Eczema Vaccinatum

Viral infections in atopic dermatitis Pathogenic aspects and clinical management

“…Because AD is a contraindication to smallpox vaccination, EV is more frequently caused from accidental contact with vaccinated individuals (65%) than from vaccination. 16 In the past, the incidence of EV in the United States was 123 per million primary vaccines, with case fatality rates of approximately 1% to 5%. 17,18 Recent data from a cohort of Israel Defense Force recruits showed an overall complication rate of 40 per million vaccinees, with a low rate of severe complications similar to previously published data.…”

“…19 Seemingly contradictory are published data suggesting that two thirds of patients with EV did not have active atopic disease at the time of their vaccinia virus exposure. 16 If variola virus is released as a biologic weapon, ring vaccination of first and second contacts with vaccinia virus will certainly produce some cases of EV. 20 The main differential diagnostic consideration is smallpox infection, which might be suspected from the centripetal and less dense distribution pattern of the lesions, which show a clear predilection for wrists and face.…”

Orthopoxviruses: Variola, Vaccinia, Cowpox, and Monkeypox

“…Underlying defects in the immune system of atopic individual's skin render them particularly vulnerable to infection with vaccinia virus and subsequent local spread or wider dissemination [ 102 , 103 ]. This susceptibility persists even in the absence of active disease as one case series found that two thirds of eczema vaccinatum patients had no active or obvious eczema at the time of vaccination [ 104 ]. Eczema vaccinatum occurred at a rate of 10-39 cases per million primary smallpox vaccinations and 1-3 cases per million smallpox revaccinations in the United States during 1968 [ 70 , 71 ].…”

Human Antibody Responses to the Polyclonal Dryvax Vaccine for Smallpox Prevention Can Be Distinguished from Responses to the Monoclonal Replacement Vaccine ACAM2000

“…The Dryvax product consists of a heterogeneous pool of VACV clones that could potentially become contaminated by bovine pathogens or other adventitious material during processing, as well as having an increased risk for selection of more-virulent strains of VACV (5)(6)(7)(8)(9). Dryvax vaccination has significant limitations, including risks to pregnant and immunocompromised individuals, serious and occasional lethal adverse events such as myopericarditis, and the potential for transmission of VACV to others who are at risk for adverse events (5,(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Further, there is significant variability in human antibody responses to traditional polyclonal VACV vaccines (21-23).…”