A few outbreaks of generalized vaccinia have been provoked, in hospitals1-4 and houses,5,6 by spontaneous spread from vaccinated inmates. Two mass vaccinations conducted in a hospital for patients with pemphigus foliaceus located at São Paulo City resulted in 2 consecutive outbreaks, each composed of cases of generalized vaccinia, vacciniolae (secondary pocks around the "take"), and vaccinia localized to the inoculation place (vaccination "take"). Incidentally, while pemphigus foliaceus is a rare, sporadic disease in the United States and Europe, its incidence in Brazil definitely warrants the qualification of endemic,7,8 to the extent that a few urban and numerous rural endemic foci of the disease have been observed.
When 2 patients showed smallpox in an adjoining hospital, the staff of the Pemphigus Foliaceus Hospital decided upon a mass vaccination. Due to scarcity of lymph, only 47 inmates were vaccinated on Dec. 13, 1955, and this provoked 36 cases of