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At least 19 recordsLinked to original sources
PubMed1999

[Historical review of smallpox, the eradication of smallpox and the attenuated smallpox MVA vaccine].

After the WHO had declared smallpox to be eradicated in 1980, smallpox vaccination ceased to be carried out in humans all over the world. The cutaneous inoculations carried out with live vaccines based on the vaccinia virus from 1798 onwards protected both the global population and, indirectly, the animals living with humans against orthopox infections in general. A large percentage of humans and animals no longer enjoy this protection. Idiopathic orthopox in animals (reservoir possibly rats and mice) are thus experiencing a renaissance, posing a threat to humans and animals. The paper provides an historical retrospective of smallpox epidemics in humankind, their course of development and methods employed to combat this disease, commencing long before the birth of Christ with primitive attempts in China and India and from the end of the 18th century with increasingly enhanced methods, most recently with worldwide smallpox vaccination programmes using live vaccinia vaccines. Smallpox vaccination was always accompanied by a variety of complications, especially postvaccinal encephalitis. The MVA strain was developed to reduce or prevent such adverse effects. MVA has meanwhile proved its worth both as a parenteral vaccine against orthopox infections in humans and animals and as a vector for insertion of foreign genes. The history of smallpox, the fight against this disease and the development of MVA are documented with the help of figures and tables.

Animals↗
PubMed2003

Smallpox and smallpox vaccine: ocular and systemic risks and ethical uncertainties.

BACKGROUND: The threat of bioterrorism and use of biological weapons has drawn renewed attention to smallpox, and smallpox vaccinations have been resumed in the United States. Both smallpox and smallpox vaccine carry risk of potentially debilitating or fatal adverse effects. The optometrist must be familiar with the signs and symptoms of smallpox disease and complications of smallpox vaccine for proper management and preservation of vision. OVERVIEW: The literature on the ocular and systemic effects of smallpox and smallpox vaccination is reviewed to provide the practicing optometrist with an overview of the issues involved in case management. Recent guidelines have placed additional ocular-related contraindications to receiving the smallpox vaccine. Risk factors for complications arising from smallpox vaccination are discussed. A discussion of the ethical implications is also presented. CONCLUSIONS: Knowledge of the signs and symptoms of smallpox infection, and of adverse effects caused by smallpox vaccination, can provide the necessary background to help eye care providers make appropriate diagnoses and referrals. Understanding ethical and legal/Constitutional questions surrounding the risk of outbreak and various vaccination containment strategies will help optometrists make informed decisions as health care professionals, patient advocates, and concerned citizens, as well as weigh the risks and benefits of vaccination, if it is offered to them.

Contraindications↗
PubMed2003

The ocular complications of smallpox and smallpox immunization.

Although smallpox was eradicated worldwide, concerns have been raised about the use of smallpox as a biological weapon. Plans are being considered for smallpox immunization in the United States. Variola virus, the cause of smallpox, and vaccinia virus, used in smallpox immunization, are both orthopoxviruses that are associated with serious ocular complications, including eyelid and conjunctival infection, corneal ulceration, disciform keratitis, iritis, optic neuritis, and blindness. About 5% to 9% of patients with smallpox develop ocular complications, and case-fatality rates reach 20% to 35% among unvaccinated individuals. About 10 to 20 patients develop ocular complications per 1 million smallpox immunizations, usually through autoinoculation, in which the patient transfers vaccinia from the immunization site to the eye. The risk of ocular vaccinia infection may be reduced by instructing patients and individuals in close contact with the vaccinee to wash their hands often and avoid touching the immunization site and their eyes. Topical antiviral therapy, topical steroids, and topical and oral antibiotics have been used to reduce the ocular complications of smallpox immunization. In contrast, there has been little experience with the use of these therapies for the ocular complications of smallpox.

Biological Warfare↗
PubMed2004

Smallpox, vaccination and adverse reactions to smallpox vaccine.

