Encephalitis Following Smallpox Vaccination

Dolgopol, Vera B.

doi:10.1001/archneurpsyc.1955.02330080094018

Cited by 24 publications

(11 citation statements)

References 9 publications

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“…The American literature discusses only two non-fatal adult cases (36,37) and two fatal adult cases (38,39). Multiple reports exist discussing other complications, but none were cardiac (40 -43).…”

Section: Abbreviations and Acronymsmentioning

confidence: 99%

“…Historically, most cases of postvaccinial myopericarditis were self-limited and resolved completely in time (1,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Unfortunately, a few did not (11,13,35,38,39). Therapeutic approaches to myopericarditis after vaccinia immunization are based on limited data, and there is a clear need for improved evidence regarding the efficacy of different approaches.…”

Section: Review Of Treatment Optionsmentioning

confidence: 99%

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Smallpox vaccination and myopericarditis: a clinical review

Cassimatis

Atwood

Engler

et al. 2004

Journal of the American College of Cardiology

171

131

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Smallpox is a devastating viral illness that was eradicated after an aggressive, widespread vaccination campaign. Routine U.S. childhood vaccinations ended in 1972, and routine military vaccinations ended in 1990. Recently, the threat of bioterrorist use of smallpox has revived the need for vaccination. Over 450,000 U.S. military personnel received the vaccination between December 2002 and June 2003, with rates of non-cardiac complications at or below historical levels. The rate of cardiac complications, however, has been higher than expected, with two confirmed cases and over 50 probable cases of myopericarditis after vaccination reported to the Department of Defense Smallpox Vaccination Program. The practicing physician should use the history and physical, electrocardiogram, and cardiac biomarkers in the initial evaluation of a post-vaccination patient with chest pain. Echocardiogram, cardiac catheterization, magnetic resonance imaging, nuclear imaging, and cardiac biopsy may be of use in further workup. Treatment is with non-steroidal anti-inflammatory agents, four to six weeks of limited exertion, and conventional heart failure treatment as necessary. Immune suppressant therapy with steroids may be uniquely beneficial in myopericarditis related to smallpox vaccination, compared with other types of myopericarditis. If a widespread vaccination program is undertaken in the future, many more cases of post-vaccinial myopericarditis could be seen. Practicing physicians should be aware that smallpox vaccine-associated myopericarditis is a real entity, and symptoms after vaccination should be appropriately evaluated, treated if necessary, and reported to the Vaccine Adverse Events Reporting System.

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Section: Abbreviations and Acronymsmentioning

confidence: 99%

Section: Review Of Treatment Optionsmentioning

confidence: 99%

Smallpox vaccination and myopericarditis: a clinical review

Cassimatis

Atwood

Engler

et al. 2004

Journal of the American College of Cardiology

171

131

View full text Add to dashboard Cite

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“…Myocarditis and pericarditis after smallpox vaccination were reported during the smallpox-eradication era, most commonly in Europe and Australia [20][21][22], and during the current US vaccination campaigns [7,8,10,11]. ICEs have rarely been reported after smallpox vaccination.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Cardiac Events during the Department of Health and Human Services Smallpox Vaccination Program, 2003

et al. 2008

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Ten ischemic cardiac events (ICEs) were reported among 37,901 initial US Department of Health and Human Services (DHHS) smallpox vaccinees. Symptoms developed a median of 10 days after vaccination (range, 0-28 days). The median age of case patients was 56 years (range, 42-65 years), and 60% were male. Seven (70%) of the case patients had >/=3 cardiac risk factors or probable coronary artery disease before vaccination. Two women, 55 and 57 years of age, experienced acute myocardial infarction and fatal cardiac arrests. Background rates of ICEs during a 3-week period for civilian populations that were age and sex matched to DHHS vaccinees were estimated. The observed number of myocardial infarctions exceeded estimated expectations (5 vs. 2) but remained within the 95% predictive interval (PI) (0.6-5.4). New onset angina was observed significantly less frequently than estimated expectations (1 vs. 10; 95% PI, 3.5-15.7). After persons with >/=3 cardiac risk factors or known heart disease were deferred from vaccination, no ICEs were reported among an additional 6638 vaccinees.

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“…The vaccine strain was not reported, but strains used in Europe were associated with more complications than was the NYCBOH strain [9]. The occurrence of myocarditis after vaccination with the NYCBOH strain has been reported [2,12].Fatal myocarditis has been reported after vaccination with non-NYCBOH vaccinia virus [3][4][5]8], but this virus has not been shown to be present in myocardial tissue. Without demonstration of replicating vaccinia virus or vaccinia virus DNA in the myocardium, we cannot determine whether myocarditis is caused by direct invasion of vaccinia virus or by an immunemediated mechanism.…”

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confidence: 99%

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confidence: 99%