Eczematous Skin Disease and Recall of Past Diagnoses: Implications for Smallpox Vaccination

1 July 2003 | Volume 139 Issue 1 | Pages 1-7

Background: Persons with atopic dermatitis or eczema, regardless of disease severity or activity, may develop eczema vaccinatum if they or their close contacts receive the smallpox vaccine. According to current recommendations, a preexposure vaccination program should identify these persons and exclude them from participating.

Objective: To determine the prevalence of diagnosed atopic dermatitis and eczema in a defined population and assess the sensitivity of screening questions to identify patients who have received these diagnoses.

Design: Population-based prevalence survey and telephone interview.

Setting: 14 ZIP code regions in Wisconsin.

Patients: Persons given a diagnosis of atopic dermatitis or eczema in 2000 and 2001 were identified from a population-based cohort. Persons with a history of atopic dermatitis diagnosed since 1979 were eligible for the telephone survey.

Measurements: Prevalence of diagnosed atopic dermatitis or eczema; proportions of respondents able to recall a past diagnosis of atopic dermatitis, eczema, or recurrent rash.

Results: The prevalence of atopic dermatitis or eczema diagnosis in 2000 or 2001 was 0.8%. At least 2.4% of the cohort would be ineligible for smallpox vaccination because of active skin disease in themselves or household members. Among 94 adult respondents with atopic dermatitis, 55 (59%) correctly self-reported skin disease. Seventy-nine (60%) of 133 household contacts of adults with atopic dermatitis correctly reported the presence of skin disease in a household member. Parental recall of skin disease in children with atopic dermatitis was 70% (123 of 177).

Conclusions: Identifying dermatologic contraindications to smallpox vaccination by relying only on a self-reported history of rash illnesses is likely to miss a substantial proportion of individuals who should not receive smallpox vaccine in a preexposure vaccination campaign.

Editors' Notes Context People with a history of atopic dermatitis or eczema in themselves or their close contacts should not receive preexposure smallpox vaccination because of the risk for eczema vaccinatum. Contribution This population-based study suggests that about 40% of people would not correctly report that they or a close contact has these skin conditions even though medical records confirm that they do. Implications Relying on patient self-report about dermatologic contraindications to smallpox vaccination would miss a substantial proportion of people with true contraindications. –The Editors

 

Author and Article Information

From Marshfield Clinic Research Foundation, Marshfield, Wisconsin, and Centers for Disease Control and Prevention, Atlanta, Georgia.

Acknowledgments: The authors thank Drs. John Melski, Scott Norton, and Cynthia Henry for their advice on study design and case definition; Kathy Brecke, Theresa Esser, Nancy Gilge, Juanita Herr, Deborah Hilgemann, Debra Kempf, Tina Kollmansberger, Jacklyn Salzwedel, and Sonia Weigel for their assistance with data collection; Lorelle Benetti, Marilyn Bruger, Jaime Elliott, and Donna Wittman for their assistance with data entry and data management; and Carol Beyer for assistance with manuscript preparation.

Grant Support: By the Vaccine Safety Datalink, contract 200-95-0957 (task order 57) from the Centers for Disease Control and Prevention.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Edward A. Belongia, MD, Epidemiology Research Center, Marshfield Clinic Research Foundation, 1000 North Oak Avenue-Mailstop ML2, Marshfield, WI 54449; e-mail, belongia.edward{at}mcrf.mfldclin.edu.

Current Author Addresses: Drs. Naleway, Belongia, and Greenlee and Mr. Kieke: Epidemiology Research Center, Marshfield Clinic Research Foundation, 1000 North Oak Avenue-Mailstop ML2, Marshfield, WI 54449.

Drs. Chen and Shay: Immunization Safety Branch, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-61, Atlanta, GA 30333.

Author Contributions: Conception and design: A.L. Naleway, E.A. Belongia, R.T. Greenlee, R.T. Chen, D.K. Shay.

Analysis and interpretation of the data: A.L. Naleway, E.A. Belongia, R.T. Greenlee, B.A. Kieke.

Drafting of the article: A.L. Naleway, E.A. Belongia, R.T. Greenlee, R.T. Chen, D.K. Shay.

Critical revision of the article for important intellectual content: A.L. Naleway, E.A. Belongia, R.T. Greenlee, R.T. Chen, D.K. Shay.

Final approval of the article: A.L. Naleway, E.A. Belongia, R.T. Greenlee, R.T. Chen, D.K. Shay.

Statistical expertise: B.A. Kieke.

Obtaining of funding: R.T. Chen, D.K. Shay.

Administrative, technical, or logistic support: R.T. Chen, D.K. Shay.

Collection and assembly of data: A.L. Naleway, R.T. Greenlee.