PURPOSE OF REVIEW: Public fear of the reintroduction of smallpox as a biological weapon or agent of bioterrorism has led to a renaissance of interest in smallpox, and a military and public health vaccination programme in the USA. Clinical experience from the last century together with novel immunobiological findings is the basis for current knowledge on smallpox as a disease. Pre-existing knowledge on smallpox vaccination, plus recent vaccination campaign-derived data, is the basis of current risk-benefit assessments. This article summarizes, from a dermatologist's point of view, current aspects of smallpox, smallpox vaccination and adverse reactions to vaccinia, the live virus smallpox vaccine. RECENT FINDINGS: The smallpox vaccination campaign in the USA has involved over 600,000 vaccinees, and has largely confirmed incidence data on complications. An increased rate of myopericarditis is the new finding in the current vaccination campaign. Immunodeficiencies, manifest atopic dermatitis lesions and a history of atopic dermatitis remain contraindications to vaccination. Plasmacytoid dendritic cells are a key regulator of the human antiviral immune response and are recruited to inflamed skin in many skin diseases, but are depleted in atopic dermatitis lesions. The lack of plasmacytoid dendritic cell recruitment, together with the missing upregulation of antiviral peptides such as cathelicidin LL37 in atopic dermatitis lesions, is considered relevant for an atopic dermatitis patient's susceptibility to eczema vaccinatum. SUMMARY: Recent experience from the US smallpox vaccination campaign has largely confirmed what was known in the 1960s. Current immunobiological research will enhance our understanding of the interaction between poxviruses and the skin's immune system.

Diagnosis, Differential↗
PubMed2004

Anticipating smallpox and monkeypox outbreaks: complications of the smallpox vaccine.

BACKGROUND: The recent outbreak in the Midwest of monkeypox, as well as the continued fears of a terrorist-induced epidemic of smallpox, prompted the authors' review of the literature regarding past and current experiences with smallpox vaccination. The smallpox vaccine, which is highly effective in preventing the spread of both these orthopoxvirus infectious illnesses, might be administered to numerous health care workers and, in the event of a smallpox attack, millions of other citizens. However, vaccinees would be at risk for several vaccine-related neurologic complications. REVIEW SUMMARY: According to prior reports, neurologic complications have occurred in 2.5 per million US individuals, with the most common being postvaccinal encephalomyelitis (PVEM). In older children and adults, PVEM causes stupor and coma, seizures, paraparesis, and other neurologic and mental abnormalities, and, in 16% of cases, permanent neurologic sequelae. The overall mortality rate of neurologic complications is approximately 1.5 per million vaccinees. Risk factors for PVEM were age younger than 1 year and no previous smallpox vaccination, but not a prior episode of PVEM or other preexisting neurologic illnesses. Neither the current smallpox vaccination campaigns in Israel nor the one in the United States has had comparable complications, but the US campaign has been associated with myocarditis and myopericarditis. CONCLUSION: Although the potential neurologic complications of the smallpox vaccine must be weighed against the threat of monkeypox and smallpox, current experience with vaccination suggests it carries a very low risk of neurologic complications and does not lead to exacerbations of chronic neurologic illnesses.

Animals↗
PubMed2006

Pediatricians knowledge, views, and perspectives on smallpox and smallpox vaccine.

Increasing concerns regarding smallpox as a biologic weapon have led to massive production of vaccinia vaccine and targeted vaccination campaigns. A regional mail survey was conducted among pediatricians to assess their knowledge and perceptions on smallpox and smallpox vaccine. Fifty-nine percent of the responders were unable to differentiate chickenpox from smallpox, and the majority would not accept vaccination in the absence of an outbreak and would not recommend smallpox vaccine to their patients. Even in previously vaccinated pediatricians, willingness to receive smallpox vaccine is poor and vaccination campaigns in the absence of a smallpox outbreak may not be successful.

Chickenpox↗
PubMed2003

Women with smallpox vaccine exposure during pregnancy reported to the National Smallpox Vaccine in Pregnancy Registry--United States, 2003.

