Randomized Trial Comparing Vaccinia on the External Surfaces of 3 Conventional Bandages Applied to Smallpox Vaccination Sites in Primary Vaccinees

Abstract

At 7 days after smallpox vaccination, a peak time for vaccinia shedding, a self-adhesive bandage was as effective as 2 bulkier, less convenient bandages in limiting PCR-detectable virus on the external surface.

Optimal Bandaging of Smallpox Vaccination Sites to Decrease the Potential for Secondary Vaccinia Transmission Without Impairing Lesion Healing

“…Although the volunteers with gauze and a semipermeable dressing reported significantly less discomfort and had a lower percentage of specimens positive for vaccinia by PCR, the results did not significantly differ from those for the other types of bandage. 7 The present study, in contrast, provides a more detailed comparison of different types of smallpox vaccination site bandages. This study followed up more individuals, stratified study participants by prior vaccination status, and obtained specimens throughout lesion development and healing.…”

“…6 Few investigations have specifically examined retrieval of vaccinia from the surface of vaccination site bandages (Table 2). 4,7,[11][12][13] Before recent vaccination campaigns, studies conducted with recombinant human immunodeficiency virus vaccines in the late 1980s provided the best data on the infectivity of vaccination lesions and the protection provided by standard site dressings. In one such trial in which the vaccination site was covered with gauze and an occlusive bandage, vaccinia was not recovered from the outer bandage surfaces, and no household or sexual contacts developed clinical or serologic evidence of vaccinia exposure.…”

“…7 One week (range, 6-8 days) after vaccination, 63 vaccinia-naive volunteers were randomized to receive 1 of 3 types of bandages: a self-adhesive bandage, a gauze bandage, or gauze covered by a semipermeable bandage. After 8 hours of routine daily activity, specimens from the outer bandage and the vaccination lesion were obtained for vaccinia culture and PCR testing.…”

“…5,6 Studies that compared different bandages with respect to the risk of transmission of vaccinia and their impact on lesion healing are limited, and, to our knowledge, only one randomized study that examined different vaccination site bandages has been published to date. 7 However, this prior study only examined the degree of viral shedding outside the bandage for vaccinia-naive individuals and at only one time point after vaccination. The purpose of the present study was to directly compare 3 different types of vaccination site bandages over time among both vaccinia-naive and vaccinia-experienced volunteers with respect to recovery of vaccinia, reactogenicity, tolerability, and ease of use.…”

Lack of Transmission of Vaccinia Virus

“…Talbot et al observed that <1% (N = 918) of dressing samples were positive for vaccinia (an initial semipermeable OpSite Post-Op dressing and an outer semipermeable Tegaderm bandage) ( 5 ). In a single-blind randomized trial design, Waibel et al compared the presence of vaccinia virus on the external surface of 3 different types of bandages and noted that the semipermeable membrane with gauze had the smallest proportion of recoverable virus compared with the groups that used a Band-Aid or double gauze with adherent tape ( 6 ). Despite the difference in types of bandages from these studies, the results were remarkably consistent with regard to the limited dissemination of vaccinia virus outside the dressing.…”