Generalized Vaccinia

Less than 50 cases of fetal vaccinia have occurred, usually following primary vaccination of the mother in early pregnancy. Fetal vaccinia generally causes a stillbirth or neonatal death. The vaccine is not associated with congenital anomalies. No cases occurred among the 39,213 civilians receiving vaccination in 2003 (15). 

Generalized vaccinia Secondary lesions of the skin following vaccination which may occur in subjects with previously healthy skin but are more common in the case of traumatized skin, especially in the case of eczema(eczema vaccinatum). In the latter instance, generalized vaccinia may result from mere contact with a vaccinated person. Secondary vaccinial lesions may also occur following transfer of virus from the vaccination to another site by means of the fingers (autoinnoculation). 

The last known naturally occurring case of smallpox occurred in Somalia in 1977. In May 1980, the World Health Assembly certified that the world was free of naturally occurring smallpox. By the 1960s, because of vaccination programs and quarantine regulations, the risk for importation of smallpox into the United States had been reduced. As a result, recommendations for routine smallpox vaccination were rescinded in 1971. In 1976, the recommendation for routine smallpox vaccination of health-care workers was also discontinued. In 1982, the only active licensed producer of vaccinia vaccine in the United States discontinued production for general use, and in 1983, distribution to the civilian population was discontinued. All military personnel continued to be vaccinated, but that practice ceased in 1990. Since January 1982, smallpox vaccination has not been required for international travelers, and International Certificates of Vaccination forms no longer include a space to record smallpox vaccination. 

Vaccines Immunization may be ineffective when given during methotrexate therapy. Immunization with live virus vaccines is generally not recommended. Disseminated vaccinia infections after smallpox immunization have occurred in patients receiving methotrexate. 

Generalized vaccinia (vaccinia generalisata). Here the Vaccinia virus is spread by the blood stream and vaccinial lesions can develop all over the body some 9-10 days after vaccination. 

Post-exposure antibiotic therapies for plague and anthrax are generally effective if administered within a day or so after exposure. There is no approved therapy for smallpox, but cidofavir and possibly vaccinia-immune globulin (VIG) are showing some promise. 

Fig. Z9 (See color plate) Generalized vaccinia in an infant. From smallpox vaccination adverse reaction. CDC Smallpox. http //www.bt.cdc.gov/training/smaUpoxvaccine/reactions/adverse.html...

Vaccinia immune globulin IV is a vaccinia-specific immunoglobulin G (IgG), which directly neutralizes vaccinia virus. It is indicated in treatment and/or modification of aberrant infections induced by vaccinia virus (including accidental implantation in eyes, mouth, or other areas where vaccinia infection would constitute a special hazard), eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, and vaccinia infections in individuals who have skin conditions such as bums, impetigo, varicella-zoster, or poison ivy, or in individuals with eczematous skin lesions. Treat complications that include vaccinia keratitis with caution. 

Vaccinia Vaccinia immune globulin Treatment generalized, ocular, skin infections... 

Generally difficult to work with in the lab and also require specialized facilities for handling and containment except vaccinia virus. 

Undoubtedly, both cellular and humoral immune responses are important to recovery from smallpox. The inability of poxviruses to persist stably within the host cell accounts for their infections being relatively short-lived, without establishment of a latent infection. The importance of cellular immunity in recovery from infection has been demonstrated with other poxviruses,39 and the same is generally assumed with variola. Vaccination experiences demonstrated the rare but terrible consequence of vaccinia necrosum in persons with defects of cellular immunity. Early presentation on the host cell membrane of virus-encoded proteins provides means for immune recognition.40 It has been demonstrated that both antibody-dependent cellular cytotoxicity41 and heterogeneous cluster of differentiation (CD) 4+ cytotoxic T-lymphocyte clones42 are induced in response to vaccinia infection, and some immunodominant B-cell epitopes have been defined in both mice and vaccinated humans.43 The relatively large size of poxvirus polypeptides facilitates their rec-... 

One of the most thorough surveys of adverse reactions associated with vaccinia vaccines was conducted in the United States and published by the CDC in 1968,89 and is summarized in Table 27-3. As a consequence of percutaneous inoculation, infectious vaccine virus is present in the local lesion. Consequently, inadvertent inoculation to other skin and mucous membrane sites (autoinoculation) or to other persons (secondary inoculation) is the most frequent complication of vaccinia intradermal vaccination.90 92 Ocular vaccinia is a particularly troublesome problem resulting from secondary inoculation (Figure 27-6). Erythematous or urticarial rashes may occur approximately 10 days after primary vaccination and, rarely, Stevens-Johnson syndrome occurs. Generalized vaccinia is characterized... 

In the past, about 1,000 people for every 1 million people vaccinated for the first time experienced reactions that, while not life-threatening, were serious. These reactions included a toxic or allergic reaction at the site of the vaccination (eiythema multiforme), spread of the vaccinia virus to other parts of the body and to other individuals (inadvertent inoculation), and spread of the vaccinia virus to other parts of the body through the blood (generalized vaccinia). These types of reactions may require medical attention. In the past, between 14 and 52 people out of every 1 million people vaccinated for the first time experienced potentially life-threatening reactions to the vaccine. Based on past experience, it is estimated that 1 or 2 people in 1 million who receive the vaccine may die as a result. Careful screening of potential vaccine recipients is essential to ensure that those at increased risk do not receive the vaccine. 

A widespread vaccinia rash. The virus spreads from the vaccination site through the blood. Sores break out on parts of the body away from the vaccination site (generalized vaccinia). 

---