Smallpox Autoinoculation Via Tattoo in a Soldier



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Title: Smallpox Autoinoculation Via Tattoo in a Soldier.
Abstract: The Authors: "present the case of a soldier with smallpox autoinoculation, who reported receiving a tattoo directly over his inoculation site 4 days after vaccination. Initial scattered flesh-colored papules evolved over several days to classic umbilicated lesions with additional fevers, chills, myalgias, and suspected secondary infection".
Industry Significance Rating: Medium - Industry wide monitoring is recommended.
Publication: Military Medicine. 2018 Jul 31. doi: 10.1093/milmed/usy180.
Authors: Carius BM, Dodge PM, Randles JD.
Links:  Article Link Link to Publisher Pdf Link Search Google
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Discussion:

The authors report a case of a 21 year old African American Soldier who had body art tattooing over the site of a smallpox vaccination 4 days after receiving the vaccination with live vaccinia virus. The soldier began experiencing symptoms a short time after having a tattoo refresh procedure over the site of the vaccination, he subsequently developed a papular rash which evolved into pustular crusting within 7 days post tattooing and he became febrile.

The authors noted that "Current US Army Public Health Command (USAPHC) guidance mandates no new tattoos for 30 days post-inoculation, Military Vaccine Agency notes that this period may be extended to a window of greater than 60 days on a case-by-case basis" and that this recommendation had not been followed in this particular case.

The article contains an excellent time series of photographs of the affected area of skin.

Recommendations:

All tattooists should note there are risks associated with providing tattooing on or near the site of prior vaccinations but particularly during the 30-60 days after vaccination therapy when the risk of autoinoculation (transfer and reinoculation of the vaccine by the tattoo needle) is highest. For this reason it is advisable to avoid collocating a tattoo at the site of prior vaccination therapy regardless of the age of the vaccination/tattoo.

As emphasised by the authors "
Providers should continue to make every effort to avoid collocating sites of tattoos and smallpox inoculation regardless of tattoo age".

Keywords:

Medical Report, Smallpox, Autoinoculation, Tattoo, Body Art, Soldier, vaccination

 

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