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Recognition of Adverse Reactions following Smallpox Vaccination

Recognition of Adverse Reactions following Smallpox Vaccination. Department of Health and Human Services Centers for Disease Control and Prevention February 2003. Evaluation, Management, and Treatment of Adverse Events of Smallpox Vaccine. Learning Objectives:

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Recognition of Adverse Reactions following Smallpox Vaccination

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  1. Recognition of Adverse Reactions following Smallpox Vaccination Department of Health and Human Services Centers for Disease Control and Prevention February 2003

  2. Evaluation, Management, and Treatment of Adverse Events of Smallpox Vaccine • Learning Objectives: • Recognize the common and serious adverse events expected after smallpox vaccination • Distinguish between common and serious adverse events

  3. Progression of smallpox vaccination site in a non-immune person

  4. Common Symptoms • Fatigue (50%) • Headache (40%) • Muscle aches and Chills (20%) • Nausea (20%) • Fever 37.7 ºC or 100 ºF (10%)

  5. Clinical Response to Vaccination* Symptom/sign Papule Pustule Maximum erythema Scab Scab separation Time after Vacc 3-5 days 5-8 days 8-10 days 14 days 14-21 days *typical response in a nonimmune person

  6. Smallpox Vaccine Reactions Among Susceptible Adults • About 10% with temperature > 100F • Systemic symptoms (malaise, myalgias) • 36% sufficiently ill to miss work, school, or recreational activities or had trouble sleeping

  7. Lymphangitis following smallpox vaccination

  8. Satellite lesions

  9. Allergic reaction to tape

  10. Large Vaccination Reactions and Robust Takes Robust take with lymphangitis

  11. Secondary bacterial infection of vaccination site

  12. Smallpox Vaccine Adverse Reaction Rates* *Rates per million primary vaccinations

  13. Erythema multiforme following smallpox vaccination

  14. Erythema Multiforme

  15. Inadvertent inoculation

  16. Vaccinia Specific Adverse Events Palebral Autoinoculation

  17. Generalized vaccinia

  18. Generalized Vaccinia • Differential diagnosis • Erythema multiforme • Eczema vaccinatum • Inadvertent inoculation at multiple sites • Early progressive vaccinia • Disseminated herpes • Severe varicella

  19. Eczema vaccinatum

  20. Progressive vaccinia

  21. Post-vaccinial Encephalitis • Diagnosis of exclusion • Other infectious or toxic causes of encephalitis should be ruled out • Pathophysiology not well understood • CSF may have increased opening pressure, lymphocytosis, elevated protein

  22. Fetal vaccinia

  23. For More Information • CDC Smallpox website www.cdc.gov/smallpox • National Immunization Program website www.cdc.gov/nip

  24. Certain images supplied by: Dr. John Leedom Dr. J. Michael Lane Dr. Vincent Fulginiti World Health Organization University of Rochester National Institutes of Health Logical Images, Inc.

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