In December 2018, a 26 yo lab worker was injecting vaccinia virus (VACV, a member of the poxviridae family, 1) into the tails of mice (2). She accidentally stuck herself in the left index finger with the same needle. Her safety procedure post-stick was a 15 minute water rinse and a visit to the local emergency department. In September of the same year, before starting work with VACV, she had discussed the risks of working with VACV and was offered ACAM2000, the smallpox vaccine, but declined.
An important note about ACAM2000 is that while it has low risk of complication (for both the recipient and close contacts), it is a live-virus vaccine and the lesion at the administration site is infectious (3). In addition, while recommended unless medically contraindicated, ACAM2000 is optional and each lab working with VACV sets its own vaccine policy (2-3).
Her symptoms began on day 12 post-prick when she was treated for a 100.9°F fever, malaise, pain, lymph node swelling, and worsening edema of the prick site finger. She received Vaccinia Immunoglobulin Intravenous (VIGIV) on day 12 and tecovirimat on day 14, and her symptoms gradually began to lessen. There was necrotic tissue present all the way until day 94, though.
The CDC has highlighted three main takeaways from this incident (2). First, there was an inadequate understanding of the danger of VACV. Second, there needs to be better information about the danger of working with VACV and better awareness of the proper post-exposure procedures. Third, the drug tecovirimat can be used to treat VACV infections, but it needs further investigation.
-- Brian Smith
Sources:
1 - Viralzone: Poxviridae
2 - CDC Morbidity and Mortality Weekly Report: Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick
3- CDC MMWR: Use of Vaccinia Virus Smallpox Vaccine
An important note about ACAM2000 is that while it has low risk of complication (for both the recipient and close contacts), it is a live-virus vaccine and the lesion at the administration site is infectious (3). In addition, while recommended unless medically contraindicated, ACAM2000 is optional and each lab working with VACV sets its own vaccine policy (2-3).
Her symptoms began on day 12 post-prick when she was treated for a 100.9°F fever, malaise, pain, lymph node swelling, and worsening edema of the prick site finger. She received Vaccinia Immunoglobulin Intravenous (VIGIV) on day 12 and tecovirimat on day 14, and her symptoms gradually began to lessen. There was necrotic tissue present all the way until day 94, though.
The CDC has highlighted three main takeaways from this incident (2). First, there was an inadequate understanding of the danger of VACV. Second, there needs to be better information about the danger of working with VACV and better awareness of the proper post-exposure procedures. Third, the drug tecovirimat can be used to treat VACV infections, but it needs further investigation.
-- Brian Smith
Sources:
1 - Viralzone: Poxviridae
2 - CDC Morbidity and Mortality Weekly Report: Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick
3- CDC MMWR: Use of Vaccinia Virus Smallpox Vaccine
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