eMedicine Specialties > Infectious Diseases > Viral Infections

Vaccinia: Follow-up

Author: Tasneem A Poonawalla, MD, Staff Physician, Department of Internal Medicine, University of Texas Medical Branch at Galveston
Coauthor(s): Dayna Diven, MD, Clinical Professor, Department of Dermatology, University of Texas Medical Branch at Galveston; Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University; Ken Flanagan, BS, Department of Microbiology and Immunology, Albert Einstein College of Medicine
Contributor Information and Disclosures

Updated: Aug 24, 2006

Follow-up

Further Inpatient Care

  • Patients with minor complications related to vaccinia immunization usually can be treated in the ambulatory setting. Severe complications require hospital admission and supportive intervention.
  • Infected patients should be isolated in a reverse airflow setting until the diagnosis is confirmed. These patients should avoid contact with other immunosuppressed persons (eg, persons with neutropenic cancer, HIV infection). These patients also should avoid contact with pregnant women, individuals with eczema, and young children.
  • Note that health care workers, including nurses, phlebotomists, house staff, and nutritionists, also should avoid direct contact with infected patients.

Further Outpatient Care

  • Immunocompetent individuals with generalized vaccinia require supportive care and isolation from immunocompromised individuals until the infection resolves.
  • Less severe complications (eg, accidental infections) can be treated expectantly in the outpatient setting, provided the patient can avoid contact with high-risk individuals.

Deterrence/Prevention

  • Avoiding vaccination of high-risk individuals can prevent vaccinia complications. Recent vaccinees also should avoid high-risk individuals for 10-14 days after vaccination. High-risk individuals include people with eczema, pregnant women, young children, and immunosuppressed individuals.
  • Current guidelines recommend that vaccinees defer blood donation for 21 days after vaccination or until the scab separates, whichever is later. Further studies indicate that extending the duration may be appropriate.

Prognosis

  • Recovery from minor vaccinia complications usually is complete.
  • Severe complications, especially in hosts who are immunocompromised and young children with encephalopathy, carry significant mortality rates.

Patient Education

  • Patients should be instructed about proper wound care after vaccination with vaccinia virus. This includes changing any bio-occlusive dressings and avoiding inappropriate disposal of infected bandages.
  • Patients must be educated to avoid high-risk individuals during the period of maximal viral shedding, approximately 10 days after exposure to the virus.

Miscellaneous

Medicolegal Pitfalls

  • Although no legal precedents exist for vaccinia virus infection, the intentional infection of individuals with the virus for therapeutic purposes poses risks to the infected individual and to the public that must be considered.
  • Failure to isolate recently infected individuals from other high-risk individuals (eg, individuals with a compromised immune system, pregnant women, children <3 y, individuals with eczema) is a potential pitfall because vaccinia can be transferred by direct contact.
  • Failure to recognize the risk to the vaccinated individual is a potential pitfall. Immunization should be administered only by physicians and nurses familiar with the biology and complications of vaccinia virus.
  • Failure to carefully explain the indications and risks associated with vaccinia virus administration to all patients before immunization is a potential pitfall.
  • The liability for vaccinia-related complications in patients and contacts outside the smallpox eradication era remains uncertain.

Special Concerns

  • Pregnant women should not receive vaccinia virus, and they should not be exposed to recent vaccinees.
  • Vaccinia virus can replicate in most animal species, including mammals and rodents.
  • Disseminated vaccinia has been reported in a military recruit with HIV disease.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Thomas W McGovern, MD, to the development and writing of this article.



More on Vaccinia

Overview: Vaccinia
Differential Diagnoses & Workup: Vaccinia
Treatment & Medication: Vaccinia
Follow-up: Vaccinia
Multimedia: Vaccinia
References
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Further Reading

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Keywords

vaccinia, vaccinia virus, smallpox, variola, cowpox, poxviruses, Poxviridae, vaccinia necrosum, eczema vaccinatum, vaccinia immune globulin, VIG, orthopoxvirus

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Contributor Information and Disclosures

Author

Tasneem A Poonawalla, MD, Staff Physician, Department of Internal Medicine, University of Texas Medical Branch at Galveston
Tasneem A Poonawalla, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Dayna Diven, MD, Clinical Professor, Department of Dermatology, University of Texas Medical Branch at Galveston
Dayna Diven, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Idaho Medical Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Howard L Kaufman, MD, Chief, Division of Surgical Oncology, Columbia University
Howard L Kaufman, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, Association for Academic Surgery, Illinois State Medical Society, Massachusetts Medical Society, New York Academy of Sciences, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Ken Flanagan, BS, Department of Microbiology and Immunology, Albert Einstein College of Medicine
Ken Flanagan, BS is a member of the following medical societies: American Association for Cancer Research
Disclosure: Nothing to disclose.

Medical Editor

Brenda Jones, MD, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, University of Southern California School of Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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