>>147414, >>147416, >>147417
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Protecting Contacts at Highest Risk for Adverse Events
Vaccine recipients or caregivers must be informed that they should avoid contact with individuals at high risk of serious adverse effects of vaccinia virus, for instance, those with past or present eczema, immunodeficiency states including HIV infection, pregnancy, or infants less than 12 months of age.

Self-inoculation and Spread to Close Contacts
Vaccine recipients or caregivers must be advised that virus is shed from the cutaneous lesion at the site of inoculation from approximately Day 2 post-vaccination until the scab eparates and the lesion is re-epithelialized typically 3 to 6 weeks after primary vaccination. Vaccinia virus may be transmitted by direct physical contact. Accidental infection of skin at sites other than the site of intentional vaccination (self-inoculation) may occur by trauma or scratching. Contact spread may also result in accidental inoculation of household members or other close contacts (including sexual contacts). The result of accidental infection is a pock lesion(s) at an unwanted site(s) in the vaccinee or contact and resembles the vaccination site. Self-inoculation occurs most often on the face, eyelid, nose, anus and mouth, but lesions at any site of traumatic inoculation can occur. Self inoculation of the eye may result in ocular vaccinia, a potentially serious complication.

Care of the Vaccination Site and Potentially Contaminated Materials
Vaccine recipients or caregivers must be given the following instructions:
• The vaccination site must be completely covered with gauze secured loosely with first aid adhesive tape. If the vaccine recipient is directly involved in patient care, the gauze may be covered with a semipermeable dressing that allows passage of air but not fluids. Keep the site covered until the scab falls off on its own.
• The vaccination site must be kept dry. Normal bathing may continue, but cover the vaccination site with waterproof bandage when bathing. Do not scrub the site. Cover the vaccination site with loose gauze held in place with first aid adhesive tape after bathing.
• Don’t scratch the vaccination site. Don’t scratch or pick at the scab.
• Do not touch the lesion or soiled gauze, semipermeable dressing, or bandages and then touch other parts of the body such as the eyes, anal and genital areas where the virus can spread.
• After changing the gauze, semipermeable dressing, or bandages, or touching the site, wash hands thoroughly with soap and water or >60% alcohol-based hand-rub solutions.
• To prevent transmission to contacts, physical contact of objects that have come into contact with the lesion (e.g., soiled bandages, clothing, fingers) must be avoided.