Individuals with eczema (more correctly termed atopic dermatitis) are at special risk for developing extensive vaccinial lesions either through direct inoculation of the virus onto diseased skin or possibly viremic spread if they were recently vaccinated. This can sometimes lead to a fatal outcome. Atopic dermatitis implies both a skin abnormality and an immunologic difference, ill defined, in individuals subject to this disease.
If smallpox is not an immediate risk, vaccination should not be performed in persons with eczema or atopic dermatitis or in persons with household or close physical contacts with these conditions.
In a recently vaccinated individual, dissemination of vaccinia virus to other parts of the body can occur from viremia or direct inoculation. Transfer of virus can also occur from contact with a recent vaccinee whose vaccine site lesion is in the florid stages of development. With early recognition and appropriate use of Vaccinia Immune Globulin (VIG), morbidity and mortality can be significantly reduced.