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PubMed1977

Human poxvirus disease after smallpox eradication.

A 5-year-old boy living in a small camp in the rural Ivory Coast had a disease resembling smallpox. This occurred 4 years after smallpox had been eradicated from the Ivory Coast and 1.5 years after the last case of smallpox was detected in West and Central Africa. Clinical, serological, and epidemiological evidence indicated this disease was probably monkeypox, a poxvirus of the variola/vaccina subgroup. A serologic survey of poxvirus antibodies in the wild animal population detected neutralizing antibodies in rodents, larger mammals, primates, and birds. The laboratory and ecological characteristics of poxviruses require further elucidation, especially those which have been found in animals near human monkeypox cases.

Adolescent↗
PubMed2004

Papular spongiotic dermatitis of smallpox vaccination: report of 2 cases with review of the literature.

We report 2 cases of nonspecific postvaccinial dermatitis following smallpox vaccination. The patients presented with diffuse, pruritic, erythematous macules and papules 11 days (case 1) and 7 days (case 2) following routine smallpox vaccination. Biopsies of the lesions demonstrated spongiotic dermatitis without evidence of viral cytopathic changes. One case showed a pityriasis rosea-like histologic pattern. The exanthema resolved without sequelae with symptomatic treatment (case 1). Review of historical literature demonstrated the association of a variety of nonspecific cutaneous complications with vaccinia inoculation, including erythema multiforme, urticaria, and pityriasis rosea. The association of these various dermatitides with smallpox immunization is not well known and is likely underreported.

Adult↗
PubMed1976

Smallpox vaccination and eczema.

Smallpox has disappeared from all countries except Ethiopia and the possibility of its eradication appears within reach. The need for vaccination of eczema patients against smallpox appears to be ending. Eczema vaccinatum is a rare but sometimes fatal complication of smallpox vaccination in atopic aczema and its incidence is discussed. Precautions in vaccinating atopic eczema patients include suitable treatment of the eczema, injection of vaccinial immunoglobulin and testing the competence of humoral and cellular immunity.

Child↗
PubMed1975

The minimum protective level of antibodies in smallpox.

Blood samples from 57 contacts of 6 smallpox cases were tested for haemagglutination-inhibiting (HI) and neutralizing antibodies. All 6 contacts who subsequently developed smallpox were unvaccinated and had neutralizing antibody titres of 10 or less. However, 6 unvaccinated contacts with similar antibody levels did not develop smallpox. None of the 41 vaccinated contacts, regardless of their antibody level, contracted the disease.

Adolescent↗
PubMed1975

Smallpox vaccination during pregnancy.

The obstetric outcome (abortions, stillbirths, prematurity, mature births, and congenital abnormalities) in a group of 1522 consecutive pregnant patients who had smallpox vaccinations during recent pregnancies was compared to that in a similar control group of 2024 consecutive pregnant patients who did not receive any antenatal vaccination. Results showed that smallpox vaccination during pregnancy did not increase the rate of stillbirths, premature births, or congenital abnormalities in patients who had been vaccinated at least once before. However, it was noted that women vaccinated during the first trimester of pregnancy more often had children with clubfoot. Therefore, unless there is an immediate risk, we recommend delaying smallpox vaccination during pregnancy until the second or third trimester. However, during epidemic, vaccination should be done regardless of gestational age.

Abortion, Spontaneous↗
PubMed2001

Smallpox nursing in Britain, Part II: Nursing care and nurse training.

Part I of this paper attempted to justify the need for this research for historical purposes, that is, to fill a gap in the history of nursing, and sought to raise awareness of possible bioterrorist activity with the smallpox virus. The disease process, now unfamiliar to most nurses, was briefly described, and reference was made to the change from a predominantly childhood to adult disease. The gradual removal of patients from home to hospital or other institutions was considered and the diverse nature of their attendants was discussed. Smallpox was then explained from two nursing perspectives: firstly, the concept of smallpox as a nurses' disease. In this, it was universally acknowledged that only nurses could make some difference to a patient's survival and minimal disfigurement, but secondly, in so doing, they put their own lives at risk. Examples were given of nurses who succumbed. Finally, some central and local government measures which endeavoured to prevent the spread of the disease were outlined. Part II focuses specifically on nursing care and training as it is through this medium that knowledge may be passed from earlier to present day nurses.

Disease Outbreaks↗
PubMed2003

SWOT analysis: strengths, weaknesses, opportunities and threats of the Israeli Smallpox Revaccination Program.

During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated "first responders" among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached, we conducted a SWOT analysis of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. SWOT analysis--a practical tool for the study of public health policy decisions and the social and political contexts in which they are reached--revealed clear and substantial strengths and weaknesses of the current smallpox revaccination program, intrinsic to the vaccine itself. A number of threats were identified that may jeopardize the success of the current program, chief among them the appearance of severe complications of vaccination. Our finding of a lack of a generation of knowledge on smallpox vaccination highlights the need for improved physician education and dissipation of misconceptions that are prevalent in the public today.

