Generalized Vaccinia in an Eczematous Child

Generalized vaccinia is an uncommon but serious complication of vaccination, surveys placing the incidence at 1 in 20,000 to 1 in 96,000 vaccinations and the case fatality rate at 12 to 30 per cent.1About two thirds of the persons in whom this complication occurs have diseases of the skin; many are children with eczema. Therefore, although the disease itself is uncommon, it constitutes a real danger to persons with cutaneous diseases, and warnings have been sounded against vaccination of such persons and against their exposure to recently vaccinated persons. The subject has been discussed in several recent reviews.2 Generalized vaccinia in persons with eczema has been called eczema vaccinatum. Clinically similar conditions in persons with eczema or other cutaneous diseases have been called Kaposi's varicelliform eruption or pustulosis varioliformis acuta when there was no history of preceding vaccination or of contact with recently vaccinated persons, or when