Severe eczema vaccinatum in a household contact of a smallpox vaccinee

Surabhi Vora, Inger Damon, Vincent Fulginiti, Stephen G. Weber, Madelyn Kahana, Sarah L. Stein, Susan I. Gerber, Sylvia Garcia-Houchins, Edith Lederman, Dennis Hruby, Limone Collins, Dorothy Scott, Kenneth Thompson, John V. Barson, Russell Regnery, Christine Hughes, Robert S. Daum, Yu Li, Hui Zhao, Scott Smith & 9 others Zach Braden, Kevin Karem, Victoria Olson, Whitni Davidson, Giliane Trindade, Tove Bolken, Robert Jordan, Debbie Tien, John Marcinak

Research output: Contribution to journalArticle

130 Citations (Scopus)

Abstract

Background. We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine. The child's mother also developed contact vaccinia infection. Methods. Treatment of the child included vaccinia immune globulin administered intravenously, used for the first time in a pediatric patient; cidofovir, never previously used for human vaccinia infection; and ST-246, an investigational agent being studied for the treatment of orthopoxvirus infection. Serological response to vaccinia virus and viral DNA levels, correlated with clinical events, were utilized to monitor the course of disease and to guide therapy. Burn patient-type management was required, including skin grafts. Results. The child was discharged from the hospital after 48 days and has recovered with no apparent systemic sequelae or significant scarring. Conclusion. This case illustrates the need for careful screening prior to administration of smallpox vaccine and awareness by clinicians of the ongoing vaccination program and the potential risk for severe adverse events related to vaccinia virus.

Original languageEnglish (US)
Pages (from-to)1555-1561
Number of pages7
JournalClinical Infectious Diseases
Volume46
Issue number10
DOIs
StatePublished - May 15 2008
Externally publishedYes

Fingerprint

Kaposi Varicelliform Eruption
Smallpox
Vaccinia
Smallpox Vaccine
Vaccination
Vaccinia virus
Fathers
Infection
Orthopoxvirus
Eczema
Viral DNA
Atopic Dermatitis
Cicatrix
Immunoglobulins
Therapeutics
Vaccines
Mothers
Pediatrics
Transplants
Skin

ASJC Scopus subject areas

  • Immunology
  • Medicine(all)

Cite this

Vora, S., Damon, I., Fulginiti, V., Weber, S. G., Kahana, M., Stein, S. L., ... Marcinak, J. (2008). Severe eczema vaccinatum in a household contact of a smallpox vaccinee. Clinical Infectious Diseases, 46(10), 1555-1561. https://doi.org/10.1086/587668

Severe eczema vaccinatum in a household contact of a smallpox vaccinee. / Vora, Surabhi; Damon, Inger; Fulginiti, Vincent; Weber, Stephen G.; Kahana, Madelyn; Stein, Sarah L.; Gerber, Susan I.; Garcia-Houchins, Sylvia; Lederman, Edith; Hruby, Dennis; Collins, Limone; Scott, Dorothy; Thompson, Kenneth; Barson, John V.; Regnery, Russell; Hughes, Christine; Daum, Robert S.; Li, Yu; Zhao, Hui; Smith, Scott; Braden, Zach; Karem, Kevin; Olson, Victoria; Davidson, Whitni; Trindade, Giliane; Bolken, Tove; Jordan, Robert; Tien, Debbie; Marcinak, John.

In: Clinical Infectious Diseases, Vol. 46, No. 10, 15.05.2008, p. 1555-1561.

Research output: Contribution to journalArticle

Vora, S, Damon, I, Fulginiti, V, Weber, SG, Kahana, M, Stein, SL, Gerber, SI, Garcia-Houchins, S, Lederman, E, Hruby, D, Collins, L, Scott, D, Thompson, K, Barson, JV, Regnery, R, Hughes, C, Daum, RS, Li, Y, Zhao, H, Smith, S, Braden, Z, Karem, K, Olson, V, Davidson, W, Trindade, G, Bolken, T, Jordan, R, Tien, D & Marcinak, J 2008, 'Severe eczema vaccinatum in a household contact of a smallpox vaccinee', Clinical Infectious Diseases, vol. 46, no. 10, pp. 1555-1561. https://doi.org/10.1086/587668
Vora S, Damon I, Fulginiti V, Weber SG, Kahana M, Stein SL et al. Severe eczema vaccinatum in a household contact of a smallpox vaccinee. Clinical Infectious Diseases. 2008 May 15;46(10):1555-1561. https://doi.org/10.1086/587668
Vora, Surabhi ; Damon, Inger ; Fulginiti, Vincent ; Weber, Stephen G. ; Kahana, Madelyn ; Stein, Sarah L. ; Gerber, Susan I. ; Garcia-Houchins, Sylvia ; Lederman, Edith ; Hruby, Dennis ; Collins, Limone ; Scott, Dorothy ; Thompson, Kenneth ; Barson, John V. ; Regnery, Russell ; Hughes, Christine ; Daum, Robert S. ; Li, Yu ; Zhao, Hui ; Smith, Scott ; Braden, Zach ; Karem, Kevin ; Olson, Victoria ; Davidson, Whitni ; Trindade, Giliane ; Bolken, Tove ; Jordan, Robert ; Tien, Debbie ; Marcinak, John. / Severe eczema vaccinatum in a household contact of a smallpox vaccinee. In: Clinical Infectious Diseases. 2008 ; Vol. 46, No. 10. pp. 1555-1561.
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N2 - Background. We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine. The child's mother also developed contact vaccinia infection. Methods. Treatment of the child included vaccinia immune globulin administered intravenously, used for the first time in a pediatric patient; cidofovir, never previously used for human vaccinia infection; and ST-246, an investigational agent being studied for the treatment of orthopoxvirus infection. Serological response to vaccinia virus and viral DNA levels, correlated with clinical events, were utilized to monitor the course of disease and to guide therapy. Burn patient-type management was required, including skin grafts. Results. The child was discharged from the hospital after 48 days and has recovered with no apparent systemic sequelae or significant scarring. Conclusion. This case illustrates the need for careful screening prior to administration of smallpox vaccine and awareness by clinicians of the ongoing vaccination program and the potential risk for severe adverse events related to vaccinia virus.

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