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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