Smallpox vaccination carries with it well-known risks of adverse events, but problems may also arise from the risk of secondary transmission of the live virus. This review article examines what is known about the potential for nosocomial infection and for spread within families. The author also assesses the implications for vaccination policy.

https://www.nejm.org/doi/pdf/10.1056/NEJMra022500

How contagious is vaccinia

Ocular complications of smallpox vaccination.

KERATOSIS follicularis (Darier's disease) is an unusual, genetically determined skin disease characterized by a papular, verrucous and crusting eruption. The etiology is unknown, though the familial tendency is well documented. Viral and metabolic origins have been postulated, but these have not been substantiated.1 In this relation it is interesting that exposure to sunlight and ultraviolet light has long been recognized as capable of producing typical lesions in the susceptible person (Koebner phenomenon). Finally, the evidence that keratosis follicularis may actually be a neoplastic process has been summarized elsewhere.2 Patients with keratosis follicularis are subject to various complications, some of which . . .

Eczema vaccinatum as a complication of keratosis follicularis.

Since 11 September 2001, fears of further terrorist attacks have occupied the thoughts of many Americans. One form such an attack could take is a biological agent unleashed upon the population, with the smallpox virus being one of the more frightening possibilities. As a result of this threat, there has increasingly been talk of widespread vaccination against smallpox, despite many concerns that the vaccine may pose as much of a problem as the virus. This article looks at the effects of the vaccine on patients with skin conditions such as eczema and psoriasis, as well as on those on immunosuppressive drugs and with immune system disorders like AIDS, in attempt to provide recommendations aimed at maximizing the effectiveness of smallpox vaccine by minimizing the dangers. Debate on smallpox vaccination is particularly problematic because the risks and benefits are not entirely clear. Smallpox was eradicated from the natural environment over two decades ago and the only currently known stocks of the virus are stored by government agencies in the USA and Russia. As a result of this remarkable achievement, vaccination against smallpox ended in the 1970s, and even those who received the vaccine as children no longer have immunity to the virus. During the Cold War, however, the Soviets weaponized the smallpox virus in massive quantities, and there are fears that the virus may have made its way into the hands of terrorists who could use it against civilian populations. 1,2

Complications of the smallpox vaccine.

Ein von Kaposi und nachher von Juliusberg beschriebenes Krankheitsbild findet sich im Schrifttum unter verschiedenen Bezeichnungen. In England und Amerika (USA) wird es gewohnlich „Kaposis varicelliforme Eruption“ genannt, in Deutschland neuestens „Eczema herpeticatum“. Am kennzeichnendsten ware der Ausdruck „Eczema herpetiformeKaposi”, denn er berucksichtigt historische Tatsachen, tragt der Morphologie des Krankheitsbildes und seiner Atiologie weitgehend Rechnung. Die Krankheit ist die Sekundarinfektion einer erkrankten Haut mit dem Herpesvirus, ihr Bild kann einer varioliformen Pyodermie oder haufiger einem Eczema vaccinatum ahnlich sehen, ist aber von diesem klinisch meist einwandfrei zu unterscheiden. Insgesamt sind in der Weltliteratur ungefahr 180 derartige Beobachtungen verzeichnet; die hier beschriebenen 13 Erkrankungen traten ausschlieslich in den Winter- und Ubergangsmonaten auf.

[Kaposi's varicelliforme eruption, eczema herpetiforme].

T H E purpose of this paper is to describe a group of cases of Kaposi 's varicellifonii eruption (K.V.E.) which appeared at the time of Avidespread vaccination occasioned by the preseuce of smallpox iu GlasgOAv. They are recorded for their pictorial value, for the laboratory fiudiugs, and for the appareut effect ou some of them of aureomycin. Notes are added on the mode of infection, ou the grades of severity and ou the occurrence of dermatitis gangrenosa infautum as a complication of one case. Of the ten patients observed, four were unrelated, two were members of the same household, and four were infected while iu hospital for t rea tment of a pre-existiug skin condition. All had suffered from pre\\aous skiu damage, aud all but one were unvacciuated, but had had contact Avith recently vaccinated persons. The exception had been vaccinated about a Aveek before his illness. All showed the clinical picture described by McLachlau and Gillespie (1936) of a grouped pustular eruption situated ou an erysipeloid base. Vaccinia virus was recovered in four cases.

Kaposi's varicelliform eruption: recoed of an outbreak.

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Kaposi's varicelliform eruption: recoed of an outbreak.