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Tertiary contact vaccinia in a breast-fed baby.

Breast-fed infants living in close contact with small-pox 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, Dr. Vinaya Garde and associates said (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, the investigators and associates reported.

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 probably occurred after secondary transmission from the husband to his wife, although the mechanism of transfer is uncertain, Dr. Garde and associates reported.

"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 to include 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 living in a household with someone who has been vaccinated be reminded to wash their hands before breast-feeding.

In addition, "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" and told to stop breast-feeding if they develop any skin lesions and wait until the lesions can be evaluated, the authors advised.

BY DIANA MAHONEY

New England Bureau
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Title Annotation:Case Report
Author:Mahoney, Diana
Publication:Internal Medicine News
Geographic Code:1USA
Date:Mar 15, 2004
Words:446
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