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Progressive vaccinia.

Mike Bray1, Mary E Wright

  • 1Biodefense Clinical Research Branch, Office of Clinical Research, Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA. mbray@niaid.nih.gov

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 11, 2003
PubMed
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Concerns about smallpox vaccine complications in immunocompromised individuals, including those with human immunodeficiency virus, are rising. Progressive vaccinia, a severe complication, primarily affects those with cell-mediated immunodeficiency and can be fatal in infants.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Vaccinology

Background:

  • Resumption of smallpox vaccination raises concerns for immunocompromised populations, particularly those with human immunodeficiency virus (HIV).
  • Progressive vaccinia, a rare but severe complication of smallpox vaccination, involves relentless spread of infection from the vaccination site.
  • Historically, approximately 1 in a million vaccinees developed progressive vaccinia during universal vaccination eras.

Purpose of the Study:

  • To review the occurrence and outcomes of progressive vaccinia in individuals with immunodeficiency disorders.
  • To assess the characteristics and risk factors associated with progressive vaccinia in immunocompromised populations.

Main Methods:

  • Systematic review of 56 cases of progressive vaccinia reported in English-language medical literature from 1893 to 1997.

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  • Analysis focused on patient characteristics, underlying immunodeficiency, clinical presentation, treatment, and outcomes.

    • Main Results:

    • Progressive vaccinia exclusively occurred in individuals with severe cell-mediated immunodeficiency.
    • The condition was lethal in infants with complete absence of cellular immunity but resolved in many adults with acquired immunodeficiency.
    • Vaccinia immune globulin was used in almost all cases, though its efficacy lacks placebo-controlled trial data.

    Conclusions:

    • Severe cell-mediated immunodeficiency is a critical risk factor for developing progressive vaccinia.
    • Outcomes vary significantly based on age and the degree of immune deficiency.
    • Further research is essential to establish effective therapeutic strategies for progressive vaccinia.