In the absence of circulating smallpox, pregnant women should not be exposed to live vaccinia virus contained in the smallpox vaccine. The smallpox vaccine should not be administered to women who are pregnant or might become pregnant within 4 weeks after vaccination because of the risk for fetal vaccinia, a rare but serious infection of the fetus. In addition, persons who have close contact (e.g., household contact or sexual contact) with pregnant women are advised to forego vaccination. To prevent inadvertent exposure of pregnant women to vaccinia virus, screening for pregnancy is a component of pre-event smallpox vaccination programs. To monitor outcomes of pregnancy in women exposed to smallpox vaccines, CDC, in collaboration with the Department of Defense (DoD) and the Food and Drug Administration (FDA), has established the National Smallpox Vaccine in Pregnancy Registry. This report summarizes data from the registry about these exposures. CDC and the Advisory Committee on Immunization Practices (ACIP) recommendations to screen for pregnancy as a contraindication to smallpox vaccination appear to be effective at preventing inadvertent exposures.

Adult↗
PubMed1979

[Abolition of compulsory vaccination against smallpox. Increased danger to humans from animal smallpox? (author's transl)].

After the world-wide eradication of human smallpox, compulsory vaccination against smallpox will no longer be applicable in future in most countries. Although the human smallpox virus (variola virus) appears to have no animal reservoir, humanity is increasingly endangered in future by animal smallpox viruses pathogenic in man against which he has been so far protected by the general smallpox vaccination. This is a virus type of the Genus Orthopox virus. The risk from animal pox viruses, which are not related to the Orthopox virus, remains unchanged. Of the animal Orthopox viruses the monkey pox viruses deserve special attention; possibly rodents also play a decisive role in transmission of smallpox.

Animals↗
PubMed2003

Smallpox Vaccine Injury Compensation Program: Smallpox (Vaccinia) Vaccine Injury Table. Interim final rule.

The Smallpox Emergency Personnel Protection Act of 2003 (SEPPA), Public Law 108-20, 117 Stat. 638, authorized the Secretary of Health and Human Services (the Secretary), through the establishment of the Smallpox Vaccine Injury Compensation Program (the Program), to provide benefits and/or compensation to certain persons who have sustained injuries as a result of the administration of smallpox covered countermeasures (including the smallpox vaccine) or as a result of vaccinia contracted through accidental vaccinia inoculations. The SEPPA directed the Secretary to establish, by interim final rule, a table identifying adverse effects (including injuries, disabilities, conditions, and deaths) that shall be presumed to result from the administration of or exposure to the smallpox vaccine, and the time interval in which the first symptom or manifestation of each listed injury must manifest in order for such presumption to apply. As mandated by law, the Secretary is establishing such a Smallpox (Vaccinia) Vaccine Injury Table (the Table) through this interim final rule. The Secretary is also establishing a set of Table Definitions and Requirements, which define the terms and conditions included on the Table and are to be read in conjunction with the Table. The Secretary is seeking public comment on the Table established through this interim final rule. At a later date, the Secretary will publish a companion final rule setting forth the administrative implementation of the Program. The public will then be afforded an additional opportunity to comment on the procedures set forth therein.

Compensation and Redress↗
PubMed2004

Bichat guidelines for the clinical management of smallpox and bioterrorism-related smallpox.

Smallpox is a viral infection caused by the variola virus. It was declared eradicated worldwide by the Word Health Organization in 1980 following a smallpox eradication campaign. Smallpox is seen as one of the viruses most likely to be used as a biological weapon. The variola virus exists legitimately in only two laboratories in the world. Any new case of smallpox would have to be the result of human accidental or deliberate release. The aerosol infectivity, high mortality, and stability of the variola virus make it a potential and dangerous threat in biological warfare. Early detection and diagnosis are important to limit the spread of the disease. Patients with smallpox must be isolated and managed, if possible, in a negative-pressure room until death or until all scabs have been shed. There is no established antiviral treatment for smallpox. The most effective prevention is vaccination before exposure.

Bioterrorism↗
PubMed2005

Monitoring health care workers after smallpox vaccination: findings from the Hospital Smallpox Vaccination-Monitoring System.

