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Smallpox vaccine: tertiary contact vaccinia possible in breast-fed babies.

Breast-fed infants living in close contact with smallpox vaccinees are at risk for contact vaccinia, even if the vaccinee is not the breast-feeding mother, according to a case report.

Physicians at the Madigan Army Medical Center in Tacoma, Wash., have reported the first documented case of inadvertent contact vaccinia transmission from mother to infant through direct skin-to-skin and skin-to-mucous membrane contact while breast-feeding. In this case, the infant's mother had not been vaccinated for smallpox but her husband received the vaccine before the baby developed symptoms (JAMA 291[6]:725-27, 2004).

Approximately 10 days after the father was inoculated, the mother developed blisters on her nipples. Shortly thereafter, the baby developed a blister on the upper lip. Positive polymerase chain reaction and culture for vaccinia of both the maternal and infant lesions confirmed contact vaccinia, said Dr. Vinaya Garde and associates.

Because of the timing of lesion onset and the plausible route of spread involving infant contact with the maternal breast, the contact vaccinia in the infant likely occurred after secondary transmission from the husband to his wife, although the mechanism of transfer is uncertain.

"Although the vaccinee's wife denied any direct contact of her breasts with the dressing site, this possibility cannot be completely excluded. Another possibility is that she failed to wash her hands between handling the laundry and initiating breast-feeding," they wrote.

Current guidelines from the Centers for Disease Control and Prevention recommend that breast-feeding mothers do not receive smallpox vaccination because of potential transmission. However, there is no recommendation against vaccination of other family members when there is a breast-feeding infant in the home. In fact, the CDC smallpox fact sheet states that it is safe for a woman to breast-feed her baby if a close contact received smallpox vaccine, provided that the vaccinee follows the standard procedures for hand washing and site protection.

Dr. Garde and colleagues advised that the CDC revise its guidelines by including a recommendation that vaccine recipients handle their own laundry and not sleep in the same bed as a breast-feeding mother, and that breast-feeding mothers in a household with someone who has been vaccinated be reminded to wash their hands before breast-feeding.

Additionally, "clinicians should be alert to the possibility of contact vaccinia in any family member of a smallpox vaccine recipient presenting with a pustular or vesicular rash, and breast-feeding women living with vaccine recipients should be educated about the appearance of contact vaccinia lesions." Nursing mothers should be told to stop breast-feeding if they develop any skin lesions until the lesions can be evaluated, the authors advised.


New England Bureau
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Title Annotation:Obstetrics
Author:Mahoney, Diana
Publication:OB GYN News
Date:Mar 15, 2004
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