Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T21:32:10.975Z Has data issue: false hasContentIssue false
  • English
  • Français

Optimal Bandaging of Smallpox Vaccination Sites to Decrease the Potential for Secondary Vaccinia Transmission Without Impairing Lesion Healing

Published online by Cambridge University Press:  21 June 2016

Thomas R. Talbot ,
Jody Peters ,
Lihan Yan ,
Peter F. Wright  and
Kathryn M. Edwards
Thomas R. Talbot*
Affiliation:
Divisions of Infectious Diseases, Departments of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
Jody Peters
Affiliation:
Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
Lihan Yan
Affiliation:
EMMES Corporation, Rockville, Maryland
Peter F. Wright
Affiliation:
Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
Kathryn M. Edwards
Affiliation:
Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee Pediatric Clinical Research Office, Vanderbilt University School of Medicine, Nashville, Tennessee
*
A-2200 Medical Center North, 1161 21 st Avenue South, Vanderbilt University Medical Center, Nashville, TN 37232 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To assess the optimal method for covering smallpox vaccination sites to prevent transmission of vaccinia.

Design.

Randomized, nonblinded clinical trial.

Setting.

Tertiary care medical center.

Participants.

Vaccinia-naive and vaccinia-experienced volunteers.

Interventions.

After vaccination, study participants were randomized to receive 1 of 3 types of bandage: gauze, occlusive with gauze lining, or foam. Vaccination sites were assessed every 3 to 5 days until the lesion healed. During each visit, specimens were obtained from the vaccination site, the bandage surface before removal, and the index finger contralateral to the vaccination site and were cultured for vaccinia. Time to lesion healing was assessed.

Results.

All 48 vaccinia-naive and 47 (87%) of 54 vaccinia-experienced participants developed a vesicle or pustule at the injection site 6-11 days after vaccination. Fourteen (14%) of 102 participants had bandage cultures positive for vaccinia. All but 1 of these vaccinia-positive cultures were of a bandage from participants randomized to the gauze bandage group, and all but 3 were of bandages from vaccinia-naive participants. No finger-specimen cultures were positive for vaccinia. One episode of neck autoinoculation occurred in a vaccinia-naive individual who had vaccinia recovered from his gauze bandage on multiple visits. The foam bandage was associated with more local adverse effects (skin irritation and induration). The time to healing did not differ among the bandage groups.

Conclusions.

The potential for transmission of vaccinia from a vaccination site is greater if the site is covered by gauze than if it is covered by occlusive or foam bandages. Use of an occlusive bandage with a gauze lining is the best choice for coverage of smallpox vaccination sites because of a reduced potential for vaccinia transmission and a lower reactogenicity rate. Bandage choice did not affect vaccination lesion healing.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1184 - 1192
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wharton, M, Strikas, RA, Harpaz, R, et al. Recommendations for using smallpox vaccine in a pre-event vaccination program: supplemental recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003; 52:1–16.Google Scholar
2. Sepkowitz, KA. How contagious is vaccinia? N Engl J Med 2003; 348:439–446.Google Scholar
3. Centers for Disease Control and Prevention. Smallpox vaccine: vaccination site care and precautions for recipients. Available at http://www.bt.cdc.gov/agent/smallpox/vaccination/vaccination-program-qa.asp?tvpe=cat&cat=Smallpox+Vaccine&subCat =Vaccination+Site+Care+and+Precautions+for+Recipients. Accessed November 17, 2005.Google Scholar
4. Talbot, TR, Ziel, E, Doersam, JK, LaFleur, B, Tollefson, S, Edwards, KM. Risk of vaccinia transfer to the hands of vaccinated persons after smallpox immunization. Clin Infect Dis 2004; 38:536–541.Google Scholar
5. Lane, JM, Fulginiti, VA. Transmission of vaccinia virus and rationale for measures for prevention. Clin Infect Dis 2003; 37:281–284.CrossRefGoogle ScholarPubMed
6. Cono, J, Casey, CG, Bell, DM. Smallpox vaccination and adverse reactions: guidance for clinicians. MMWR Recomm Rep 2003; 52:1–28.Google Scholar
7. Waibel, KH, Ager, EP, Topolski, RL, Walsh, DS. Randomized trial comparing vaccinia on the external surfaces of 3 conventional bandages applied to smallpox vaccination sites in primary vaccinees. Clin Infect Dis 2004; 39:1004–1007.Google Scholar
8. Talbot, TR, Stapleton, JT, Brady, RC, et al. Vaccination success rate and reaction profile with diluted and undiluted smallpox vaccine: a randomized controlled trial. JAMA 2004; 292:1205–1212.Google Scholar
9. National Cholesterol Education Program. Risk assessment tool for estimating your 10-year risk of having a heart attack. Available at http://hm.nhlbi.nih.gov/atpiii/calculator.asp?usertype=pub. Accessed July 5, 2004.Google Scholar
10. Henderson, DA, Inglesby, TV, Bartlett, JG, et al; Working Group on Civilian Biodefense. Smallpox as a biological weapon: medical and public health management. JAMA 1999;281:2127–2137.CrossRefGoogle ScholarPubMed
11. Graham, BS, Belshe, RB, Clements, ML, et al. Vaccination of vaccinia-naive adults with human immunodeficiency virus type 1 gp 160 recombinant vaccinia virus in a blinded, controlled, randomized clinical trial: The AIDS Vaccine Clinical Trials Network. J Infect Dis 1992; 166:244–252.Google Scholar
12. Hepburn, MJ, Dooley, DP, Murray, CK, et al. Frequency of vaccinia virus isolation on semipermeable versus nonocclusive dressings covering smallpox vaccination sites in hospital personnel. Am J Infect Control 2004; 32:126–130.Google Scholar
13. Cooney, EL, Collier, AC, Greenberg, PD, et al. Safety of and immunological response to a recombinant vaccinia virus vaccine expressing HIV envelope glycoprotein. Lancet 1991; 337:567–572.CrossRefGoogle ScholarPubMed
14. Regules, JA, Dooley, DP, Hepburn, MJ, et al. The effect of semipermeable dressings on smallpox vaccine site evolution. Am J Infect Control 2004; 32:333–336.Google Scholar