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In keeping with current standards, we urge that old smallpox vaccines that were made in animal skin and are still a key part of our strategic national stockpile be tested for adventitious infectious agents. The advisory especially applies to viruses that have the potential for zoonotic transmission to human vaccine recipients.
A historical study evaluated maternal outcomes in pregnancy complicated by smallpox. The overall case fatality was estimated to be 34.3% (95% confidence interval [CI] 31.4-37.1), and the proportion of miscarriage or premature birth was estimated to be 39.9% (95% CI 36.5-43.2). Vaccination before pregnancy reduced the risk for death.
The threat of bioterrorism with use of viruses is increasing. Smallpox, encephalitis, and hemorrhagic fevers are the most likely diseases to result from viral deployment. It is critical that all healthcare professionals become familiar with the clinical presentation, diagnosis, management, and prevention of these diseases. Awareness and preparedness are instrumental in reducing viral transmission and improving survival of the victims.
The proportion of T and B cells in the peripheral blood of smallpox patients was determined. The average initial percentage of T cells was depressed (41 +/- 8.4%) in comparison with uninfected controls (65 +/- 7.6%), while the initial B cell counts averaged 26 +/- 11.4% and 28 +/- 5.1%, respectively. However, initial B cell percentages in four infected patients (two of whom died) were between 9 and 14, which are considerably lower than any control value, the lowest of which was 19%. Review of the literature emphasizes the both cellular and serological immunity play a role in recovery from pox disease; the two patients who had the highest initial nul cell (lymphocytes not identified as either T or B cells) counts died, while none of five patients who had consistently low nul cell counts died.
The comparative study of the specimens of the morphological elements of exanthema obtained from 8 children with the clinical diagnosis of secondary exogenic vaccinia, dried smallpox vaccine and the cultures of other orthopoxviruses (rabbit pox, monkey pox and buffalo pox viruses) was made. The isolation and identification of the causative agents from the specimens was carried out with the use of modern virological, electron microscopic and molecular methods. The study proved the fact that 8 children had orthopoxvirus infection with its causative agent identified as vaccinia virus.
Sixty-two volunteers were studied to determine their local cutaneous, serologic, and virologic reactions to smallpox revaccination. Of 55 subjects available for examination, 45 (82%) had major cutaneous reactions. Subjects over 30 years old were more likely to have a major reaction. An increase in complement-fixing antibody titer was found in 74% of revaccinees with a major reaction. An increase in complement-fixing antibody titer was found in 74% of revaccinees with a major cutaneous reaction and is felt to be the best serologic indicator revaccination did not yield vaccinia virus. Cultures of the vaccination site demonstrated the virus to be present for a mean of 7.8 days (range 0--18 days) which coincided with separation correlate with antibody response. However, subjects vaccinated more than 3 years previously and subjects with major skin reactions shed vaccinia virus for longer periods than those vaccinated less than 3 years previously or who had equivocal reactions.
In updated recommendations, a Centers for Disease Control and Prevention advisory committee says that a small group of predesignated personnel should receive smallpox vaccinations, but not the general public or other health care workers. Some managers insist that any group who could be exposed without advance notice should be vaccinated. There is a concern about time off for vaccination if an exposure occurs. The risk of side effects is a concern.
The Author explains some anomalous reactions in adult, after revaccination smallpox, represented by delay in the loss of the crust and in the lack of the cicatrice.
New recommendations for smallpox vaccination have addressed key concerns of emergency department (ED) managers. The program would be voluntary. Vaccinated staff would not be quarantined. Fifteen or more ED staff members at each hospital would receive the vaccine as part of a total team of 40 or more, with the exact number varying according to individual needs.
With recent events, the threat of bioterrorism has become a reality. In late 2001, multiple cases of cutaneous and inhalation anthrax were spread through the US mail. On the front line were dermatologists who diagnosed the first cases of cutaneous anthrax in New York City. Since then, physicians who are unsure if they are facing a new form of bioterrorism frequently have consulted dermatologists to evaluate rashes. Because most biological weapons (anthrax, tularemia, plague, smallpox) can have cutaneous manifestations, dermatologists will continue to have an important role in evaluating these potential threats.