Contraindications↗
PubMed2003

Update: adverse events following smallpox vaccination--United States, 2003.

During January 24-March 28, 2003, smallpox vaccine was administered to 29,584 civilian health-care and public health workers in 54 jurisdictions as part of an effort to prepare the United States for a terrorist attack using smallpox virus. This report summarizes data on ten cases of cardiac adverse events reported among civilian vaccinees since the beginning of the smallpox vaccination program, including three new cardiac adverse events reported to CDC from the Vaccine Adverse a fall Event Reporting System (VAERS) during March 24-30. Fourteen cases of myocarditis and one fatal myocardial infarction have been reported among military personnel. This report summarizes data on the three new cases of cardiac adverse events, updates data on seven previously reported cases among civilian vaccinees (Table 1), summarizes selected cases of cardiac adverse events among military vaccinees, and updates information on all adverse events reported in the civilian vaccination program as of March 30.

Adult↗
PubMed2003

Supplemental recommendations on adverse events following smallpox vaccine in the pre-event vaccination program: recommendations of the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP) has issued recommendations previously for use of smallpox vaccine and supplemental recommendations for use of smallpox vaccine in the pre-event civilian vaccination program. On March 28, 2003, CDC reported cases of cardiac adverse events among persons vaccinated recently with smallpox vaccine. In response to these reports, ACIP held an emergency meeting on March 28 to make recommendations to CDC about medical screening of potential vaccinees and follow-up of persons with cardiovascular risk factors after vaccination. These recommendations supplement those previously issued by ACIP.

Cardiovascular Diseases↗
PubMed2003

Update on adverse events following civilian smallpox vaccination--United States, 2003.

During January 24-April 4, 2003, smallpox vaccine was administered to 31,297 civilian health-care and public health workers in 54 jurisdictions as part of an effort to prepare the United States for a possible terrorist attack using smallpox virus. This report updates information on all vaccine-associated adverse events among civilians vaccinated since the beginning of the smallpox vaccination program and among contacts of vaccinees, received by CDC from the Vaccine Adverse Event Reporting System (VAERS) as of April 4.

Adverse Drug Reaction Reporting Systems↗
PubMed1977

[Smallpox vaccine, then and now. From the "cow lymphe" to the cell-culture vaccine].

There have been few changes in the preparation of smallpox vaccine since Eduard Jenner described his method of preventive inoculation in 1798. Jenner's vaccine, "the matter", was maintained in man by arm to arm passage. The only major achievement in production methods was the introduction of an animal host for virus propagation. The skin of living calves or sheep was inoculated with seed virus and the "pulp" harvested three to four days later. The disadvantages of this procedure are evident: massive bacterial contamination in spite of rigorous cleanliness and excessive amounts of undesired tissue debris in the crude material to be used for vaccine production. In spite of these obvious disadvantages the method is still in use all over the world. Advances in tissue culture techniques have led to the production of all modern vaccines for use in animals and in the human from this substrate with low initial content of foreign protein and of primary sterility. The only exception today is conventional smallpox vaccine. Sporadic attempts to produce smallpox vaccine in tissue culture have been recently and successfully made in England, Holland and Yugoslavia. The Bavarian State Institute of Vaccination has adopted Vaccinia strain Elstree to primary cultures of chick embryo fibroblasts. The virus propagation in roller bottles permits the economical production of a high titered vaccine with a stability equal to that of calf origin. The cell culture harvest is bacteriologically steril and has a minimal content of foreign protein. Within the past two years this cell culture vaccine has totally replaced the old "calf lymph". Vaccination takes are equal, complications have so far not come to our attention.

Animals↗
PubMed2003

Smallpox vaccine: contraindications, administration, and adverse reactions.

Since the terrorist attacks of September 11, 2001, and the anthrax exposures in the following weeks, concern that smallpox could be used as a biologic weapon has increased. Public health departments and the U.S. military have begun the process of vaccinating soldiers and civilian first-responders. Smallpox vaccination carries some serious risks: approximately one in 1 million primary vaccinees and one in 4 million revaccinees will die from adverse vaccine reactions. The most serious side effects of smallpox vaccine include progressive vaccinia, postvaccinial central nervous system disease, and eczema vaccinatum. Some of these reactions can be treated with vaccinia immune globulin or cidofovir. Proper patient screening and site care are essential. Family physicians must learn to screen potential vaccinees for contraindications (e.g., immunodeficiency, immunosuppression, certain skin and eye diseases, pregnancy, lactation, allergy to the vaccine or its components, moderate or severe intercurrent illness) and to treat vaccine-associated adverse reactions.

Adverse Drug Reaction Reporting Systems↗
PubMed1961

Studies on the virus content of mouth washings in the acute phase of smallpox.

