Talbot Thomas R, Peters Jody, Yan Lihan, Wright Peter F, Edwards Kathryn M
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Infect Control Hosp Epidemiol. 2006 Nov;27(11):1184-92. doi: 10.1086/508827. Epub 2006 Oct 17.
To assess the optimal method for covering smallpox vaccination sites to prevent transmission of vaccinia.
Randomized, nonblinded clinical trial.
Tertiary care medical center.
Vaccinia-naive and vaccinia-experienced volunteers.
After vaccination, study participants were randomized to receive 1 of 3 types of bandage: gauze, occlusive with gauze lining, or foam. Vaccination sites were assessed every 3 to 5 days until the lesion healed. During each visit, specimens were obtained from the vaccination site, the bandage surface before removal, and the index finger contralateral to the vaccination site and were cultured for vaccinia. Time to lesion healing was assessed.
All 48 vaccinia-naive and 47 (87%) of 54 vaccinia-experienced participants developed a vesicle or pustule at the injection site 6-11 days after vaccination. Fourteen (14%) of 102 participants had bandage cultures positive for vaccinia. All but 1 of these vaccinia-positive cultures were of a bandage from participants randomized to the gauze bandage group, and all but 3 were of bandages from vaccinia-naive participants. No finger-specimen cultures were positive for vaccinia. One episode of neck autoinoculation occurred in a vaccinia-naive individual who had vaccinia recovered from his gauze bandage on multiple visits. The foam bandage was associated with more local adverse effects (skin irritation and induration). The time to healing did not differ among the bandage groups.
The potential for transmission of vaccinia from a vaccination site is greater if the site is covered by gauze than if it is covered by occlusive or foam bandages. Use of an occlusive bandage with a gauze lining is the best choice for coverage of smallpox vaccination sites because of a reduced potential for vaccinia transmission and a lower reactogenicity rate. Bandage choice did not affect vaccination lesion healing.
评估覆盖天花疫苗接种部位以预防牛痘传播的最佳方法。
随机、非盲临床试验。
三级医疗中心。
未接触过牛痘和有牛痘接触史的志愿者。
接种疫苗后，研究参与者被随机分配接受三种绷带中的一种：纱布、带纱布内衬的封闭性绷带或泡沫绷带。每3至5天评估一次接种部位，直至损伤愈合。每次访视时，从接种部位、去除前的绷带表面以及接种部位对侧的食指获取标本，并培养牛痘。评估损伤愈合时间。
所有48名未接触过牛痘的参与者以及54名有牛痘接触史的参与者中的47名（87%）在接种疫苗后6至11天在注射部位出现水疱或脓疱。102名参与者中有14名（14%）的绷带培养物牛痘呈阳性。这些牛痘阳性培养物中，除1份外均来自随机分配到纱布绷带组的参与者，除3份外均来自未接触过牛痘的参与者的绷带。没有手指标本培养物牛痘呈阳性。一名未接触过牛痘的个体发生了一次颈部自体接种，该个体在多次访视时从其纱布绷带上感染了牛痘。泡沫绷带与更多局部不良反应（皮肤刺激和硬结）相关。各绷带组的愈合时间无差异。
与使用封闭性或泡沫绷带覆盖相比，接种部位用纱布覆盖时牛痘传播的可能性更大。使用带纱布内衬的封闭性绷带是覆盖天花疫苗接种部位的最佳选择，因为其牛痘传播可能性降低且反应原性率较低。绷带选择不影响疫苗接种损伤的愈合。
