Smallpox Vaccination: A Review, Part I. Background, Vaccination Technique, Normal Vaccination and Revaccination, and Expected Normal Reactions

Fulginiti, Vincent A.; Papier, Arthur; Lane, John; Neff, John M.; Henderson, Donald A.; Inglesby, Thomas V.; O’Toole, Tara

doi:10.1086/375824

Cited by 83 publications

(49 citation statements)

References 17 publications

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“…Because the ultimate goal of eradication seems to be within reach, development of a rational "endgame" strategy and vaccination policies for the posteradication period has become a high priority (14). The original assumption was that after cessation of circulation and containment of wild-type polioviruses, worldwide immunization against polio- on May 12, 2018 by guest http://jcm.asm.org/ myelitis would eventually be stopped (46,47), similar to the strategy employed in the smallpox eradication campaign (20)(21)(22). However, recent discoveries of long-term circulation of VDPV that may cause outbreaks of paralytic disease in communities with inadequate immunity (25,48,49,51) raise questions about the prudence of this approach (7,22,27,37).…”

Section: Discussionmentioning

confidence: 99%

Genomic Analysis of Vaccine-Derived Poliovirus Strains in Stool Specimens by Combination of Full-Length PCR and Oligonucleotide Microarray Hybridization

et al. 2005

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Sabin strains of poliovirus used in the manufacture of oral poliovirus vaccine (OPV) are prone to genetic variations that occur during growth in cell cultures and the organisms of vaccine recipients. Such derivative viruses often have increased neurovirulence and transmissibility, and in some cases they can reestablish chains of transmission in human populations. Monitoring for vaccine-derived polioviruses is an important part of the worldwide campaign to eradicate poliomyelitis. Analysis of vaccine-derived polioviruses requires, as a first step, their isolation in cell cultures, which takes significant time and may yield viral stocks that are not fully representative of the strains present in the original sample. Here we demonstrate that full-length viral cDNA can be PCR amplified directly from stool samples and immediately subjected to genomic analysis by oligonucleotide microarray hybridization and nucleotide sequencing. Most fecal samples from healthy children who received OPV were found to contain variants of Sabin vaccine viruses. Sequence changes in the 5 untranslated region were common, as were changes in the VP1-coding region, including changes in a major antigenic site. Analysis of stool samples taken from cases of acute flaccid paralysis revealed the presence of mixtures of recombinant polioviruses, in addition to the emergence of new sequence variants. Avoiding the need for cell culture isolation dramatically shortened the time needed for identification and analysis of vaccine-derived polioviruses and could be useful for preliminary screening of clinical samples. The amplified full-length viral cDNA can be archived and used to recover live virus for further virological studies.Live trivalent oral poliovirus vaccine (OPV) prepared from attenuated Sabin strains is highly efficacious, and its worldwide use resulted in eradication of poliomyelitis in the United States (41) and most other countries (37,38). Roughly half of the approximately eight cases reported yearly in the United States involved immunodeficient individuals. Vaccine-derived poliovirus (VDPV) strains isolated from stools of individuals with vaccine-associated paralytic poliomyelitis (VAPP) have been found to contain a number of mutations and exhibit increased neurovirulence. While some of the mutations occurring in VDPV strains restore the sequences present in the wild-type progenitors of the vaccine strains (direct reversions), other mutations either are incidental or are second-site suppressors of attenuated phenotype. All three Sabin strains contain a single base change in the same domain of the 5Ј untranslated region (5Ј-UTR) that contributes to the attenuated phenotype, as indicated by increased neurovirulence in strains where this base change is reversed or altered by a compensating mutation (17, 31). Such Sabin strain variants with reversion in the 5Ј-UTR have been identified in type 3 (5, 17), type 2 (30), and type 1 (9, 24) isolates from patients with VAPP, as well as from healthy vaccine recipients (1,11,16,42). Isolation of suc...

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Section: Discussionmentioning

confidence: 99%

Genomic Analysis of Vaccine-Derived Poliovirus Strains in Stool Specimens by Combination of Full-Length PCR and Oligonucleotide Microarray Hybridization

et al. 2005

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“…Consequently, potent and selective antiviral therapy may be valuable for the treatment of such conditions. Complications that result from excessive replication of vaccinia virus include accidental infection, generalized vaccinia, eczema vaccinatum, and progressive vaccinia (4,18,19). Images of complications of smallpox vaccination are available at www.bt.cdc.gov/agent/smallpox /vaccineimages.asp.…”

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confidence: 99%

Efficacy of Cidofovir in a Murine Model of Disseminated Progressive Vaccinia

Neyts

Leyssen

Verbeken

et al. 2004

Antimicrob Agents Chemother

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An animal model that mimics progressive disseminated vaccinia was elaborated. To this end nude (athymic) mice were inoculated intracutaneously with vaccinia virus in the lumbosacral area. Viral replication (DNA) in the skin was detected as early as day 2 postinfection (p.i.). Mice developed typical vaccinia lesions at the site of inoculation by day 4 to 6 p.i. By about 2 weeks p.i., the infection had spread all over the body, a situation reminiscent of disseminated vaccinia in humans. The infection resulted in viremia and spread of the virus to visceral organs, as well as to the brain. Topical treatment with cidofovir, initiated at the day of infection or at day 1 p.i., completely protected against virus-induced cutaneous lesions and against associated mortality. When treatment was initiated at a later time (day 2 to 5 p.i.), a partial but marked protective effect was noted, which can be explained by the fact that by that time, the virus had spread from the skin to the visceral organs. Next, infected animals were left untreated until the time (ϳ2 weeks p.i.) at which disseminated vaccinia had developed. When systemic treatment with cidofovir was initiated at that time, it caused lesions to heal and regress. In most of these animals, lesions had completely (or almost completely) disappeared by day 10 to 15 after the start of therapy. The observation that cidofovir is able to cause healing of disseminated vaccinia lesions in animals should have implications for the therapy of complications of vaccination against smallpox.

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“…For these individuals, DFA was positive in 58% of specimens (Table 2) versus a positive rate of only 22% for previously vaccinated individuals. Primary vaccination is usually associated with the development of a vesicle followed by a pustule at the vaccine site, while revaccination is often associated with induration rather than a pustule (8). Thus, it is more difficult to obtain adequate numbers of cells to perform a DFA in lesions from vaccinated persons.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Methods for Detection of Vaccinia Virus in Patient Specimens

et al. 2005

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We analyzed a shell vial culture assay (SVA), real-time PCR, and a direct fluorescent antibody assay (DFA) for rapid detection of vaccinia virus from vaccination sites of Dryvax vaccine recipients. Of 47 samples assayed, 100% were positive by PCR, 89% were positive by SVA, and 40% were positive by DFA. DFA was limited by the need for adequate numbers of cells, with 32% of samples inadequate for interpretation. DFA performed better with specimens from patients who had not previously received the vaccine. PCR was positive for longer times postvaccination than was SVA. Infectious virus could be recovered after 45 min of acetone fixation of shell vial coverslips. Commercially available polyclonal antibodies cross-reacted with other orthopoxviruses and herpes simplex 1, but commercially available monoclonal antibodies were specific for vaccinia virus. In summary, PCR was the most sensitive test for detecting vaccinia virus in clinical specimens, while the DFA was the most rapid but the least sensitive test.

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Smallpox Vaccination: A Review, Part I. Background, Vaccination Technique, Normal Vaccination and Revaccination, and Expected Normal Reactions

Cited by 83 publications

References 17 publications

Genomic Analysis of Vaccine-Derived Poliovirus Strains in Stool Specimens by Combination of Full-Length PCR and Oligonucleotide Microarray Hybridization

Genomic Analysis of Vaccine-Derived Poliovirus Strains in Stool Specimens by Combination of Full-Length PCR and Oligonucleotide Microarray Hybridization

Efficacy of Cidofovir in a Murine Model of Disseminated Progressive Vaccinia

Comparison of Methods for Detection of Vaccinia Virus in Patient Specimens

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