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In Reply: In response to Dr Klote and colleagues, we detected vaccinia DNA in the blood or oropharynx in 16 (21%) of 77 military members 1 week to 3 weeks after smallpox vaccination using real-time PCR and confirmatory acrylamide gel electrophoresis. Vaccinia DNA was found in the blood of 1 vaccinee (1.96%; 95% CI, 0.05%-10.40%) at 21 days and after scab separation, beyond the recommendation from the US Food and Drug Administration for blood donation deferral. Our article acknowledged that presence of vaccinia DNA does not necessarily translate to the presence of replicating virus. However, only a few orthopox virions may be necessary to establish infection,¹ and presence of foreign DNA in the blood 21 days after inoculation raises some concern for infectivity.

Cummings et al² observed a rate of 0% viremia (95% CI, 0%-12.3%) following smallpox vaccination, using viral culture, electrochemiluminescence antigen detection assay, and PCR. Although viral culture . . . [Full Text of this Article]

Michael R. Savona, MD
msavona@med.umich.edu
Department of Internal Medicine
University of Michigan
Ann Arbor

Patrick J. Danaher, MD
Department of Infectious Disease
David Grant US Air Force Medical Center
Travis Air Force Base, Calif