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Diagnosis 

Generalized Vaccinia

Generalized vaccinia is a rare (250 cases per 1 million vaccinations¹) complication of the smallpox vaccine, which contains a live virus (vaccinia) that confers immunity to the variola virus (smallpox). It is secondary to viremia and usually has a benign course. Most lesions occur within a week of vaccination and may appear on any part of the body. The differential diagnosis includes erythma multiforme, eczema vaccinatum, progressive vaccinia, varicella, and variola itself.² Most patients with generalized vaccinia do not require admission. Severe cases with numerous or recurrent lesions or immunocompromised patients may require vaccinia immunoglobulin. In all cases, prompt referral to an infectious disease specialist is recommended.

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References 

1. Lane JM, Ruben FL, Neff JM, et al.  Complications of smallpox vaccination, 1968: results of ten statewide surveys. J Infect Dis. 1970;122:303–309
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2. Smallpox vaccination and adverse events training module [Centers for Disease Control and Prevention Web site]. Available at: http://www.bt.cdc.gov/training/smallpoxvaccine/reactions. Accessed July 16, 2003.
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