December 24, 1982 / 31(50);682-683
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: 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.