A study was carried out on the humoral response and vaccinal reaction after repeated administration of the smallpox vaccine (1 to 3 times), at ten days interval, to 97 subjects with a past history of repeated vaccination failures. Revaccination ended in 52.6% failures. After revaccination the antibody titer increased in 97.8% of the cases of successful vaccination and in 43.5% of the negative cases. In 29.5% of the latter cases a decrease in the antibody titer by 1--3 binary dilutions was found. The results suggest that the repeated application at short intervals of an antigenic stimulus perturbs the immune response.
A product of the fear stirred by variola and the need to avoid contagion and spread of the disease, smallpox immunization has been a longstanding practice around the world, applied in different forms in different societies. Three methods have been used in Brazil-'variolization', Jennerian vaccination, and animal vaccination- prompting profound discord within the national medical community. The article endeavors to identify the main points of these debates, as found in the Gazeta Médica da Bahia and the Gazeta Médica do Rio de Janeiro, periodicals of note at the time and important spaces where those wielding medical knowledge and power sought legitimacy.
The 1945-1955 smallpox epidemic was the last in Europe while until 1977 there were numerous epidemics each year in East-Africa, South Asia, and Vietnam. In 1954 the disease was brought in France by a soldier who came back from Vietnam. As his child was sent to hospital in Vannes the illness spread out of the hospital due to a lack of preventive vaccination among the child population. Some members of the medical staff were ill and one of them died. Severe measures were undertaken and the virus disappeared four months after the beginning of the epidemic in Finistere and two months in Morbihan. On the other hand the preventive vaccination was very efficient except for the first cases. Isn't an argument in favour of vaccination for all young members of aid agencies?
The US cases of anthrax in 2001 and the recent severe acute respiratory syndrome outbreak have heightened the need for preparedness and response to naturally emerging and re-emerging infections or deliberately released biological agents. This report describes the response model of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (INMI), Rome, Italy for managing patients suspected of or affected by smallpox or viral haemorrhagic fever (VHF) either in the context of an intentional release or natural occurrence. The INMI is Italy's leading hospital in its preparedness and response plan to bioterrorism-related infectious agents. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available. Biomolecular and traditional diagnostic assays are currently performed in the biosafety level 3/4 (BSL 3/4) laboratories. Continuing education and training of hospital staff, consistent application of infection control practices, and availability of adequate personnel protective equipment are additional resources implemented for the care of highly infectious patients and to maintain the readiness of an appropriately trained workforce to handle large scale outbreaks.
On the basis of comparative experimental evaluation of specific features in the course of the vaccinal process after the immunization of laboratory animals with live smallpox vaccines, intended for oral use (in tablets) and for skin scarification was proposed. In experiments on rabbits, made with the use of virological and immunological methods, the counteraction of the elements constituting the vaccinal process was analyzed, the integral evaluation of its course was given, the greater safety of the oral preparation in comparison with the traditional vaccine for immunization by skin-scarification method were established. The conclusion was made that oral immunization was the safest immunization method under modern conditions and promising one for using live vaccines with population immunity being at a low level or absent.
These revised recommendations on vaccinia (smallpox) vaccine update the previous recommendations (MMWR 1985; 34:341-2) and include current information on its use among laboratory and health-care workers occupationally exposed to vaccinia, recombinant vaccinia viruses, and other orthopoxviruses that can infect humans. This report also contains revised recommendations on revaccination of high-risk workers and information on contraindications to vaccination.
More than 400 papers on medicinal chemistry were presented at the 231st National Meeting of the American Chemical Society in Atlanta, Georgia, U.S.A., March 26-30, 2006. A major focus was a large number of papers on new AIDS drug therapies being developed. The rapid development of HIV viral mutations is one reason expensive highly active antiretroviral therapy multidrug treatments are preferred. This increasing resistance of HIV to current drugs is spurring new drug development. In addition, concerns about bioterrorism have awakened interest in drug treatments for a viral disease once thought to be extinct, smallpox. This report will focus on these areas of research.
Virological and immunofluorescent methods were applied to the study of the distribution of the smallpox vaccine virus in the organs and tissues of rabbits immunized orally. It appeared that the vaccinal process developed with a predominant localization of the antigen in the regional (in respect to the site of administration) lymph nodes; the virus was revealed in the cell cytoplasm.