eval-ae - Evaluation, Management, and Treatment of Adverse...

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Evaluation, Management, and Treatment of Adverse Events of Smallpox Vaccine Department of Health and Human Services Centers for Disease Control and Prevention December 2002
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Evaluation, Management, and Treatment of Adverse Events of Smallpox Vaccine Learning Objectives: Describe the common and serious adverse events expected after smallpox vaccination Describe the treatment options available to clinicians when treating a patient with an adverse event to smallpox
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Dryvax Smallpox Vaccine Prepared from calf lymph containing live vaccinia virus Contains polymyxin B, streptomycin, tetracycline and neomycin Diluent is 50 percent glycerin and phenol as a preservative
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New Smallpox Vaccines Live vaccinia virus produced using cell culture technology Distributed as a freeze dried powder Do not contain antibiotics Diluent contains glycerin and phenol
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Clinical Response to Vaccination* Symptom/sign Papule Pustule Maximum erythema Scab Scab separation Time after Vacc 2-5 days 7-10 days 8-10 days 14 days 21 days *typical response in a nonimmune person
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Progression of smallpox vaccination site in a non-immune person
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Smallpox Vaccine Local Reactions Among Susceptible Adults Local sign Pustule Erythema Induration Mean Diameter 12 mm 16-24 mm 11-16 mm
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Smallpox Vaccine Local Reactions Among Susceptible Adults Pain, swelling, erythema at vaccination site Regional lymphadenopathy Begins 3-10 days after vaccination Can persist for 2-4 weeks after vaccination site heals
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Smallpox Vaccine Reactions Among Susceptible Adults Elevated temperature 17% > 100 o F 1.4% > 102 o F Systemic symptoms (malaise, myalgias) 36% sufficiently ill to miss work, school, or recreational activities or had trouble sleeping
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Normal Variants of Vaccine Reaction Local edema at vaccination site Lymphangitis Regional lymphadenopathy (nonfluctuant) Satellite lesions
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Lymphangitis following smallpox vaccination
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Satellite lesions
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Local Reactions Following Smallpox Vaccine Allergic reactions to bandage and tape adhesives Large primary vaccination reactions (“robust primary takes” – RPT) Secondary bacterial infection
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Allergic reaction to tape
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Local Reactions to Adhesive Erythema corresponds to placement of adhesive tape No systemic symptoms Treat with antihistamines, NSAIDs, frequent bandage/tape change Steroid treatment not recommended
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Robust Primary Takes (RPT) Expected variant of normal reaction >3 inches of erythema with induration, pain, warmth Occur in 5%-15% of recipients Peak at day 8-10 post-vaccination May resemble bacterial infection
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Robust primary take
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Robust Primary Takes (RPT) Observe carefully Supportive therapy Rest affected limb Analgesia (non-aspirin) NSAIDs Usually improve in 24-48 h
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Secondary bacterial infection of vaccination site
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Secondary Bacterial Infection More common among children than adults Usually Staphylococcus aureus or Group
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eval-ae - Evaluation, Management, and Treatment of Adverse...

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