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

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 ...