BACKGROUND: The Advisory Committee on Immunization Practices and the Healthcare Infection Control Practices Advisory Committee recommended that hospitals establish on-site, daily assessments of health care workers vaccinated with smallpox vaccine. The Hospital Smallpox Vaccination Monitoring System (HSVMS) was 1 component of the smallpox vaccination plan to monitor adverse events on-site in hospitals. This report presents findings from February to August 2003. METHODS: All US institutions participating in the smallpox vaccination program were eligible to enroll in and use HSVMS through the Internet-based Centers for Disease Control Secure Data Network. RESULTS: Of the 730 enrolled vaccinees, 341 (47%) were nurses; 122 (17%) physicians; 75 (10%) laboratory, patient care, radiology, or other technicians; 39 (5%) administrators; 22 (3%) housekeepers; 21 (3%) physical or respiratory therapists; 20 (3%) infection control professionals; 19 (3%) safety or security staff; and 17 (2%) epidemiologists; and 54 (7%) were workers in other job categories. Most (86%) vaccinees had been previously vaccinated. Postvaccination signs and symptoms were frequent: itching (75.2%), pain at the vaccination site (31.6%), swollen or tender lymph nodes (26.4%), fatigue (26.2%), and headache (20.8%). Symptoms were highest during the first week after vaccination; symptoms were more frequently reported among vaccinees without previous vaccination. Adherence to recommended vaccination site care was reported in 2732 of 3091 (88.4%) follow-up visits among workers with patient contact. Of the 4379 days workers planned to work, during 31 (0.7 per 100) days, workers performed restricted activities, and, in 60 (1.4 per 100) days, workers were absent. CONCLUSIONS: Findings from HSVMS indicate that adherence to post-smallpox vaccination site care was high and that the number of days of work affected was low.

Health Personnel↗
PubMed2006

Still protected against smallpox? Estimation of the duration of vaccine-induced immunity against smallpox.

BACKGROUND: Although the potential for bioterrorism has led to discussions on the durability of vaccine-induced immunity, the actual duration of protection against smallpox is still unknown. It has previously been suggested that at least partial protection against severe and fatal smallpox may persist throughout life. METHODS: In this article, we analyzed 6 major smallpox outbreaks that occurred before and after 1900 in the United Kingdom. These analyses are based on the age-dependent incidence of smallpox and the fraction of severe manifestations among individuals with or without prior vaccination. We used a likelihood-based approach to estimate the duration of immunity from the age-specific frequencies. RESULTS: The expected median duration of protection from disease ranged from 11.7 to 28.4 years after primary vaccination, and the qualitative pattern of duration could be described using Gompertz's Law. Vaccinated individuals appear to have been protected from severe disease with more than 50% probability even 50 years after successful primary vaccination. CONCLUSIONS: These findings suggest that successful primary vaccination offered full protection for a few decades, with partial protection from severe smallpox possibly lasting a lifetime, for a substantial fraction of the population.

Age Factors↗
PubMed2005

Safety profile of smallpox vaccine: insights from the laboratory worker smallpox vaccination program.

BACKGROUND: The frequency of mild-to-moderate adverse events following smallpox vaccination was not well documented or reported during the pre-eradication era. This report describes the frequency of such symptoms among 936 adult smallpox vaccinees with and without a history of prior smallpox vaccination. METHODS: Diary cards were distributed to 1006 laboratory workers and members of the Centers for Disease Control and Prevention (CDC) smallpox response team who received smallpox vaccination under an investigational new drug protocol during 2001-2002. Vaccinees were requested to complete the diary card daily and return it to the CDC 28 days after vaccination. The proportion of vaccinees reporting symptoms was determined and compared among subgroups. RESULTS: Ninety-three percent of the diary cards were returned. The most common symptom reported was "itching at vaccination site." Primary vaccines reported statistically higher proportions of the following 11 symptoms: joint pain (25% vs. 11%; P=.0011), muscle pain (46% vs. 19%; P<.0001), fatigue (43% vs. 29%; P=.0161), swelling at vaccination site (58% vs. 33%; P<.0001), itching on the body (31% vs. 17%; P=.0048), abdominal pain (11% vs. 2%; P=.0012), swollen or tender lymph nodes (71% vs. 33%; P<.0001), pain at injection site (48% vs. 30%; P=.0018), headache (40% vs. 25%; P=.0088), backache (17% vs. 7%; P=.0090), and fever (temperature, >or=100 degrees F [37.7 degrees C]; 20% vs. 9%; P=.0047). CONCLUSIONS: This analysis suggests that previously unvaccinated persons aged <30 years experienced more symptoms than did previously vaccinated persons. The findings of increased proportions with joint pain, abdominal pain, backache, and difficulty breathing were unexpected. As with recently described cardiac adverse events, these symptoms are suggestive of systemic involvement and warrant further study.

