Smallpox Autoinoculation Via Tattoo in a Soldier

by Science Editor

What can happen if you do not follow the guidelines on waiting times after some Injectables/Vaccinations  prior to getting a tattoo.

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Smallpox Autoinoculation Via Tattoo in a Soldier.

Abstract: The Authors: "present the case of a soldier with smallpox autoinoculation, who reported receiving a tattoo directly over his inoculation site 4 days after vaccination. Initial scattered flesh-colored papules evolved over several days to classic umbilicated lesions with additional fevers, chills, myalgias, and suspected secondary infection".
Industry Significance Rating:

Medium - Industry wide monitoring is recommended.


Military Medicine. 2018 Jul 31. doi: 10.1093/milmed/usy180.

Authors: Carius BM, Dodge PM, Randles JD.
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The authors report a case of a 21 year old African American Soldier who had body art tattooing over the site of a smallpox vaccination 4 days after receiving the vaccination with live vaccinia virus. The soldier began experiencing symptoms a short time after having a tattoo refresh procedure over the site of the vaccination, he subsequently developed a papular rash which evolved into pustular crusting within 7 days post tattooing and he became febrile.

The authors noted that "Current US Army Public Health Command (USAPHC) guidance mandates no new tattoos for 30 days post-inoculation, Military Vaccine Agency notes that this period may be extended to a window of greater than 60 days on a case-by-case basis" and that this recommendation had not been followed in this particular case.

The article contains an excellent time series of photographs of the affected area of skin.


All tattooists should note there are risks associated with providing tattooing on or near the site of prior vaccinations but particularly during the 30-60 days after vaccination therapy when the risk of autoinoculation (transfer and reinoculation of the vaccine by the tattoo needle) is highest. For this reason it is advisable to avoid collocating a tattoo at the site of prior vaccination therapy regardless of the age of the vaccination/tattoo.

As emphasised by the authors "
Providers should continue to make every effort to avoid collocating sites of tattoos and smallpox inoculation regardless of tattoo age"..


Scientific Report,  Smallpox, Autoinoculation, Tattoo, Body Art, Soldier, vaccination


The Education Team here at keeps a close eye on the scientific and medical literature for new publications relating to cosmetic and medical tattooing that may be of interest to our customers. The intent is to alert industry members to important publications within the literature to expand the knowledge base particularly in relation to high impact reports.

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