The mechanisms underlying apparent viremic spread from a primary vaccination site to other parts of the body are not known. Virus is present in the blood, but clinically only the skin appears to be a target for implantation. Subtle minor immunologic abnormalities, particularly of the immunoglobulin B-cell system, are suspected to be present but such studies were not available at the time this complication was observed.
The fact that recurrent episodes are seen in some individuals lends credence to an immunologic defect. Antibody deficiency is likely because the lesions result from viremia, which is normally controlled by antibodies. Also, each of the lesions, as well as the primary, heals without incident and in normal fashion, suggesting that cell-mediated immunity is intact.
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