Age: 25.0
Sex: M
Vaccine: SMALL, SMALL
Symptoms: Rash vesicular, Secondary transmission, Skin lesion, Vaccinia virus infection, Viral test positive
Clinical narrative: Initial case retrieved from the scientific literature on 25 April 2011. It pertains to 1 of 4 patients who experienced adverse events following exposure to a military service member who had recently received the ACAM2000 vaccine. The other 3 patients are captured in case numbers 2010-04089, 2010-04090, 2011-02467; the case for the military service member is captured in 2011-02465. This case involves tertiary spread of vaccinia due to inadvertent inoculation. This case was coded as secondary transmission despite the reported term of tertiary transmission due to coding limitations. Abstract: During February and March 2010, the 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. On 5 March 2010, one of the exposed wrestlers participated in another wrestling match with a 25-year-old male, whose information is captured in this case. The patient had a history of recent mild eczema involving his hands; in addition, he was a roommate of the vaccinee. On 7 March 2010, 2 days after his wrestling match with one of the exposed wrestlers from the 27 February 2010 match, he developed lesions, described as pruritic papules, on the chest, trunk, and arm. On 10 March 2010 he sought treatment for the lesions. His physician thought the lesions appeared to be molluscum contagiosum, however given the patient's history he consulted an infectious disease physician who observed lesions compatible with vaccinia virus (VAVC). At his public health evaluation on 12 March 2010, he was noted to have grouping of vesicular lesions with central umbilication on mildly erythematous bases on his trunk, with a solitary lesion near his left areola and on the volar aspect of his right forearm. VACV was clinically diagnosed. The patient was followed until he had complete lesion resolution, approximately 7 weeks. A tissue sample was obtained by unroofing a vesicle, collecting the tissue, performed 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 a complete hemagglutinin gene was sequenced by the CDC (Centers for Disease Control and Prevention) and was identical to that of ACAM2000. Follow-up information was retrieved via a third-party query of the VAERS database on 21 July 2011, and provided the VAERS number (422007). The following codes have been added: erythema, exposure to vaccinated person, papule, pruritis, rash vesicular, and vaccinia virus infection. No new information was added to the case. Document held by sender: None.