Also, see CDC site for medical management of adverse reactions to vaccinia vaccination.
1st Line Agent
2nd Line Agent
Comment: Given rising incidence, instructive to be fully up to date on diagnosing atopic dermatitis/eczema if administering smallpox vaccine.
Comment: Helpful images and directions regarding immunization with vaccinia (currently ACAM2000) regarding indications, exclusions, diagnosis of vaccina complications and management of adverse reactions.
Comment: This investigational vaccine did not appear to cause EV when administered to patients (n = 45) with either allergic rhinitis or atopic dermatitis. The MVA is not thought to significantly replicate within the skin.
Comment: Report of EV in a non-vaccinee who had atopic dermatitis and likely acquired from a sexual encounter with a recently immunized military person.
Comment: In this murine model, blocking IL-17 appeared to replicate severe skin lesions which these authors say implicates a role for NK cells in the pathogenesis potentially in humans with atopy, etc.
Comment: Severe case of eczema vaccinatum in a child of vaccinated Iraq soldier on leave after smallpox vaccination. The child had eczema and was critically but survived with vaccinia IG, cidofovir, ST-246 and skin grafts.
Comment: Genotyping of patients with severe reactions to smallpox vaccination showed single nucleotide polymorphisms in the interferon regulatory factor-1 gene in those with severe reactions.
Comment: Review of ACAM 2000 which was FDA approved as a suitable replacement for Dryvax in the event of bioterrorism in 2007.
Comment: Among 407,923 there were 30 reported cases of contact vaccinia. Most were "bed partners" - 12 spouses and 8 adult friends. There were no transmissions to health care workers or pts. The rate with primary vaccinees was 7.4/100,000 and for secondary vaccines, it was 5.2/100,000 (this may be underreported, but the data may be better in the military population and the paucity of children compared to prior experience is striking).
Comment: The frequency of atopic dermatitis is 0.8% involving 2.3% of households. History will miss 30-40%.
Comment: Review of contact vaccinia, which is the transmission of this virus to others. Risk is close contact nearly always household contact, occasionally in hospitals. Frequency from the 1960’s was 20-60/mil vaccinees. Disease in recipient depends on host-the the greatest risks are vaccinia necrosum in persons w/T cell, cell defects & eczema. Vaccination in persons w/eczema was a major risk. This accounted for most vaccine-associated deaths and most uses of VIG. The greatest risks were young age & primary vaccination. The risk of EV is thought to be substantially increased due to an increased rate of atopic dermatitis.
Comment: Cidofovir is active in vitro vs. vaccinia and all other poxviruses. Clinical data are limited to case reports of treatment of molluscum contagiosum and orf.
Comment: Review of the disease. The last case was 1977; last in the U.S. was 1949. SP vaccination stopped in the US in 1971 so few (< 30yrs have been vaccinated). The vaccine is highly effective for 5-10yrs. Disease is acquired by inhalation. Contagious primarily at the rash stage or about 3wks.
Comment: Mice were challenged with cowpox and treated with cidofovir that was 100% effective at 30mg/kg/d.
Comment: This study showed a prevalence of atopic dermatitis to be 7-17%.
Comment: The MIC50 for cidofovir vs. vaccinia was 1.32 mcg/ml.
Comment: Atopic dermatitis is associated with reduced CMI, defective antibody-dependent cellular cytotoxicity, reduced immunoregulatory T cells, elevated IgE, and high incidence of IgE mediated responses to skin tests to common inhaled antigens.
Comment: A case report of lethal EV in a 4-month-old with "allergic dermatitis". Skin lesions showed vaccinia was cytoplasm of cells at the stratum malpighii of the dermis + neutrophils and macrophages. The virus was also cultivated.
Typical rash of EZ.
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