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To the Editor: Dr Garde and and colleagues¹ stated that "The mechanism of transfer from the vaccinee to the spouse is uncertain." They did not report, however, whether they asked about mouth-to-nipple contact from the vaccinee to the spouse. Oral shedding of virus could transmit the virus via direct mucosal contact.

Harrison G. Weed, MD
weed-2@medctr.osu.edu
The Ohio State University College of Medicine
Columbus

1. Garde G, Harper D, Fairchok MP. Tertiary contact vaccinia in a breastfeeding infant. JAMA. 2004;291:725-727. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:2314.

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