Sex: U
Vaccine: SMALL
Symptoms: Scab, Secondary transmission, Secretion discharge, Skin lesion, Vaccinia test positive
Clinical narrative: Initial report received on 30 July 2010 via a QScan search on the VAERS database, under reference number 383935. This case involves tertiary spread of vaccinia due to inadvertent inoculation. A 29-year-old female patient was hospitalized after she developed secondary transmission of vaccinia virus infection on 09 March 2010. The patient's brother was a secondary case exposed to a military person who had received ACAM2000 (lot number not reported) on an unspecified date. The brother had been exposed during a wrestling match on 27 February 2010. The patient was a household contact with her brother. On 16 March 2010, the patient had vesicles that were positive for vaccinia by rt-PCR lab. The patient's recovery status was not reported. Of note: VAERS noted that follow-up on 13 May 2010 indicated this 29-year-old female patient had developed vaccinia from the same individual mentioned in VAERS report with ID numbers 384016 (patient's brother, case number 2010-04090), 384017 (unidentified), and 384018 (unidentified). This report pertains to the 29 year-old female patient. This case was coded as secondary transmission despite the report term of tertiary transmission due to coding limitations. Information regarding her brother (a case of secondary transmission) is reported in case number 2010-04090. Follow-up information was retrieved from the scientific literature on 25 April 2011. This case pertains to 1 of 4 patient's who experienced adverse events following exposure to a military service member who had been vaccinated with ACAM2000 (captured in case number 2011-02465). Information for the other 3 patients have been captured in case number 2010-04090, 2011-02467 and 2011-02468. Abstract: During February and March 2010, a State Department of Health investigated secondary and tertiary vaccinia contact transmission from a military vaccinee to 4 close contacts. Identification of these cases underscores the need for strict adherence to postvaccination infection control guidance to avoid transmission of the live virus. On 23 February 2010, a military service member received ACAM2000 in preparation for deployment. On 27 February 2010 he wrestled 2 persons in a semi-professional wrestling match, during which the dressing covering the vaccination site was detached. This case pertains to the 29-year-old sister of one of the wrestlers. On 9 March 2010, the patient developed lesions along the mandible, and on 11 March 2010 she was evaluated by a dermatologist who performed a punch biopsy for suspected herpes. Over the next several days, she developed fever, chills, arthralgias, and submandibular swelling. She was seen by a public health physician on 16 March 2010 and VACV (vaccinia virus) was clinically diagnosed. Per the reporter, "the most plausible route of exposure was a shared hand towel" with her brother. Over the next several days her lesions started draining and became substantially more erythematous and painful. She reported a lesion in her right nostril on 18 March 2010. Following consultation with her physician and the local department of health, "varicella immune globulin was released from the Strategic National Stockpile for administration because of the new mucosal involvement". Varicella immune globulin was administered with no complications on 19 March 2010, and the patient reported that the pain associated with her lesions resolved over the next 24 hours. The nostril lesion resolved on 22 March 2010 with the loss of a small scab. Follow-up continued through resolution of the lesions, which lasted approximately 3 weeks. A tissue sample was obtained by unroofing a vesicle, collecting the tissue, performing slide touch preps of the unearthed base of the vesicle, and obtaining viral swabs by using pox collection kits which had been distributed through the state department of health. The specimen was tested by real-time PCR, and preliminary results indicated VAVC. Test results were subsequently confirmed, and complete hemagglutinin gene was sequenced by the CDC (Centers for Disease Control and Prevention) and was identical to that of ACAM2000. Documents held by sender: None.