[Active immunization and prevention of post-vaccination complications].
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Humans↗
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Lessons in giving vaccines: soft tissue complications of vaccinations.
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Adjuvants, Pharmaceutic↗
[Persistent and early post-vaccinal allergy; complications from BCG vaccination; benign mediastinitis caused by BCG].
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BCG Vaccine↗
[The effect of reduced doses of BCG vaccine on the occurrence of osseous complications after vaccination].
The authors present a review on the incidence of osseous complications after calmettization with the Soviet BCG vaccine during the period from February 1, 1980 and June 30, 1985 when the total dose of the vaccine was used, as compared with the period from July 1, 1985 to December 31, 1989 when the dose of the vaccine was reduced to half. During the first period 28 cases of the disease were recorded (on average 5 cases in every year of birth) which was an incidence of 3.71/100,000 vaccinated children. After reduction of the vaccine dose to half another 11 cases of the disease were recorded, i.e. a reduction of the incidence to 2.30/100,000 vaccinated children. During the last two years of this period only one case in each vaccinated birth year was notified. A major part of the children with bone complications after calmettization was vaccinated with a batch of vaccine which contained a higher number of germs, close to the upper range of normal values. In the development of these complications thus, no doubt, among other factors also the dose of vaccine participates. As bone complications occur after calmettization even after reduction of the dose of vaccine to half, though the incidence was lower, is should be considered whether the hitherto used dose used for vaccination of neonates is not too high.
BCG Vaccine↗
[Recurrent soft tissue infections after accidental inoculation with BCG vaccine].
Complications after BCG vaccine (bacilli Calmette-Guérin) occur rarely. They can reach from a local acute abscess to chronic ulceration's. Therapeutically concepts of these complications range from conservative to operative treatment. In the following case history recurrent soft tissue infections occurred after accidental inoculation with BCG vaccine. The time course of these recurrent infections with its therapeutic options is discussed and a treatment strategy is suggested. Currently, radical excision combined with antituberculotic treatment seems to be the most promising therapy of this specific soft tissue infection.
Antitubercular Agents↗
[Tuberculosis lupus after BCG vaccination. A rare complication of the vaccination].
BACKGROUND: Cutaneous reactions to BCG have rarely been a problem and BCG is one of the safest vaccines in use. CASE REPORT: Two children, 6 and 7 years old, developed local tuberculosis lupus 7 and 8 months, respectively, after BCG vaccination. Cutaneous changes cured after a treatment with isoniazid for 9 months in one case with observance of the treatment was uncertain in the other. CONCLUSION: Tuberculosis lupus is a rare complication of BCG vaccination. Its clinical features are identical to those of the vulgaris lupus. The diagnosis is based on clinical, pathology aspects and anamnesia. This complication should not be a contra-indication of BCG immunization.
Antitubercular Agents↗
Caseating regional lymphadenitis complicating BCG vaccination: a report of 6 cases.
Six infants had caseating regional lymphadenitis complicating BCG vaccination. There was a delayed onset and a lack of immediate vaccination complications. Three infants had frank abscesses. Additional affected nodes undetected clinically were found at operation in all cases. All lymph nodes contained tubercles, 3 showing acid-fast bacilli, 2 of which grew Mycobacterium bovis. Complete excision followed by antiuberculous chemotherapy produced satisfactory results.
Abscess↗
BCG lymphadenitis in an HIV-infected child 9.5 years after vaccination.
Complications of Bacillus Calmette-Guerin (BCG) vaccination have been reported in immunocompetent as well as in immunocompromised individuals. Severe and/or late complications have been associated with impairment of cell-mediated immunity. A case of BCG lymphadenitis in a vertically infected HIV-positive boy 9.5 years after vaccination is presented. The vaccination was performed within the first week of life, the HIV status of the mother being unknown. When the boy was 2.5 years old, his HIV infection was diagnosed after his mother had died from AIDS. At that time his CD4 count was 739 cells/microL. In the course of the following years, his CD4 count declined steadily, until it reached a low of about 20 cells/microL at the age of 5.5 years. He was troubled with recurring respiratory infections and one incidence of severe pancreatitis. Apart from that, he was in stable condition and led a more or less normal life. At the age of 9.5 years he developed lymphadenitis in his left axilla. The node was examined via biopsy, and the appropriate tests showed an infection with Mycobacterium bovis BCG variety. The CD4 count at that time was 16 cells/microL, polymerase chain reaction showed 220,000 RNA copies/mL. There were no signs of dissemination. Antitubercular agents were administered, and an antiretroviral combination therapy was started. The patient was discharged from the hospital after approximately 2 months. After an uneventful period of 9 months, the boy, still on antitubercular medicine, exhibited a secreting fistula in his left axilla, again due to Mycobacterium bovis, BCG variety. The fistulous tissue was removed surgically, and the antitubercular treatment was given intravenously for almost 3 months before being changed to an oral application. In addition, the antiretroviral regimen was completely exchanged. The case presented illustrates that there is a risk of very late complications in HIV-infected individuals, even when they are vaccinated when they are asymptomatic newborns. Although the risk seems low, one has to be aware of the problem because timely treatment is probably essential to prevent dissemination of the infection. Late complications of BCG vaccinations are most likely to be detected in countries with high medical standards, where HIV-infected children are surviving for longer periods of time.
