Delay of chemotherapy to prevent progressive vaccinia

Abstract

Objective: The goal was to discuss the potential risk of progressive vaccinia in the setting of smallpox vaccination with immunosuppression and to present strategies to avoid progressive vaccinia. Methods: A case report and literature review are presented. Results: A 21-year-old, male, military member received smallpox vaccination and was coincidentally diagnosed as having osteosarcoma ∼2 weeks later. His recent vaccination was recognized, and chemotherapy was subsequently delayed until separation of the scab at the vaccination site. The patient received neoadjuvant chemotherapy and fared well, without any evidence of progressive vaccinia or other smallpox vaccine complications. Conclusions: Smallpox vaccine should be withheld from immunocompromised patients because of the risk of progressive vaccinia. Conversely, immunosuppressive therapies should be delayed for recently vaccinated patients. There are no controlled trials in this area, but withholding immunosuppressive therapy until separation of the scab is a rational approach. This patient was exposed to chemotherapy after scab separation and did not develop progressive vaccinia.