Vaccinia virus as the smallpox vaccine
- Stuart N Isaacs, MD
Stuart N Isaacs, MD
- Associate Professor
- Perelman School of Medicine at the University of Pennsylvania
- Harvey M Friedman, MD
Harvey M Friedman, MD
- Perelman School of Medicine at the University of Pennsylvania
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Vaccinia virus is the live poxvirus that was used as the smallpox vaccine. The development of this vaccine was an important step in the successful eradication of smallpox, an infection characterized by fever, rash and constitutional symptoms, with a high rate of morbidity and mortality.
This topic will address the virology of vaccinia virus, available vaccines, vaccination procedures, contraindications, and adverse events (see 'Specific complications' below). Vaccinia virus in the research setting is discussed elsewhere. (See "Vaccinia virus in the research setting".)
Attempts at control of smallpox began after it was noted that accidental exposure to smallpox by a scratch on the skin reduced the severity of infection. This led to the practice of “variolation”, which involved intentional administration of pustular fluids from smallpox scabs to uninfected persons. The practice of variolation began in China and India in the tenth century; deaths were reported as a complication of this procedure.
In 1796, Edward Jenner showed that inoculation with cowpox virus protected against smallpox and carried less risk of illness than variolation. Subsequently, vaccinia virus became the basis for the smallpox vaccine. The origins of vaccinia virus are uncertain. Successful vaccination was highly protective for development of any disease for five years and could protect from death or severe smallpox for up to 20 years. Periodic revaccination was necessary for optimal protection.
In 1959, the World Health Assembly adopted a program aimed at global eradication of smallpox. The development of stable, freeze-dried vaccine meant that vaccination programs could reach less-developed tropical countries. By 1967, efforts towards eradication were intensified.
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- HISTORICAL BACKGROUND
- BIOTERRORISM AND THE SMALLPOX VACCINE
- Smallpox as a public health emergency
- SMALLPOX VACCINATION
- Available vaccines
- Vaccine administration
- Vaccination against smallpox and monkeypox
- ADVERSE EVENTS
- Historical data
- Contemporary data
- Risk of complications and vaccine status
- SPECIFIC COMPLICATIONS
- Acute vaccinia syndrome
- Postvaccinial encephalitis
- Progressive vaccinia
- Eczema vaccinatum
- Generalized vaccinia
- Myocarditis and myopericarditis
- Accidental inoculation
- Sexual transmission of vaccinia virus
- REPORTING GUIDELINES
- TREATMENT OF COMPLICATIONS
- Vaccinia immune globulin
- Experimental agents
- PREVENTION OF COMPLICATIONS
- SUMMARY AND RECOMMENDATIONS