Vaccinia Virus

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VACCINIA VIRUS

Vaccinia virus is a big mystery in virology. It is not known whether

vaccinia virus is the product of genetic recombination, or if it is a

species derived from cowpox virus or variola virus by prolonged serial

passage, or if it is the living representative of a now extinct virus.

Vaccinia virus was used for smallpox vaccination via inoculation into the

superficial layers of the skin of the upper arm. However, with the

eradication of smallpox, routine vaccination with vaccinia virus has

ceased. Recent interest in vaccinia has focused on its possible usage as a

vector for immunization against other viruses.

Much less virulent strains than those used for vaccination against smallpox

are being developed for use as vectors, in hopes of reducing the likelihood

of the development of serious complications previously seen with smallpox

vaccination. In this page, you will learn more about the very rare, though

serious, complications that arose as a result of smallpox vaccination.

Primary response to vaccination

Four to five days following vaccination with vaccinia virus, a papule

appeared at the site of vaccination. Two or three days later the papular

lesion became vesicular, growing until it reached its maximum diameter on

the 9th or 10th day. During this time, the draining lymph nodes of the

axial were enlarged and tender. Many patients also presented a mild fever.

The lesion dried from the center outward, and the brown scab fell off after

about three weeks, leaving a scar- a mark by which previous vaccinees could

be recognized.

Complications of Vaccination

Progressive vaccinia (vaccinia necrosum)- Progressive vaccinia is a severe,

potentially fatal illness characterized by progressive necrosis at the site

of vaccination. This occurred only in immunocompromised individuals with

deficiencies in their cell-mediated immune system. There were only about

1.6 cases of progressive vaccinia per million vaccinations reported. See

picture below for clinical manifestation of progressive vaccinia.

Eczema vaccinatum- This occurred only in persons who suffered from eczema.

Unvaccinated contact with a vaccinated individual was the usual mode of

transmission.

In a national survey in the United States conducted after smallpox had been

eliminated, there were 66 cases, with no deaths, among 14.5 million vaccinees.

Generalized vaccinia- Generalized vaccinia was characterized by a vesicular

rash that sometimes covered the entire body. This usually occurred 6 to 9

days after vaccination.

The lesions usually resembled the initial lesion found at the inoculation

site, but they sometimes varied in size. Generalized vaccinia was not

associated with immunodeficiency. The rash was usually self-limiting and

thus, little or no therapy was administered. There were about 23.4 cases

per million vaccinees.

Postvaccinial encephalitis- Neurological complications were the most

serious ones that occurred from vaccination with vaccinia virus.

Postvaccinal encephalitis usually occurred in patients over the age of two.

The case fatality rate was about 35% within a week of onset. In the United

States, there were 12 cases, of which one resulted in death, among the 13

million vaccinees.

Accidental infection- Accidental infection of some part of the body away

from the inoculation site was the most common complication that arose from

vaccination with vaccinia. Ocular vaccinia was a common manifestation of

accidental infection.

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Sheri Nakken, R.N., MA

Vaccination Information & Choice Network, Nevada City CA & UK

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