Epidemiological observations suggest that smallpox is not highly infectious in the febrile pre-eruptive period of illness. As virus is first discharged by most patients from lesions in the mouth or upper respiratory passages, mouth washings or garglings from smallpox patients in the acute stage of the disease were examined for virus. Only five specimens were obtained in the first two days of illness but no virus was recovered from them. Virus was most frequently found in specimens collected from the sixth to the ninth day of illness inclusive-a period when lesions in the mouth were breaking down and discharging virus. The results are in conformity with the view that the smallpox patient is most infective in the first few days of the eruptive phase of his illness.

Humans↗
PubMed1961

Comparison of dried vaccine with fresh Indian buffalo-calf lymph in revaccination against smallpox.

It was known that the liquid glycerinated buffalo-calf lymph issued for routine use in smallpox vaccination in Madras gave a high take rate in primary vaccination but that successful takes on revaccination amounted to less than 10%. In the course of studies on smallpox carried out in Madras, it was therefore decided to compare a potent freeze-dried English vaccine with the current Madras lymph by revaccinations carried out on persons admitted to the Madras Infectious Diseases Hospital for ailments other than smallpox. The take rate of the freeze-dried preparation in these tests was 63% as against 27% for the liquid preparation. It would seem that, in the conditions prevailing in Madras at the time of the tests, the local lymph is not sufficiently potent for successful revaccination or for maintaining the immunity of the population at a satisfactory level. The authors suggest that freeze-dried vaccine produced in embryonated eggs might be more effective and economical.

Animals↗
PubMed2003

Terror and triage: prioritizing access to mass smallpox vaccination.

In response to the threat of a smallpox attack on the United States, the Centers for Disease Control and Prevention ("CDC") recommended the establishment of smallpox clinics designed to distribute a vaccine to the entire U.S. population in a ten day period. However, a number of potential obstacles raise questions about the feasibility of this plan. What is needed is a plan that applies principles of triage to smallpox vaccine distribution following a bioterrorism attack. Only in this way can those most vulnerable--the previously unvaccinated--be protected from a significantly increased risk due to delays that might arise in executing the CDC plan.

Bioterrorism↗
PubMed2001

Vaccinia (smallpox) vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001.

These revised recommendations regarding vaccinia (smallpox) vaccine update the previous Advisory Committee on Immunization Practices (ACIP) recommendations (MMWR 1991;40; No. RR-14:1-10) and include current information regarding the nonemergency use of vaccinia vaccine among laboratory and health-care workers occupationally exposed to vaccinia virus, recombinant vaccinia viruses, and other Orthopoxviruses that can infect humans. In addition, this report contains ACIP's recommendations for the use of vaccinia vaccine if smallpox (variola) virus were used as an agent of biological terrorism or if a smallpox outbreak were to occur for another unforeseen reason.

Contraindications↗
PubMedDate not supplied

Public health nurses' views on voluntary smallpox vaccination.

Between January and June 2003, voluntary smallpox vaccination of healthcare workers and mandatory vaccination of military personnel was an important public health topic. This paper discusses the attitudes of nurses from two county public health departments in an upper-Midwestern state who were asked to volunteer to take the smallpox vaccine and to prepare to assist in the operation of possible mass immunization clinics. The responses of these healthcare professionals are compared to those of physicians and the general public. The public health nurses in this sample were less likely to view smallpox as a potential biological weapon than was the general public or other healthcare workers studied previously.

Attitude of Health Personnel↗
PubMed2004

[The real philanthropic expedition of the smallpox vaccine: monarchy and modernity in 1803].

Smallpox resulted in the death of 30 % of those who acquired it, so the preventive method discovered by Edward Jenner (London, 1798) spread very quickly. At the request in 1803 of Carlos IV, king of Spain, his government evaluated offers to carry smallpox vaccine to the colonies. The selected proposal, by doctor Francisco Xavier de Balmis, sought to take the lymph to America and Asia in a chain of arm to arm vaccination of foundlings. The Expedition set sail from Corunna on November 30, 1803, stopped in the Canary Isles, Puerto Rico, and Venezuela and after Caracas (1804) split in two groups. Balmis led some members of the Expedition to Cuba and Mexico. For the trip to the Philippines, in 1805, parents lent their children in exchange for economic compensation and the promise that the boys would be returned home. The Expedition returned to Mexico in August, 1807, but Balmis separately took vaccine to China and returned to Spain. Another contingent of the Expedition, under vice-director José Salvany, took vaccine to what we know as Colombia, Ecuador, Peru and Bolivia. His assistant Manuel Grajales reached the Chilean Patagonia in 1811. This article also comments on three principal themes - the institutional management of the scientific project, the conflicts that characterized its course, and the children's experience. The Vaccine Expedition was a brave and humanitarian endeavor, but also an extraordinary sanitary and administrative success. It was not until the twentieth century that a global eradication campaign eliminated smallpox in the world.

History, 19th Century↗