Following vaccination against smallpox, a variety of adverse reactions may occur. These may range from mild to severe. In severe reactions vaccinia immunoglobulin (VIG) may be indicated.


NOTE: I am not sure what the availability of vaccinia immunoglobulin is, but it probably is hard to get and fairly expensive. CDC should be contacted for information on availability and use.


Type of Adverse Reaction



mild to moderate

inadvertent autoinoculation (face, eyelid, nose, mouth, genitalia, rectum)

mild to moderate

erythematous or urticarial rashes

mild to moderate

bullous erythema multiforme (Stevens- Johnson syndrome)

moderate to severe

eczema vaccinatum

moderate to severe

generalized vaccinia

moderate to severe

progressive vaccinia (vaccinia necrosum, vaccinia gangrenosum)

moderate to severe

postvaccinial encephalitis

moderate to severe

vaccinial keratitis

moderate to severe


Indications for vaccinia immunoglobulin:

(1) possibly ocular autoinoculation (contraindicated with keratitis)

(2) severe eczema vaccinatum

(3) severe generalized vaccinia

(4) generalized vaccinia in a patient with a severe underlying illness

(5) severe progressive vaccinia (vaccinia necrosum)


Contraindications for vaccinia immunoglobulin:

(1) vaccinia keratitis (infection of the cornea)

(2) allergy to components


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