Progressive vaccinia as an adverse event following exposure to vaccinia virus: Case definition and guidelines of data collection, analysis, and presentation of immunization safety data
Department of Pediatrics, Columbia University, New York, New York, United StatesVaccine (Impact Factor: 3.62). 09/2007; 25(31):5735-44. DOI: 10.1016/j.vaccine.2007.02.088
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ABSTRACT: A subgroup of patients with atopic dermatitis develops one or more episodes of a severe viral skin infection caused by herpes simplex virus superimposed on eczematous skin lesions. This condition is named atopic dermatitis complicated by eczema herpeticum. Characteristic features of patients developing eczema herpeticum include an early age of onset of atopic dermatitis with a persistent and severe course into adulthood, predilection for eczematous skin lesions in the head and neck area, elevated total serum IgE levels and increased allergen sensitisation. Deficiencies at the level of both the innate and the adaptive immune system, which have been identified in atopic dermatitis, are much more pronounced in this subgroup. Predisposing cellular factors include a reduced number of plasmacytoid dendritic cells in the epidermis and a modified capacity of these cells to produce type I interferons after allergen challenge. In addition, lower levels of antimicrobial peptides in the skin of atopic dermatitis patients, resulting in part from a Th2-prone micromilieu, contribute to the lack of an effective defence against viral attack. In this review, we summarise the current knowledge of the molecular pathogenesis of eczema herpeticum.
Article: 32 Vaccines[Show abstract] [Hide abstract]
ABSTRACT: This chapter discusses different studies conducted to analyze effects of vaccines on patients. The safety and reactogenicity of a booster dose of hexavalent DTaP–HBV–IPV/Hib vaccine has been compared with the separate administration of DTaP–IPV/Hib and HBV vaccines. In the first study, the incidences of symptoms were similar in the two groups; no serious adverse events were either reported within 4 days of immunization or considered to be causally related to immunization. In the second study, in which fever was the only solicited symptom, the rectal temperature was 39.5°C or over in 2.5 and 2.8% of the subjects respectively. Fever of 40.0°C or more was rare (0.6%), and only two cases of febrile convulsions were recorded during the 4 days after immunization, both in the control group. In another study, severe jaundice and raised serum liver enzyme activities were reported after a dose of Twinrix® (combination HA/HB vaccine). Studies on Flumist®, a cold-adapted live attenuated influenza vaccine in young children showed that it is effective against circulating H1N1 and H3N2 strains, including H3N2 strains. However, there was a significantly increased incidence of medically significant episodes of wheezing within 42 days of immunization among children aged 6–23 months.
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ABSTRACT: Smallpox, when used as a biological weapon, presents a serious threat to civilian populations. Core components of the public health management of a terrorism attack using smallpox are: vaccination (ring vaccination and mass vaccination), adverse event monitoring, confirmed and suspected smallpox case management, contact management, identifying, tracing, monitoring contacts, and quarantine. Above all, pre-event and post-event vaccination is an indispensable part of the strategies. Since smallpox patients are most infectious from onset of the rash through the first 7-10 days of the rash, vaccination should be administered promptly within a limited time frame. However, vaccination can accompany complications, such as postvaccinial encephalitis, progressive vaccinia, eczema vaccinatum, and generalized vaccinia. Therefore, vaccination is not recommended for certain groups. Public health professionals, as well as physicians and government officials, should also be well equipped with all information necessary for appropriate and effective smallpox management in the face of such a bioterrorism attack.
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