Optimal Bandaging of Smallpox Vaccination Sites to Decrease the Potential for Secondary Vaccinia Transmission Without Impairing Lesion Healing

Objective. To assess the optimal method for covering smallpox vaccination sites to prevent transmission of vaccinia. Design. Randomized, nonblinded clinical trial. Setting. Tertiary care medical center. Participants. Vaccinia‐naive and vaccinia‐experienced volunteers. Interventions. 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. Results.  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 ...