Antitubercular Agents↗
Clinical efficacy of intramuscular vaccinia immune globulin: a literature review.
BACKGROUND: Numerous literature reports describe clinical efficacy of intramuscular vaccinia immune globulin (VIG) for complications of smallpox vaccination, prophylaxis of individuals with contraindications to vaccination, and prevention of smallpox among close contacts of patients with smallpox. METHODS: We reviewed the literature regarding VIG treatment and prophylaxis of smallpox vaccine complications and the use of VIG as a preventative measure for close contacts of patients with smallpox. RESULTS: Data regarding intramuscular administration of VIG for treatment of smallpox vaccine complications occurred in 16 articles, none of which reported formal controlled trials. The indications for treatment include generalized vaccinia, progressive vaccinia, eczema vaccinatum, and certain accidental implantations. Six publications suggest VIG efficacy for prophylaxis of vaccinial superinfection of eczema, burns, chickenpox, immunosuppression, pregnancy, or certain skin conditions. Prophylactic VIG has also been used in healthy military recruits to reduce the incidence of postvaccinial encephalitis. The use of intramuscular administration of VIG to prevent smallpox in contacts of patients with documented cases of smallpox is reported in 4 studies that compare contacts who received intramuscular administration of VIG with those who did not and in 1 observational study, with varying but promising results. CONCLUSIONS: Although controlled clinical trials do not exist to support the use of VIG for treatment of vaccinia-related complications or prophylaxis among individuals with contraindications to smallpox vaccination, available data suggest that VIG reduces morbidity and mortality associated with progressive vaccinia (vaccinia necrosum) and eczema vaccinatum. Furthermore, VIG seems to prevent vaccinial superinfection in patients with inflammatory skin diseases or burns, given the low incidence of vaccina-related complications associated with these conditions.
Antibodies, Viral↗
Genomic sequence and analysis of a vaccinia virus isolate from a patient with a smallpox vaccine-related complication.
BACKGROUND: Vaccinia virus (VACV)-DUKE was isolated from a lesion on a 54 year old female who presented to a doctor at the Duke University Medical Center. She was diagnosed with progressive vaccinia and treated with vaccinia immune globulin. The availability of the VACV-DUKE genome sequence permits a first time genomic comparison of a VACV isolate associated with a smallpox vaccine complication with the sequence of culture-derived clonal isolates of the Dryvax vaccine. RESULTS: This study showed that VACV-DUKE is most similar to VACV-ACAM2000 and CLONE3, two VACV clones isolated from the Dryvax vaccine stock confirming VACV-DUKE as an isolate from Dryvax. However, VACV-DUKE is unique because it is, to date, the only Dryvax clone isolated from a patient experiencing a vaccine-associated complication. The 199,960 bp VACV-DUKE genome encodes 225 open reading frames, including 178 intact genes and 47 gene fragments. Between VACV-DUKE and the other Dryvax isolates, the major genomic differences are in fragmentation of the ankyrin-like, and kelch-like genes, presence of a full-length Interferon-alpha/beta receptor gene, and the absence of a duplication of 12 ORFs in the inverted terminal repeat. Excluding this region, the DNA sequence of VACV-DUKE differs from the other two Dryvax isolates by less than 0.4%. DNA sequencing also indicated that there was little heterogeneity in the sample, supporting the hypothesis that virus from an individual lesion is clonal in origin despite the fact that the vaccine is a mixed population. CONCLUSION: Virus in lesions that result from progressive vaccinia following vaccination with Dryvax are likely clonal in origin. The genomic sequence of VACV-DUKE is overall very similar to that of Dryvax cell culture-derived clonal isolates. Furthermore, with the sequences of multiple clones from Dryvax we can begin to appreciate the diversity of the viral population in the smallpox vaccine.
