thirds of military vaccinees are receiving the vaccine for the first time.


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