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Focal and generalized folliculitis following smallpox vaccination among vaccinia-naive recipients.
JAMA. 2003 Jun 25; 289(24):3290-4.JAMA

Abstract

CONTEXT

With the reintroduction of smallpox vaccination, detailed contemporary descriptions of adverse reactions to the vaccine are needed to adequately inform the public and clinicians. During a multicenter, randomized controlled trial investigating the efficacy of various dilutions of smallpox vaccine, we observed the appearance of a papulovesicular eruption (focal and generalized) in study volunteers.

OBJECTIVE

To characterize the papulovesicular eruptions by clinical, virologic, and histopathological characteristics.

DESIGN, SETTING, AND PARTICIPANTS

Prospective case series of papulovesicular eruptions following smallpox vaccination in healthy, vaccinia-naive adult participants compared with noncases conducted from October 2002 to March 2003. Variables potentially related to these eruptions were collected retrospectively through chart review. Eruptions were described based on viral culture, clinical examination, and histopathological evaluation (1 biopsy specimen from 1 case).

MAIN OUTCOME MEASURE

Cases of papulovesicular eruptions following vaccination.

RESULTS

During the trial, of 148 volunteers (56% women; mean age 23.6 years), 4 participants (2.7%) developed generalized eruptions and 11 (7.4%) noted focal eruptions. Viral cultures of sample lesions were negative for vaccinia. The result of a skin biopsy sample from 1 case of generalized rash revealed suppurative folliculitis without evidence of viral infection. All lesions resolved without scarring. In the cohort, cases and noncases did not show significant differences in terms of sex, in the use of nonsteroidal anti-inflammatory drugs or oral or depo contraceptives, in medication allergies, in the incidence of fever or lymphadenopathy after vaccination, or in the dilution of vaccine received.

CONCLUSIONS

Folliculitis is a common and benign eruption observed in vaccinia-naive adult volunteers following smallpox vaccination. This eruption may be seen in volunteers receiving the vaccine in the newly instituted vaccination programs and may be met with heightened anxiety, potentially being confused with generalized vaccinia. This description of folliculitis using clinical, virologic, and histopathological findings should allay these concerns and provide additional insight into this eruption.

Authors+Show Affiliations

Department of Medicine, Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA. tom.talbot@vanderbilt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12824211

Citation

Talbot, Thomas R., et al. "Focal and Generalized Folliculitis Following Smallpox Vaccination Among Vaccinia-naive Recipients." JAMA, vol. 289, no. 24, 2003, pp. 3290-4.
Talbot TR, Bredenberg HK, Smith M, et al. Focal and generalized folliculitis following smallpox vaccination among vaccinia-naive recipients. JAMA. 2003;289(24):3290-4.
Talbot, T. R., Bredenberg, H. K., Smith, M., LaFleur, B. J., Boyd, A., & Edwards, K. M. (2003). Focal and generalized folliculitis following smallpox vaccination among vaccinia-naive recipients. JAMA, 289(24), 3290-4.
Talbot TR, et al. Focal and Generalized Folliculitis Following Smallpox Vaccination Among Vaccinia-naive Recipients. JAMA. 2003 Jun 25;289(24):3290-4. PubMed PMID: 12824211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Focal and generalized folliculitis following smallpox vaccination among vaccinia-naive recipients. AU - Talbot,Thomas R, AU - Bredenberg,H Keipp, AU - Smith,Michael, AU - LaFleur,Bonnie J, AU - Boyd,Alan, AU - Edwards,Kathryn M, PY - 2003/6/26/pubmed PY - 2003/7/9/medline PY - 2003/6/26/entrez SP - 3290 EP - 4 JF - JAMA JO - JAMA VL - 289 IS - 24 N2 - CONTEXT: With the reintroduction of smallpox vaccination, detailed contemporary descriptions of adverse reactions to the vaccine are needed to adequately inform the public and clinicians. During a multicenter, randomized controlled trial investigating the efficacy of various dilutions of smallpox vaccine, we observed the appearance of a papulovesicular eruption (focal and generalized) in study volunteers. OBJECTIVE: To characterize the papulovesicular eruptions by clinical, virologic, and histopathological characteristics. DESIGN, SETTING, AND PARTICIPANTS: Prospective case series of papulovesicular eruptions following smallpox vaccination in healthy, vaccinia-naive adult participants compared with noncases conducted from October 2002 to March 2003. Variables potentially related to these eruptions were collected retrospectively through chart review. Eruptions were described based on viral culture, clinical examination, and histopathological evaluation (1 biopsy specimen from 1 case). MAIN OUTCOME MEASURE: Cases of papulovesicular eruptions following vaccination. RESULTS: During the trial, of 148 volunteers (56% women; mean age 23.6 years), 4 participants (2.7%) developed generalized eruptions and 11 (7.4%) noted focal eruptions. Viral cultures of sample lesions were negative for vaccinia. The result of a skin biopsy sample from 1 case of generalized rash revealed suppurative folliculitis without evidence of viral infection. All lesions resolved without scarring. In the cohort, cases and noncases did not show significant differences in terms of sex, in the use of nonsteroidal anti-inflammatory drugs or oral or depo contraceptives, in medication allergies, in the incidence of fever or lymphadenopathy after vaccination, or in the dilution of vaccine received. CONCLUSIONS: Folliculitis is a common and benign eruption observed in vaccinia-naive adult volunteers following smallpox vaccination. This eruption may be seen in volunteers receiving the vaccine in the newly instituted vaccination programs and may be met with heightened anxiety, potentially being confused with generalized vaccinia. This description of folliculitis using clinical, virologic, and histopathological findings should allay these concerns and provide additional insight into this eruption. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/12824211/Focal_and_generalized_folliculitis_following_smallpox_vaccination_among_vaccinia_naive_recipients_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.289.24.3290 DB - PRIME DP - Unbound Medicine ER -