Female↗
[Modern microbiological methods in diagnosis of adverse reactions after BCG vaccination. Case reports].
The attenuated bacilli Calmette-Guerin (BCG) vaccine is administered worldwide to prevent tuberculosis and is considered to have an excellent safety profile. In Poland, since 1955 BCG mass vaccinations have been compulsory. More than 95% newborns and 80% of older children of the population have been vaccinated. Complications of vaccination are uncommon. Although BCG has been used safely for many years, it can cause disease in humans, especially those with cellular immunodeficiencies. The risks associated with BCG vaccination include local complications, extraregional localized disease, and disseminated BCG disease. Identification of M. bovis BCG in laboratory is a very difficult process. Routine identification of mycobacterial isolates in clinical laboratories involves culture of Mycobacterium tuberculosis complex which includes M. tuberculosis, M. bovis, M. africanum and M. microti and the vaccine strain M.bovis BCG. Most laboratories cannot quickly differentiate between BCG and other members of M. tuberculosis complex and some cases of BCG complications in children may be considered and treated as tuberculosis. Because of difficulties in proper identification of BCG strains isolated from the patients, the prevalence of BCG infections is not know exactly. Knowledge of BCG infection would be of particular interest to the clinician responsible for the therapy. We describe the several methods using in mycobacterial laboratory for identification and suggest the modern algorithm of BCG strains identification including mycolic acids profile by HPLC and 14C PZA resistance methods. The methods allowed us fast and accurate identify M. bovis BCG infection in 5 children which have been described in our paper. Preliminary diagnosis for four children among five tested was tuberculosis. One immunocompromised HIV negative child died, one still excretes BCG bacilli. To our knowledge, this is the first report of BCG complication (AEFI) in Polish children in which HPLC and 14 C PZA methods have been used for rapid identification of M. bovis BCG infection and/or complication.
BCG Vaccine↗
[After vaccination for tick-borne encephalitis must onset of neurologic disorders be expected?].
In Austria at present more than 5 million people are vaccinated against tick-borne encephalitis (TBE), some of whom have received up to 8 vaccinations. Since introduction of the mass vaccination programme an estimated 18 million TBE vaccinations have been given in this country. Hence, the change coincidental occurrence of various illnesses which might be interpreted as possible vaccination complications is inevitable. However, the appearance of true vaccination complications in addition to chance concurrent disease cannot be ruled out a priori. In any given case it is very difficult, indeed virtually impossible, to differentiate between these two possibilities since there is no available test for confirmation or exclusion of vaccine complications. Mainly disturbances of the nervous system have been ascribed to preceding TBE vaccination. From the incidence of such diseases we calculated how often their occurrence should inevitably be expected during a two-month observation period after vaccination; only significantly higher figures can be accepted as representing vaccination complications. Very large controlled field studies would be required to provide unequivocal results. This enormous expense is barely justifiable and the required money could be better spent on other projects in the public health system. All studies to date and theoretical considerations show that the potential risk of TBE vaccination is extremely low. Experts of the Paul Ehrlich Institute (Germany) came to the conclusion that one certain case of neuritis arises after 1 million TBE vaccinations. Virological investigations show that virologically unclarified (and, hence, vaccine-induced) neurological disturbances do not occur more frequently in TBE vaccines than in unvaccinated persons.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies, Viral↗
[Oculo-palpebral complication of vaccination. Review of the literature].
Post-vaccination eyes and eyelid complications are seldom seen. Clinically different, they are not only due to the small-pox vaccination which is no longer performed but may also be seen with various kinds of viral vaccines as well as bacterial vaccines except for polymyelitis and tetanus. We believe that vaccination contraindications, direction for use and propylactic treatment are useful.
Bacterial Vaccines↗
Patients' interpretation of qualitative probability statements.
