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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 (tom.talbot@vanderbilt.edu)
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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

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