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http://www.journals.uchicago.edu/CID/journal/issues/v36n6/30426/brief/30426.abstract.html

Clinical Infectious Diseases    2003;36:000
This article is in the public domain, and no copyright is claimed.
1058-4838/2003/3606-00XX

 

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Progressive Vaccinia

Mike Bray and Mary E. Wright

Biodefense Clinical Research Branch, Office of Clinical Research, Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

 

The resumption of smallpox vaccination for health care workers and other first responders has raised concern about the occurrence of complications in people with immunodeficiency disorders, including those infected with human immunodeficiency virus. During the era of universal vaccination, roughly 1 person per million vaccinees in the general population developed progressive vaccinia, which is characterized by the relentless outward spread of infection from the vaccination site and eventual dissemination to other areas on the body. Review of 56 cases reported in the English-language medical literature from 1893 through 1997 indicates that the condition occurred only in persons with severe cell-mediated immunodeficiency. Progressive vaccinia was found to be lethal in infants who completely lacked cellular immune function, but infection resolved in many adults with acquired immunodeficiency. Almost all cases were treated with vaccinia immune globulin, but its efficacy has never been tested in a placebo-controlled trial. Further research is needed to develop effective forms of therapy.

 


     Received 12 November 2002; accepted 16 December 2002; electronically published 20 February 2003.

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