A 7 m.o. white male was seen in the emergency room in July 2007 at Munson Medical Center (Traverse City, MI) for fever and rash after exposure to a military member recently vaccinated for smallpox.

Five days prior to the development of fever and rash the child and his parents had attended a going away get-together for a soldier-relative due to deploy to Iraq a short time later. At some point during this gathering the child slid down the solidier's uncovered vaccinated arm. As the child did so, he directly contacted the smallpox vaccine pustule and reportedly also licked the site in the process. The serviceman had been vaccinated nine days prior to this incident. When the parents realized what had happened, they immediately called a local emergency room. They were advised to observe the child for fever and rash.

The child had developed a fever of 102 degrees and had become somewhat fussy and less apt to feed. On examination in the emergency room he had a macular to slightly papular rash scattered variously about his body including lesions on his face, neck, chest, abdomen, and extremities (see image at upper left). The skin lesions were generally a millimeter or less in diameter, and there was no oral involvement. The rash was not pustular nor vesicular, and the infant did not appear acutely ill. Laboratory evaluation included WBC 5.4; Hgb could not be determined because of agglutination of RBCs (likely due to the capillary blood draw). Over a 24 hr period of observation the rash became more extensive in its distribution but did not become pustular or vesicular.

The 7 m.o. infant was previously healthy and was up to date on immunizations. He had no known skin conditions. Other family members were not ill, and the child's parents were unaware of exposures to other children ill with chicken pox or other childhood rash illnesses.

Successful smallpox vaccine "takes" follow a stereotypical progression of pustulation and scabbing usually over a period of three weeks. At nine days post-vaccination the pustule would appear similar to those pictured in images at lower left. Smallpox vaccination is performed using live virus. There is risk of transmission of this virus to non-immune direct contacts until the vaccination site has scabbed and the scab fallen off.