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In Reply: I share Dr Mermel's concerns about the risk of cutaneous vaccinia from immunized health care workers. Although vaccinia was rare in hospitals and other health care settings during the 1960s, it certainly can occur and may have been more frequent at the time of open wards and before there was great attention to prevention of nosocomial spread.¹ Nonetheless, the rarity of such reports in the 1960s seems to indicate that the nosocomial preventive measures used then were quite effective.

A vaccination program of some type will soon begin again in the United States, and hospital personnel will certainly be among the first to be vaccinated. It will be imperative to prevent nosocomial spread of vaccinia from an immunized health care worker or a patient in a health care facility. Alcohol-based hand rinse products may well be the most-used method to disinfect hands now and in the near future . . . [Full Text of this Article]

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Risk of Cutaneous Vaccinia From Health Care Workers Who Receive Smallpox Vaccine
Leonard A. Mermel
JAMA. 2003;289(7):844-845.
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