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.
Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Complete Product Information.