Shaving facilitated serious vaccinia infection in US airman

A recent vaccinia infection in a US Air Force trainee was facilitated by shaving and caused serious facial lesions that required a long hospital stay, according to the August issue of Medical Surveillance Monthly Report, published by the US Armed Forces Health Surveillance Center.

The case was one of two inadvertent vaccinia infections that occurred in June at Joint Base San Antonio–Lackland, Texas, the nation's largest Air Force training base. Vaccinia is the virus used in smallpox vaccine. At the Texas base, the vaccine is given to trainees who will be sent to the Korean Peninsula, the report says.

Smallpox vaccination of US soldiers being sent to the Middle East was required starting in 2002, but that requirement was dropped in May 2014, the report notes.

Progressing symptoms

The first case involved an unvaccinated male security forces student, age 30, who noticed facial bumps after completing training involving hands-on fighting skills. He had shaved the day the first lesion ruptured and the day after that.

After a dermatologic exam, the patient was hospitalized because of concern over vaccinia. He became feverish the day of his admission, and influenza-like symptoms followed, along with increased facial lesions, swelling, and pain. Samples were tested and found positive for non-variola orthopox virus.

Doctors obtained vaccinia immune globulin (VIG) from the Centers for Disease Control and Prevention and administered it on the patient's third hospital day. By the next day his fever resolved, and his lesions subsequently healed as expected, but he remained hospitalized for 23 days.

An epidemiologic investigation showed that 13 members of the patient's 87-member team had received smallpox shots about 2 weeks before the hands-on combat training and that the dressings used to cover the inoculation sites were smaller than usual. It also showed that floor mats used in the training were cleaned regularly but not sanitized.

The authors concluded that the airman probably disseminated vaccinia throughout his beard area by shaving with a blade razor, which probably caused microabrasions. They said contact-transmitted or autoinoculated vaccinia to the beard area has not been reported previously.

Second case

A few days after the first case, an unvaccinated airman on another team in the same squadron presented with an upper-arm lesion that was found to be a vaccinia infection.

The infection occurred at the same site where the man had received a tattoo 5 days earlier, and it appeared that the virus had spread from his roommate, who had been vaccinated 3 weeks earlier. The roommate had not kept his vaccination lesion covered at all times and had mistakenly used the patient's towel.

The authors make various recommendations for preventing vaccinia infections, including using strict hygiene and avoiding hand-to-hand training exercises within 4 weeks after smallpox vaccination. They note that vaccination sites should be kept covered until they have fully healed.

See also:

http://www.afhsc.mil/viewMSMR?file=2014/v21_n08.pdf#Page=01 - August MSMR  with report on vaccinia cases