Adolescent↗
PubMedDate not supplied

[Results of examining wild monkeys for the presence of smallpox antibodies and smallpox group viruses].

The results of examinations of sera, blood and organs of different species of monkeys from some Asian and African countries for the presence of antibody to smallpox and viruses of the smallpox group. Significant titers of smallpox antibodies (antihemagglutinins virus-neutralizing and, in some cases, precipitating antibody) were found in a considerable number of monkeys shot near foci with human cases (Equatorial province of Zair Republic). In the same monkeys kidney tissues yielded 3 isolates of smallpox virus group two of which were indistinguishable in the laboratory tests from variola virus. On the basis of these data it is concluded that smallpox viruses circulate among wildlife monkeys in some areas of Equatorial Africa. Further studies along these lines are necessary.

Africa↗
PubMed2001

[Smallpox and smallpox virus--200 years since the first vaccination in Norway].

In December 1801, the first vaccination against smallpox in Norway took place. Vaccine material came from Denmark, England, Ireland, and other countries; it was also obtained from a few local cowpox cases. What mattered was the effect, not the origin. Several reports indicate that variola virus itself, the cause of smallpox, was also used for human vaccination after passages through cows and horses. A vaccine institute for production of vaccine in calves was established in Kristiania in 1891. Cowpox was once a rare disease in cattle, but a total of 70,985 bovine cases were reported between 1889 and 1928. The source of infection was thought to be humans vaccinated against smallpox. Pox-like diseases were also registered in horses, pigs, sheep, goats and dogs at that time. Compulsory vaccination continued in Norway until 1976; smallpox is now eradicated. During the last decades, however, cowpox virus infections have re-emerged among zoo animals, domestic cats and humans in Western Europe, with small wild rodents and shrews as wildlife reservoirs. Vaccinia virus is also met with new interest as a vector in recombinant vaccines. Given the fact that the human population no longer has immunity against orthopoxviruses and the new possible exposure through pets and wildlife, it may be appropriate to reflect on poxvirus history in Norway in the light of the present situation.

Animals↗
PubMed2002

Duration of immunity after smallpox vaccination: a study on vaccination policy against smallpox bioterrorism in Japan.

The success of global smallpox eradication in 1980 led all the nations of the world to discontinue smallpox vaccination. To date, however, the threat of deliberate release of smallpox virus has led health authorities to reconsider smallpox vaccination and at the same time, to urge to evaluate duration of the immunity of the population vaccinated before 1980. Although available data is scarce and incomplete, the study suggests that protective immunity lasts longer in a good percentage of vaccinees, although the real percentage and duration are not known. Accordingly, how to establish a national vaccination policy for preparedness in Japan and elsewhere was discussed. The study is intended to cause interest and debate among the medical and public health community.

Bioterrorism↗
PubMed1977

[Persistant danger of smallpox and necessity of continuing mandatory smallpox vaccination in France].

The WHO stated a short time ago that the total eradication of smallpox would occur shortly. This announcement has been contradicted by an epidemic of smallpox in Somaila which in spite of the energetic measures taken, remained in the capital from August 1976 to January 1977 then extended to 10 regions out of 16 with from January 1977 to 18 June 1977, 1 567 cases of smallpox. This is only a provisional estimation as it is increasing every week. In view of the ease and rapidity of airline communication, it is very possible that infected subjects or products arrive in France, it is necessary for doctors to be warned and counteract the present tendancy to neglect the legal requirement for smallpox vaccination.

Animals↗