BACKGROUND: Physicians often use qualitative probability statements to compare treatment options or describe risks of treatment, especially if exact numerical information is not readily available. OBJECTIVES: To determine (1) the effect of context, experience, age, gender, race, occupation, and education on patients' numerical interpretation of probability terms and (2) patient preferences for information about side effects (qualitative or numerical). DESIGN: Cross-sectional survey. SETTING: A university-based family practice in Ann Arbor, Mich. PARTICIPANTS: Patients 18 years of age and older and parents of patients younger than 18 years of age seen during January and February 1993 for any reason except complete physical examination. METHODS: A questionnaire presented scenarios of minor and major complications related to four different medical conditions. Participants were asked to estimate how many people of 100 would have a complication if their physician described the risk for the complication in each scenario as unlikely. Participants were then asked whether they preferred receiving information from their physician about the risk for complications in words or numbers. RESULTS: Of 345 questionnaires distributed, 307 patients (89%) completed them. The rates assigned to the minor complications were significantly higher than the rates assigned to the major complications (P = .0001). Participants who had experienced the described complication reported significantly higher rates for the minor complications of vaccination and surgery (P = .0001 and P = .0235, respectively). Education had a significant effect only on the rates assigned to vaccination complications (P = .0069). Occupation had a significant effect only on the rates assigned to antibiotic side effects (P = .0090). CONCLUSIONS: When a physician uses qualitative probability statements, he or she must be sensitive to the patient's previous experience with that procedure or medication. Also, if one wants to convey the same potential rate of occurrence for major and minor side effects, then one needs to use different words for each.
Adult↗
Laboratory-acquired vaccinia infection.
BACKGROUND: Complications following vaccination with vaccinia virus have been well described but are not commonly observed. The use of vaccinia as a tool in molecular biology, in the development of therapeutics, and the anticipated increase of vaccinations in the general population due to the threat of bioterrorism have created a renewed awareness of the post-vaccination complications and the consequent need for clinical and laboratory diagnosis. OBJECTIVES: To report the clinical presentation and subsequent diagnosis of generalized vaccinia that resulted from a laboratory accident in an unvaccinated subject. STUDY DESIGN: The patient was seen by a local infectious disease's specialist and evaluated clinically and with laboratory support relative to a differential diagnosis. RESULTS: Careful assessment of the patient's history, an evaluation of the workplace, and the elimination of likely microbial etiologies led to the diagnosis of generalized vaccinia. Laboratory confirmation was obtained by use of electron microscopy (EM) to observe poxvirus particles in infected cell cultures. CONCLUSIONS: Exposure to vaccinia virus should raise the index of suspicion for patients with skin lesions. Rapid diagnosis may be accomplished by direct examination of lesion material by EM. The virus also readily replicates in commonly available cell cultures and in the absence of immune reagents, typical poxvirus particles may be observed in the infected cells by EM.
Adult↗
Smallpox vaccine and its stockpile in 2005.
Smallpox vaccine was the most important tool in the successful eradication of smallpox. In 1980, this achievement made it possible for all nations to cease smallpox vaccination. However, the threat of smallpox bioterrorism has made it necessary to reconsider the need for vaccination. Over the past 3 years, many nations have set up action plans for use in the event of such an attack. The setting up of these plans was not simple. Several factors needed to be considered, including the judgement of risk, vaccine complications, conventional vaccines versus new vaccines, optimal stockpile of smallpox vaccine, and its use for different target populations in different emergency situations. Here, I review measures taken by the USA, Japan, and other nations, and discuss likely national and global efforts in 2005 and subsequently, in view of the fact that half of the world's population is now apparently unvaccinated and that this proportion will increase with time.
Europe↗
[Neurological complications after vaccination against rabies as exemplified by 4 cases from Poznań province].
The author reports 4 cases of neurological complications following vaccination with cerebral-type lyophilized vaccine. The cases were observed in the Province of Poznań in the period from January to April 1984, and the patients were men aged 41 to 60 years with various clinical syndromes: Landry's ascending paralysis, polyradiculoneuritis, polyneuritis and encephalopolyradiculoneuritis. The high frequency of these complications (about 3%) might have been due to the high susceptibility of the vaccinated population, or to technical errors in the production of the vaccine leading to obtaining of a vaccine bath with a high immunoallergogenicity which could trigger off the complication in persons with individual predisposition.
Adult↗
[Lymphadenitis as a complication following vaccination with Bacillus Calmette-Guérin (BCG)].
A healthy 14-months-old boy developed suppurative adenitis some weeks after Bacillus Calmette Guérin (BCG) vaccination. The tumour grew rapidly, showed fluctuation and eventually incision was needed. Culture of the abscess was negative. The diagnosis was: regional lymphadenitis after BCG vaccination. This suppurative lymphadenitis is a non-serious complication of BCG vaccination and has been reported in 0.1 to 4% of those vaccinated. As the BCG vaccination is given only to the at-risk population in the Netherlands, BCG complications are rare. Non-suppurative nodal swellings are considered a normal post-vaccination reaction and do not require treatment.
BCG Vaccine↗