Individuals with eczema
(more correctly termed atopic dermatitis) are at special risk
from implantation of vaccinia virus into the diseased skin,
sometimes with a fatal outcome. Atopic dermatitis implies both
a skin abnormality and an immunologic difference, ill defined,
in individuals subject to this disease.
If smallpox is an immediate risk, vaccination should not
be performed in these patients and they should not be in contact
with vaccinees. If there is smallpox in the community with
potential exposure, or if the patient is a household contact
of a case, then vaccination must be performed.
Transfer of vaccinia virus can occur from autoinoculation
or from contact with a vaccinee whose lesion is in the florid
stages. With early recognition and appropriate use of Vaccinia
Immune Globulin (VIG), mortality can be reduced to zero, and
morbidity alleviated.
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