Smallpox vaccination reactions, prophylaxis, and therapy of complications.
ABSTRACT Smallpox vaccination in the United States is a routine public health measure which has been under intensive review during the last decade. The most frequently occurring adverse reactions to vaccination are benign and require little or no systemic therapy. These reactions include accidental infection, erythematous and urticarial rash, and generalized vaccinia. Chickenpox occurring concurrently with vaccination presents no problem unless vaccinia has widely superinfected the chickenpox lesions. There is no risk to the pregnant woman who is vaccinated, but there is a slight risk that the fetus will develop fetal vaccinia. The vaccinia does not cause congenital malformations. Vaccinia hyperimmune globulin (VIG) in prophylactic dosage may be given to a pregnant woman who is traveling to a smallpox infected or endemic area in order to prevent fetal vaccinia. Vaccinia necrosum and eczema vaccinatum require vigorous systemic therapy with VIG, and often thiosemicarbazone. Post-vaccinial encephalitis, while frequently serious, has not been shown to be ameliorated by VIG therapy, although there are data which suggest VIG has some value in prophylaxis for encephalitis. Prophylaxis, prompt recognition, and proper therapy may reduce the fatality rates of these complications. Revaccination of patients who have suffered a complication is a frequent clinical problem. Revaccination of an individual who has had post-vaccinial encephalitis or vaccinia necrosum is contraindicated unless the risk of contracting smallpox outweighs the risk of the above two diseases. Revaccination of children who have had eczema vaccinatum is not contraindicated. Revaccination of children with a history of accidental infection or erythematous or urticarial rash presents no known or theoretically increased risk.
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ABSTRACT: |Die Letalitätsrate bei Variola major betrug für adäquat Geimpfte etwa 3%, für Ungeimpfte – ungeachtet des Krankheitsverlaufes – etwa 30–40%. Die Letalität der hämorrhagischen Pocken liegt über 90%. In der Schwangerschaft verlaufen die Pocken in 30–50% der Fälle primär hämorrhagisch. Die Pockeninfektion in der Schwangerschaft geht mit einer erhöhten Abort-, Totgeburten- und Frühgeburtenrate einher.Ein Zusammenhang zwischen Pocken in der Schwangerschaft und kongenitalen Fehlbildungen wurde bislang nicht beschrieben . PockenschutzimpfungDer Gynäkologe 01/2003; 36(6):546-550.
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ABSTRACT: Vienna was the first city on the European continent where the cowpox vaccination was applied in 1799, shortly after Jenner's (1798) publication of his encouraging results in England. Nevertheless, substantial denial and distrust was evident among doctors and patients in Europe as well, particularly in Austria. The medical doctor Johann Gottfried Bremser remains well known even today among parasitologists as a pioneer of helminthological research in Austria. He founded, in Vienna, one of the richest parasitic worm collections worldwide and published perceptive papers about helminthology. But his role as a protagonist of the cowpox vaccine has been buried in oblivion. In the late 18th and early 19th centuries, Bremser worked as a medical doctor in Vienna and was influenced by the major proponents of the vaccine in Austria, Pascal Joseph Ferro, Jean de Carro, Johann Peter Frank and others. Beyond his practical contribution as vaccinator, he excelled as a propagandist, mainly through his publications on cow pox vaccination. Bremser used his expert knowledge and sophisticated argumentation to prompt people to accept the prophylactic treatment, especially for their children. He argued for an obligatory cowpox vaccination for all. On one hand, his argumentation summarizes the contrarian opinions of that time, on the other hand the discussion shows striking analogies with the controversies of today. In a way, Bremser's commitment was a forerunner for future health policies that led to vaccination laws and ultimately to the eradication of smallpox worldwide in the second half of the 20th century.Wiener klinische Wochenschrift 11/2013; · 0.79 Impact Factor
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ABSTRACT: Background A33 is a type II integral membrane protein expressed on the extracellular enveloped form of vaccinia virus (VACV). Passive transfer of A33-directed monoclonal antibodies or vaccination with an A33 subunit vaccine confers protection against lethal poxvirus challenge in animal models. Homologs of A33 are highly conserved among members of the Orthopoxvirus genus and are potential candidates for inclusion in vaccines or assays targeting extracellular enveloped virus activity. One monoclonal antibody directed against VACV A33, MAb-1G10, has been shown to target a conformation-dependent epitope. Interestingly, while it recognizes VACV A33 as well as the corresponding variola homolog, it does not bind to the monkeypox homolog. In this study, we utilized a random phage display library to investigate the epitope recognized by MAb-1G10 that is critical for facilitating cell-to-cell spread of the vaccinia virus. Results By screening with linear or conformational random phage libraries, we found that phages binding to MAb-1G10 display the consensus motif CEPLC, with a disulfide bond formed between two cysteine residues required for MAb-1G10 binding. Although the phage motif contained no linear sequences homologous to VACV A33, structure modeling and analysis suggested that residue D115 is important to form the minimal epitope core. A panel of point mutants expressing the ectodomain of A33 protein was generated and analyzed by either binding assays such as ELISA and immunoprecipitation or a functional assessment by blocking MAb-1G10 mediated comet inhibition in cell culture. Conclusions These results confirm L118 as a component of the MAb-1G10 binding epitope, and further identify D115 as an essential residue. By defining the minimum conformational structure, as well as the conformational arrangement of a short peptide sequence recognized by MAb-1G10, these results introduce the possibility of designing small molecule mimetics that may interfere with the function of A33 in vivo. This information will also be useful for designing improved assays to evaluate the potency of monoclonal and polyclonal products that target A33 or A33-modulated EV dissemination.Virology Journal 09/2012; 9(217). · 2.09 Impact Factor