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To the Editor: In their discussion of the risk of contact vaccinia spread from individuals who receive smallpox vaccine, Dr Neff and colleagues¹ only briefly discussed the risk to patients from health care workers who have been recently vaccinated. Scrupulous hand hygiene among vaccine recipients will be important in preventing vaccinia transmission; however, it is not clear that this would entirely negate the risk of transmission.

Enveloped lipophilic viruses such as vaccinia are more readily inactivated by alcohol and other disinfectants than are nonenveloped viruses.² There are only sparse data, however, about inactivation by topical antiseptics or nonmedicated soaps of enveloped intracellular viruses that might be encountered at the site of smallpox vaccination. Fifteen seconds of contact between an alcohol-based hand rinse product is virucidal for cell-free orthopoxvirus, leading to a 10 000-fold reduction in viral infectivity, irrespective of the presence of proteinaceous material.³ Fifteen seconds of contact between cell-free recombinant . . . [Full Text of this Article]

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