Soldier's smallpox inoculation sickens son.

A 2-year-old boy spent seven weeks in the hospital and nearly died from a viral infection he got from the smallpox vaccination his father received before shipping out to Iraq, according to a government report and the doctors who treated him, "The New York Times" reported May 18.

The boy, who lives in Indiana and has recovered, became ill in early March, two weeks after his father's deployment was delayed and he was allowed to make a trip home. Over the next few weeks, the boy suffered kidney failure and lost most of his skin to the disease eczema vaccinatum.

Experts said the father, who had eczema in childhood, should never have been given the vaccine because that fact made him more susceptible to side effects like vaccinia infection. They also said military doctors should have been doubly cautious because the son, too, suffered from eczema and would have been highly susceptible to infection. Military procedures call for asking about such conditions in soldiers and their families.

Although smallpox was eradicated in 1979, and inoculation of military personnel was suspended in 1990, vaccinations ensued after the terrorist attacks of Sept. 11, 2001, and subsequent cases of anthrax sent through the mail. About 1.2 million troops and health care workers have been vaccinated as of March, the Times reported.

Since then, a handful of vaccinia cases have been reported to the Centers for Disease Control, including one, described in the May 4 "Morbidity and Mortality Weekly Report," of vulvar infection in an Alaskan woman whose sex partner was a serviceman.

According to a report of the 2-year-old's case in the CDC publication, the boy was taken to the University of Chicago Corner Children's Hospital on March 3. The doctors gave the boy narcotics to render him unconscious and free of pain. They also inserted a breathing tube and put him on mechanical ventilation to counter the breathing problems that can come with heavy doses of narcotics.

Doctors worked with the disease control centers to get shipments of Vaccinia Immune Globulin Intravenous. They also used an antiviral drug, Cidofovir. That drug, which has been associated with kidney problems in some cases, may have caused another crisis in which the boy's kidneys began failing and his abdomen filled with fluid.

The doctors worked with FDA to allow the use of an experimental drug for smallpox, ST-246, from Siga Technologies, which appeared to begin turning the case around.

Meanwhile, doctors drained the boy's distended abdomen and cut away the dead skin, a process called debridement that is commonly used in burn victims. They put skin from cadavers over his exposed flesh to promote healing underneath and dressed the wounds.

The child's mother also developed lesions on her face and index finger. She has recovered, but because of her infection, she had to be confined to his room and witnessed every procedure performed on her child. The military brought the father back from Iraq after the boy became ill.

The procedures for smallpox vaccination were hammered out through long discussion to prevent those who were particularly susceptible to the side effects from receiving it, said William Schaffner, M.D., who served on the CDC Advisory Committee on Immunization Practices.

The case, Schaffner said, raises the question of "whether the stringent procedures that were initially put in place have eroded somewhat."

In an editorial accompanying the report, the authors said that the military was studying the incident, "which will determine whether screening and education practices need to be modified."