Overview
Vaccinia virus (VACV) infections can occur through occupational exposure, vaccination, or experimental use, presenting as localized or disseminated disease. It is primarily managed in laboratory settings and during smallpox vaccination campaigns 1234.Diagnosis
Clinical Presentation: Rash, necrotic lesions, and systemic symptoms depending on the severity (localized vs. generalized/progressive vaccinia) 34.
Laboratory Tests: PCR, viral culture, and histopathology for definitive diagnosis 3.
Imaging: Not typically required unless assessing complications 6.
Case Definitions: Utilize Brighton Collaboration and CDC guidelines for adverse events like progressive vaccinia 4.Management
First-Line Treatments:
- Tecovirimat: First-line antiviral for severe cases, particularly progressive vaccinia 24.
- Topical Treatments: For localized lesions, including cleansing and wound care 3.
Adjunctive Treatments:
- Surgical Debridement: For necrotic lesions to prevent further spread 3.
- Supportive Care: Management of systemic symptoms and complications 4.Special Populations
Immunocompromised Individuals: Higher risk of progressive vaccinia; close monitoring and early antiviral intervention are crucial 4.
Pregnancy: Limited data; smallpox vaccination is generally avoided due to potential risks 2.
Elderly and Comorbidities: Increased susceptibility to complications; tailored monitoring and management strategies advised 3.Key Recommendations
Vaccination of Laboratory Workers: Vaccinate laboratory personnel handling replication-competent VACV according to ACIP guidelines to prevent infections 3. (Evidence: Strong)
Use of Tecovirimat: Employ tecovirimat as the primary antiviral treatment for progressive vaccinia and severe cases 24. (Evidence: Strong)
Enhanced Biosafety Measures: Implement rigorous biosafety protocols, including training and vaccination (when appropriate), following occupational exposures 3. (Evidence: Moderate)
Surveillance for Adverse Events: Utilize passive surveillance systems like VAERS to monitor and identify cases of generalized vaccinia post-vaccination 5. (Evidence: Moderate)
Monitor Immunocompromised Individuals: Closely monitor and promptly treat immunocompromised individuals exposed to VACV to prevent progression to severe forms 4. (Evidence: Moderate)References
1 Paul S, Croft NP, Purcell AW, Tscharke DC, Sette A, Nielsen M et al.. Benchmarking predictions of MHC class I restricted T cell epitopes in a comprehensively studied model system. PLoS computational biology 2020. link
2 Whitehouse ER, Rao AK, Yu YC, Yu PA, Griffin M, Gorman S et al.. Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick - San Diego, California, 2019. MMWR. Morbidity and mortality weekly report 2019. link
3 Hsu CH, Farland J, Winters T, Gunn J, Caron D, Evans J et al.. Laboratory-acquired vaccinia virus infection in a recently immunized person--Massachusetts, 2013. MMWR. Morbidity and mortality weekly report 2015. link
4 . Progressive vaccinia in a military smallpox vaccinee - United States, 2009. MMWR. Morbidity and mortality weekly report 2009. link
5 Bryant-Genevier M, O'Connell K, Ball R, Braun MM, McMahon A. Passive surveillance for generalized vaccinia in the United States using the Vaccine Adverse Event Reporting System (VAERS). Vaccine 2006. link
6 Fillmore GL, Ward TP, Bower KS, Dudenhoefer EJ, Grabenstein JD, Berry GK et al.. Ocular complications in the Department of Defense Smallpox Vaccination Program. Ophthalmology 2004. link
7 Crapp AR, Macbeth WA. Perianal vaccinia: a case report. The Australian and New Zealand journal of surgery 1976. link