Smallpox inadvertent inoculation

Fig. 2.8 (See color plate) Eyelid vaccinia due to inadvertent inoculation. From Kempe, H. Smallpox vaccination adverse reaction. CDC Smallpox. http //www.bt.cdc.gov/training/smaUpoxvaccine/ reactions/adverse.html...

Inadvertent inoculation, the most frequent complication of smallpox vaccination, refers to the transmission of the vaccinia virus from the inoculation site to another part of the recipient s body (autoinoculation) or to the bodies of close contacts (Fig. 2.8 see color plate 2.8). It can occur because live vaccinia virus is present at the inoculation site from about 4 days after inoculation until the crust separates from the skin. Maximum viral shedding occurs 4-14 days after inoculation. Inadvertent inoculation is responsible for approximately half of all complications for primary vaccination and revaccination. Because inadvertent inoculation frequently results from touching the vaccination site and transmitting the virus manually, the most common affected sites are the face, eyelid, nose, mouth, genitalia, and rectum. Most cases heal without any specific treatment. Inadvertent inoculation of the eye can lead to comeal scarring and subsequent vision loss. Occasionally, vaccinia immune globulin (VIG) is necessary to treat periocular lesions (26). 

During the waning years of routine smallpox vaccination, in 1968, studies estimated the rate of inadvertent inoculation at 529 cases per million primary vaccinations. More recently, from January 24, 2003 to December 31, 2003, 39,213 civilian... 

The recommendations state that hospitals should vaccinate enough staff in each category to ensure continuity of care (32). Health care workers performing the vaccinations should first receive the vaccine to minimize the consequences of inadvertent inoculation. Laboratory workers are not included in the recommendations because the quantity of smallpox virus likely to be present in clinical specimens is low. 

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