Respiratory infection due to direct contact with rabbit-skin powder contaminated by vaccinia virus.

•We describe atypical VACV infections in five male workers who inhaled rabbit-skin powder contaminated by VCAV in China.•The workers were exposed to the virus via direct skin contact and inhalation of powder dispersed in the air.•When infected with the same virus, patients vaccinated against smallpox and those who were not all had varying degrees of symptoms, especially in the lungs.