To the Editor: Dr Talbot and colleagues1 reported that among 148 patients who received smallpox vaccination, 15 developed focal or generalized folliculitis. The authors reported 4 of these cases in detail. Similar cases have been reported in civilian2 and military3 populations. None of the cases in the study of Talbot et al represented generalized vaccinia, which is infectious.4 - 5
Erythema multiforme was relatively common among children who received routine smallpox vaccination in the 1960s.4 - 6 This spectrum of rashes, which has been attributed to either a hypersensitivity to or toxic effect of vaccination, differed from the folliculitis Talbot et al describe and from generalized vaccinia.5
Many more individuals would be expected to experience adverse events if the United States were to have a more widespread program of smallpox vaccination. It then would be critical to differentiate among serious events, infectious events, and noninfectious rashes. The study of Talbot et al adds folliculitis to the spectrum on noninfectious, nonserious rashes after vaccination. This should be differentiated from generalized vaccinia, which is an infectious, viremic rash that produces long-term immunity indistinguishable from the primary vaccination.4 These lesions can appear anywhere on the body, and in general, are dispersed throughout the body in large numbers. Unlike vaccine-related folliculitis, vaccinia virus can be cultured from these lesions. This adverse event is short-lived and benign in most individuals, although some patients may have systemic symptoms, and a few may need to be hospitalized. A small number of patients will have recurrent episodes, even for a year after vaccination. Most patients do not require treatment; those with severe or recurrent disease should be treated with vaccinia immune globulin.4 - 5 The reason patients developed generalized vaccinia is not known with certainty, but may be because of subtle immune defects that were not diagnosable by techniques available in the 1960s.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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