Adverse reactions to vaccinia vaccination range from mild and self-limited to severe and life-threatening, including inoculation site signs and symptoms, constitutional symptoms,
generalized vaccinia, eczema vaccinatum, and progressive vaccinia (1,3).
Early diagnosis is essential for differentiating cowpox from illnesses and skin reactions with similar signs and symptoms, such as smallpox, monkeypox,
generalized vaccinia virus infection, disseminated herpes zoster and herpes simplex virus infections, drug-associated eruptions, erythema multiforme, enterovirus infections, secondary syphilis, scabies, insect bites, impetigo, and molluscum contagiosum.
Some other well-documented complications of smallpox vaccination that date back to the era of routine smallpox vaccination include
generalized vaccinia, eczema vaccinatum, postvaccinial encephalitis, inadvertent inoculation, fetal vaccinia, and death.
An immunoglobulin containing antivaccinia antibody for the treatment and/or modification of serious complications of smallpox vaccination, including eczema vaccinatum, progressive vaccinia, severe
generalized vaccinia, and vaccinia infections in people who have skin conditions, such as burns, impetigo, or varicella zoster.
"Folliculitis following smallpox vaccination appears distinct from earlier descriptions of
generalized vaccinia," Dr.
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Generalized vaccinia. Vesicles or pustules may appear on normal skin distant from the vaccination site, usually 6-9 days after vaccination, and often be accompanied by fever, headache, and myalgia.
Other common adverse reactions likely to result in either ambulatory visits or time lost from work or school include a robust primary reaction (4% to 18%);
generalized vaccinia (240 out of 1 million primary vaccinations) with vesicles/pustules distant from vaccine site and mild systemic illness; inadvertent inoculation to other places on the body (529 out of 1 million); eczema vaccinia (1 out of 25,000) generally occurring among persons with a history of eczema; progressive vaccinia (1 out of 600,000) seen among persons with impaired T-cell function with necrosis at the vaccine site, with severe and potentially fatal systemic illness.