Analysis of cases reported as generalized vaccinia during the US military smallpox vaccination program, December 2002 to December 2004 - 09/08/11

Doi : 10.1016/j.jaad.2006.04.017

Felisa S. Lewis, MD ^a,^⁎ , Scott A. Norton, MD, MPH ^a, R. Dana Bradshaw, MD, MPH ^b, Joyce Lapa, MD, MPH ^c, John D. Grabenstein, RPh, PhD ^d
^a From the Dermatology Service, Walter Reed Army Medical Center, Washington
^b Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda
^c Naval Medical Research Center, Silver Spring
^d Military Vaccine Agency, US Army Medical Command, Falls Church

Correspondence to: Felisa S. Lewis, MD, 231 Little Quarry Rd, Gaithersburg, MD 20878.

Washington, District of Columbia; Bethesda and Silver Spring, Maryland; and Falls Church, Virginia

Abstract

Background

We evaluated military personnel who developed dermatologic reactions suggestive of generalized vaccinia (GV) after smallpox vaccination.

Methods

We conducted surveillance and retrospective analysis of cases from the Vaccine Adverse Event Reporting System (a passive reporting system managed by the Centers for Disease Control and Prevention), and the military’s preventive medicine channels, vaccine healthcare centers, clinical laboratory network, dermatology clinics, and pathology departments from December 2002 to December 2004.

Results

Of 74 cases investigated in 753,226 vaccinations, 50 (67.6%) met the case definition of possible GV (rate 66/million), 95% confidence interval (49-88/million), consistent with historically reported rates. Cases of possible GV occurred more frequently in primary vaccinees (81/million) than in those revaccinated (32/million) (relative risk 2.6, 95% confidence interval 1.2-5.9, P = .013). None met the case definition of probable or confirmed GV, including 15 with virologically negative laboratory evaluations (eg, culture, skin biopsy, or polymerase chain reaction).

Limitations

The methods of case collection and retrospective nature of this study are its limitations. The clinical diagnosis of possible GV was made on the basis of the authors’ interpretation of clinical notes and adverse events submitted by more than 100 different providers. Only 15 of the 74 cases of possible GV had laboratory attempts for virological confirmation.

Conclusion

GV is still a rarely reported complication of smallpox vaccination. True GV, strictly defined, may be even less common than previously reported. We named one self-limited dermatologic manifestation confused with GV “postvaccinial nonviral pustulosis.” Properly screened individuals considering smallpox vaccination may be assured most exanthemata after vaccination are benign.

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Abbreviations used : CDC, DoD, EV, GV, PCR, PV, VAERS, VIG

Plan

Methods

Results

Discussion

Significance of our findings

Funding sources: None.
Conflicts of interest: None identified.
The opinions contained herein are the private views of the authors and are not to be construed as reflecting the views of the US Army, US Navy, US Air Force, or the US Department of Defense.
Reprints not available from the authors.