Severe Eczema Vaccinatum in a Household Contact of a Smallpox Vaccinee

Section of Infectious Diseases, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 06/2008; 46(10):1555-61. DOI: 10.1086/587668
Source: PubMed


We report the first confirmed case of eczema vaccinatum in the United States related to smallpox vaccination since routine vaccination was discontinued in 1972. A 28-month-old child with refractory atopic dermatitis developed eczema vaccinatum after exposure to his father, a member of the US military who had recently received smallpox vaccine. The father had a history of inactive eczema but reportedly reacted normally to the vaccine. The child's mother also developed contact vaccinia infection.
Treatment of the child included vaccinia immune globulin administered intravenously, used for the first time in a pediatric patient; cidofovir, never previously used for human vaccinia infection; and ST-246, an investigational agent being studied for the treatment of orthopoxvirus infection. Serological response to vaccinia virus and viral DNA levels, correlated with clinical events, were utilized to monitor the course of disease and to guide therapy. Burn patient-type management was required, including skin grafts.
The child was discharged from the hospital after 48 days and has recovered with no apparent systemic sequelae or significant scarring.
This case illustrates the need for careful screening prior to administration of smallpox vaccine and awareness by clinicians of the ongoing vaccination program and the potential risk for severe adverse events related to vaccinia virus.

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Available from: John Marcinak, Feb 03, 2016
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    • "ST-246 protects ground squirrels against monkeypox challenge when administered up to 3 days post-exposure [17]. Treatment with VIGIV (Vaccinia Immune Globulin Intravenous) and cidofovir along with ST-246 (multiple doses) was successful in the treatment of a 28-month-old child with severe eczema vaccinatum [18][19]. Similarly, a combination therapy using VIGIV, ST-246, Imiquimod and CMX001, a lipid conjugate of cidofovir, were used to treat progressive vaccinia in a military vaccinee [20]. "
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