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Smallpox Vaccination

Mark Upfal, MD, MPH Detroit Medical Center Emergency Medicine Grand Rounds Detroit Receiving Hospital February 13, 2003. Smallpox Vaccination. Collaborators: Kay Cadwell, Pat Goins, Kathy Reilly. Topics. Smallpox vaccination & history Vaccine effectiveness Administration/Outcomes

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Smallpox Vaccination

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  1. Mark Upfal, MD, MPH Detroit Medical Center Emergency Medicine Grand Rounds Detroit Receiving Hospital February 13, 2003 Smallpox Vaccination Collaborators: Kay Cadwell, Pat Goins, Kathy Reilly

  2. Topics • Smallpox vaccination & history • Vaccine effectiveness • Administration/Outcomes • Revaccination

  3. Topics • Adverse Reactions • Treatment • Contraindications

  4. Topics • Smallpox & Vaccination History

  5. Smallpox

  6. Smallpox on trunk

  7. Pustules scabs scars

  8. Jenner 1798 Treatise on Vaccination

  9. Historic Timetable 1796 Dr. Jenner infects James Phipps w/ cowpox 1805 Use of cows to produce vaccine 1940s Freeze-drying technology 1949 Last US case of smallpox 1965 Licensure of bifurcated needle 1971 Routine vaccination stopped in US 1975 Last case of V. major in Bangladesh 1977 Last case of V. minor in Somalia 1983 Vaccine withdrawn from civilian market

  10. Topics • Smallpox vaccination & history • Vaccine effectiveness

  11. Protects against orthopox viruses • ATB’s w/in 10 days • Post-exposure – effective if given w/in 4-5 days

  12. Topics • Smallpox vaccination & history • Vaccine effectiveness • Administration/Outcomes

  13. Administration • No alcohol or prep • Dip into vial & pick up droplet btwn needle prongs • Never vaccinated: 3 rapid punctures perpendicular to skin, induces trace blood after 15-20” • Previously vaccinated: 3 rapid punctures perpendicular to skin, induces trace blood after 15-20” • Wipe off w/ gauze; dispose waste as biohazard

  14. Vaccine Administration

  15. Method of Administration Applied to the upper arm using a multiple-puncture technique with a bifurcated needle.

  16. Semipermeable Adhesive Dressing

  17. Infection control procedures

  18. Normal Vaccination Reaction Time

  19. Major reaction • Vesicular or pustular lesion or palpable induration surrounding a central crust or ulcer • Indicates success Equivocal reaction May be technique failure & no immunity Repeat vaccination

  20. Expected Outcome Pustular lesion 6-12 days Papules 3-5 days CDC recommends daily checks for HCWs Scab 13-21 days

  21. Topics • Smallpox vaccination & history • Vaccine effectiveness • Administration/Outcomes • Revaccination

  22. Revaccination • Those vaccinated in 1970’s may not be protected • May have fewer adverse reactions • Revaccinate researchers every 10 yrs if still working with the virus

  23. Topics • Adverse Events

  24. Smallpox Vaccination and Adverse Reactions Guidance for Clinicians January 24, 2003 / 52(Dispatch);1-29

  25. Common Side Effects • Local pain (30%), itching (80%) & erythema • Malaise • Low grade fever • Regional lymphadenopathy

  26. Adverse Events(1/800) • Autoinnoculation 529 per million • Generalized Vaccinia 242 per million • Eczema Vaccinatum 39 per million • Vaccinia necrosum 1.5 per million • Vaccinial Encephalitis 12 per million

  27. Autoinnoculation

  28. Autoinnoculation

  29. Autoinnoculation

  30. Autoinnoculation

  31. Generalized Vaccinia • Generalized vesicular skin lesions w/o eczema Hx or other preexisting skin dz • Believed 2o to viremia w/ dermal seeding • Usually minor; Few signif. sequelae

  32. Generalized Vaccinia

  33. Generalized Vaccinia

  34. Generalized Vaccinia

  35. Generalized vaccinia Child recovered without sequela

  36. Generalized Vaccinia

  37. Eczema Vaccinatum • Patients w/ h/o eczema • Generalized dermal spread • Rarely mild cases present only scattered individual lesions

  38. Eczema Vaccinatum • Can occur w/ inactive eczema • More severe in contacts • Contact almost always in household

  39. Pre-Tx Eczema Vaccinatum

  40. Post-Tx Eczema Vaccinatum

  41. Eczema vaccinatum

  42. Eczema Vaccinatum in a 27 yo

  43. Eczema Vaccinatum in a 22 yo

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