Eczema vaccinatum resulting from the transmission of vaccinia virus from a smallpox vaccinee: an investigation of potential fomites in the home environment.

On March 3, 2007, a 2-year-old boy was hospitalized with eczema vaccinatum. His two siblings, one with eczema, were subsequently removed from the home. Swabs of household items obtained on March 13th were analyzed for orthopoxvirus DNA signatures with real-time PCR. Virus culture was attempted on positive specimens. Eight of 25 household samples were positive by PCR for orthopoxvirus; of these, three yielded viable vaccinia virus in culture. Both siblings were found to have serologic evidence of orthopoxvirus exposure. These findings have implications for smallpox preparedness, especially in situations where some household members are not candidates for vaccination.

Detection of Herpes simplex virus DNA in non-herpetic areas of patients with eczema herpeticum.

BACKGROUND: Patients with atopic dermatitis may develop a widespread cutaneous herpes simplex virus (HSV) infection called eczema herpeticum. OBJECTIVE: We examined the possible routes of indirect HSV dissemination in 10 patients with eczema herpeticum, although direct spread of HSV is the most likely route of infection. METHODS: Specimens were collected from hands and 'non-herpetic' areas (i.e. without eczema herpeticum), with or without eczematous and/or erythematous lesions of atopic dermatitis, of 10 patients with eczema herpeticum. We tried to detect HSV DNA in the samples by polymerase chain reaction. RESULTS: HSV DNA was frequently detected on both hands and on cutaneous surfaces clinically free of eczema herpeticum. These patients had scratched such lesions because of itching. Moreover, they had taken baths the day before the examination. CONCLUSION: These results suggest that there may be two routes of indirect transmission of this virus, namely via manual scratching of herpetic lesions or via a contaminated bath towel or item of underwear.