Am Fam Physician. 2005 Jun 15;71(12):online.
to the editor: A 23-year-old active-duty Marine woman presented to an outpatient military clinic in Okinawa, Japan for sexually transmitted disease screening after developing painful vesicular lesions of the labia and vagina. The patient was initially diagnosed with a primary genital herpes outbreak. Viral culture was collected, and the preliminary isolate suggested herpes simplex. The culture was sent to a reference laboratory in Tokyo, Japan, for final identification that revealed vaccinia, the live virus used in the smallpox vaccine. The patient's medical record revealed that she had not received the smallpox vaccine.
Upon further questioning, it was discovered that the patient's sexual partner, also an active-duty Marine, had received the smallpox vaccination (in preparation for deployment to Iraq) approximately seven days before sexual contact with the patient. Four days after this exposure, the patient presented to the clinic with vaginal vaccinia, suggesting inadvertent inoculation.
The smallpox vaccine available in the United States and used by the U.S. military is a live virus preparation of vaccinia virus, a pox-type virus. The vaccine does not contain actual smallpox virus (variola).
Approximately four days after vaccination, an extremely itchy lesion develops at the vaccination site that contains high titers of vaccinia virus, which can be easily transferred to other body sites (autoinoculation) or other persons (inadvertent inoculation) through scratching and negligent hygiene. Transfer of vaccinia virus from the primary site to other body parts or other persons is the most common complication of smallpox vaccination, and is estimated by the Centers for Disease Control and Prevention to occur in 529 persons per 1 million primary vaccinees.1
As biologic warfare continues to be a threat, many people (military, first-responders) will continue to receive the smallpox vaccination. Patients presenting to their family physician with unusual vesicular rashes should be evaluated for exposure to the smallpox vaccine.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Navy Medical Department or the U.S. Navy Service at large.
1. Centers for Disease Control and Prevention. Emergency preparedness and response. Smallpox. Accessed online April 25, 2005, at: http://www.cdc.gov/smallpox.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2005 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions