Nine cases of eczema vaccinatum are presented, including two fatalities. Seven were caused by contact of a child with eczema with a recently vaccinated sibling.
Suddenly appearing umbilicated vesicles superimposed upon atopic eczema are almost diagnostic of eczema vaccinatum or eczema herpeticum. These do not occur with mere secondary bacterial infection.
Hyperimmune vaccinal gamma-globulin is now available for specific therapy.
Eczema vaccinatum is frequently iatrogenic and uniformly preventable.
The following steps are recommended for prophylaxis: 1) No child with atopic eczema or other skin disorder should be vaccinated. 2) No child should be vaccinated if any member of his family has eczema or other skin disorder. 3) Parents of children with eczema should be notified at the onset of the disease of the danger from vaccination contact. 4) If a sibling of a child with atopic eczema is vaccinated, he must be completely separated from that child for at least 21 days. 5) Forms used by state and local health departments for parents' consent to vaccination should include an appropriate warning of the contraindications. 6) Eczema vaccinatum should be a reportable disease. 7) Patients recently vaccinated must be excluded from pediatric wards containing patients with atopic eczema, other diseases of the skin, burns or healing surgical incisions. 8) Vaccination may be recommended at 2 months of age, especially for babies from strongly allergic families.
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