The case of an immunocompetent 3 and half-year-old girl who developed encephalitis and herpes zoster ophthalmicus 20 months after immunization with varicella-zoster virus vaccine is reported from Children's Hospital, Athens, Greece, and University College, London, UK. She presented with herpetiform rash on the right half of her face, dizziness, vomiting, and somnolence. The rash followed the distribution of the ophthalmic branch of the trigeminal nerve and extended to the tip of the nose (Hutchinson sign). EEG showed diffuse slowing. CSF had no white blood cells and normal protein and glucose. PCR was positive for VZV DNA in CSF. IV acyclovir and dexamethasone and local acyclovir treatments were followed by rapid complete recovery. Molecular analysis confirmed the vaccine strain as the causative agent. [1]

COMMENT. This case represents a rare example of herpes zoster occurring in an immunocompetent child and resulting from reactivation of the varicella vaccine virus received at immunization 20 months previously. An unusual source of vaccinia virus is reported as follows:

Human vaccinia infection after contact with raccoon rabies vaccine bait. Since 2003, US Department of Agriculture's Wildlife Services has instituted a multistate oral rabies vaccination (ORV) program using bait containing vaccinia rabies glycoprotein recombinant virus vaccine. Cases of human vaccinia virus infection are reported after contact with the bait, usually via dogs (or cats) that find and eat the bait. Owners are cautioned not to attempt removal of the bait from a dog's mouth. [2]