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To the Editor:—
Every physician should be acquainted with the three types of reactions which follow smallpox vaccination. All reactions fall within one of the three groups, vaccinia, vaccinoid or immune reaction.The vaccinia, or primary take, is the reaction obtained when one who has no immunity is vaccinated with a potent cowpox virus. The site of vaccination should not be larger than 1/8 inch. If the multiple puncture method is used, practically nothing can be seen at the site of the vaccination for the first two to four days. After this period of incubation is passed changes are quite rapid. First one or several macules form followed promptly with papules. These papules may become confluent as the vesicle forms. By the ninth day a definite pustule usually surrounded by an areola is present. At the time of the pustule the patient may suffer from a little malaise and have
Gloyne LB. SMALLPOX VACCINATION REACTIONS. JAMA. 1943;122(6):395–396. doi:10.1001/jama.1943.02840230047019
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