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1 September 2005

Volume 41, Number 5
Clinical Infectious Diseases 2005;41:689–697
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4105-0017$15.00
DOI: 10.1086/432584
CONFRONTING BIOLOGICAL WEAPONS INVITED ARTICLE

Generalized Vaccinia, Progressive Vaccinia, and Eczema Vaccinatum Are Rare following Smallpox (Vaccinia) Vaccination: United States Surveillance, 2003

Claudia Vellozzi,1,3

J. Michael Lane,a

Francisco Averhoff,1

Toby Maurer,4

Scott Norton,5

Inger Damon,2 and

Christine Casey1

1National Immunization Program and 2Poxvirus Program, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 3Logistics Health Incorporated, La Crosse, Wisconsin; 4Department of Dermatology, University of California, San Francisco; and 5Walter Reed Army Medical Center, Washington, D.C.

Generalized vaccinia (GV), progressive vaccinia (PV), and eczema vaccinatum (EV) are adverse reactions following smallpox vaccination. We investigated all reports suggestive of GV, PV, or EV among United States civilian smallpox vaccinees during 2003 and applied standard case definitions. We identified 29 reports of possible GV among 38,440 vaccinees; 2 (7%) of the reports met the case definition. One case of GV was confirmed by identifying vaccinia from a lesion distant from the vaccine site using polymerase chain reaction. The other case was classified as probable GV, because confirmatory testing was not done. We identified 3 potential EV cases and 7 potential PV cases, none of which met the standard case definition. GV, PV, and EV were rare or absent following smallpox vaccination after careful screening of potential vaccinees. GV may be difficult to distinguish from other rashes, and confirmatory testing is recommended. Careful prevaccination screening probably contributed to the low incidence of these adverse reactions following smallpox vaccination.

Received 1 April 2005; accepted 2 May 2005; electronically published 26 July 2005.

Reprints or correspondence: Dr. Claudia Vellozzi, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E‐61, Atlanta, GA 30333 ().

Donald A. Henderson, Thomas V. Inglesby, Jr., and Tara O'Toole, Section Editors

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  • Former Director, Smallpox Eradication Program, Centers for Disease Control and Prevention, Atlanta, Georgia.

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