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Ocular complications in the Department of Defense Smallpox Vaccination Program.
Ophthalmology. 2004 Nov; 111(11):2086-93.O

Abstract

OBJECTIVE

The purpose of this case series was to present an overview of the nature and frequency of ocular complications in the Department of Defense (DoD) Smallpox Vaccination Program.

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

The authors retrospectively evaluated data collected on individuals with an ophthalmologic complaint after receiving smallpox vaccination or after contact with a recently immunized individual. The vaccinee and contact cases occurred secondary to inoculations given between December 13, 2002 and May 28, 2003 as part of the DoD Smallpox Vaccination Program.

METHODS

Data were collected primarily from reports to military headquarters or to the Vaccine Adverse Event Reporting System and individual medical records.

MAIN OUTCOME MEASURES

The incidence, types, and timing of ocular complications were evaluated. Diagnostic and treatment considerations also were reviewed.

RESULTS

Between December 13, 2002 and May 28, 2003, 450,293 smallpox vaccinations were given. We identified 16 confirmed or probable cases of ocular vaccinia, with an incidence of 3.6 per 100,000 inoculations. Of these cases, 12 (75%) were seen in the vaccinees, and 4 (25%) in close contacts. Of the 12 self-inoculation cases, 7 (58.3%) were seen in individuals receiving the vaccine for the first time (primary vaccination), and 3 (25.0%) were seen in individuals previously vaccinated (revaccination); the vaccination status in 2 cases was unknown. Clinical manifestations included lid pustules, blepharitis, periorbital cellulitis, conjunctivitis, conjunctival ulcers, conjunctival membranes, limbal pustules, corneal infiltrates, and iritis, with onset of symptoms 3 to 24 days after inoculation or contact. Five of 9 tested cases were culture or polymerase chain reaction positive for vaccinia. Treatment for most cases was topical trifluridine 1% (Viroptic; King Pharmaceuticals, Inc., Bristol, TN). Vaccinia immune globulin was used in 1 case. In all patients, recovery occurred without significant visual sequelae.

CONCLUSIONS

When compared with historical data on the ocular complications of smallpox vaccination, the incidence of ocular complications during the DoD Smallpox Vaccination program has been low. In addition, the severity of disease seems to be less than during other vaccination periods. These findings perhaps are the result of improved screening of vaccinees, prevaccination counseling, postvaccination wound care, and the suggested efficacy of trifluridine in the treatment of ocular vaccinia.

Authors+Show Affiliations

Ophthalmology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

15522376

Citation

Fillmore, Gary L., et al. "Ocular Complications in the Department of Defense Smallpox Vaccination Program." Ophthalmology, vol. 111, no. 11, 2004, pp. 2086-93.
Fillmore GL, Ward TP, Bower KS, et al. Ocular complications in the Department of Defense Smallpox Vaccination Program. Ophthalmology. 2004;111(11):2086-93.
Fillmore, G. L., Ward, T. P., Bower, K. S., Dudenhoefer, E. J., Grabenstein, J. D., Berry, G. K., & Madigan, W. P. (2004). Ocular complications in the Department of Defense Smallpox Vaccination Program. Ophthalmology, 111(11), 2086-93.
Fillmore GL, et al. Ocular Complications in the Department of Defense Smallpox Vaccination Program. Ophthalmology. 2004;111(11):2086-93. PubMed PMID: 15522376.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ocular complications in the Department of Defense Smallpox Vaccination Program. AU - Fillmore,Gary L, AU - Ward,Thomas P, AU - Bower,Kraig S, AU - Dudenhoefer,Eric J, AU - Grabenstein,John D, AU - Berry,G Keith, AU - Madigan,William P,Jr PY - 2003/11/20/received PY - 2004/04/06/accepted PY - 2004/11/4/pubmed PY - 2004/12/16/medline PY - 2004/11/4/entrez SP - 2086 EP - 93 JF - Ophthalmology JO - Ophthalmology VL - 111 IS - 11 N2 - OBJECTIVE: The purpose of this case series was to present an overview of the nature and frequency of ocular complications in the Department of Defense (DoD) Smallpox Vaccination Program. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The authors retrospectively evaluated data collected on individuals with an ophthalmologic complaint after receiving smallpox vaccination or after contact with a recently immunized individual. The vaccinee and contact cases occurred secondary to inoculations given between December 13, 2002 and May 28, 2003 as part of the DoD Smallpox Vaccination Program. METHODS: Data were collected primarily from reports to military headquarters or to the Vaccine Adverse Event Reporting System and individual medical records. MAIN OUTCOME MEASURES: The incidence, types, and timing of ocular complications were evaluated. Diagnostic and treatment considerations also were reviewed. RESULTS: Between December 13, 2002 and May 28, 2003, 450,293 smallpox vaccinations were given. We identified 16 confirmed or probable cases of ocular vaccinia, with an incidence of 3.6 per 100,000 inoculations. Of these cases, 12 (75%) were seen in the vaccinees, and 4 (25%) in close contacts. Of the 12 self-inoculation cases, 7 (58.3%) were seen in individuals receiving the vaccine for the first time (primary vaccination), and 3 (25.0%) were seen in individuals previously vaccinated (revaccination); the vaccination status in 2 cases was unknown. Clinical manifestations included lid pustules, blepharitis, periorbital cellulitis, conjunctivitis, conjunctival ulcers, conjunctival membranes, limbal pustules, corneal infiltrates, and iritis, with onset of symptoms 3 to 24 days after inoculation or contact. Five of 9 tested cases were culture or polymerase chain reaction positive for vaccinia. Treatment for most cases was topical trifluridine 1% (Viroptic; King Pharmaceuticals, Inc., Bristol, TN). Vaccinia immune globulin was used in 1 case. In all patients, recovery occurred without significant visual sequelae. CONCLUSIONS: When compared with historical data on the ocular complications of smallpox vaccination, the incidence of ocular complications during the DoD Smallpox Vaccination program has been low. In addition, the severity of disease seems to be less than during other vaccination periods. These findings perhaps are the result of improved screening of vaccinees, prevaccination counseling, postvaccination wound care, and the suggested efficacy of trifluridine in the treatment of ocular vaccinia. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/15522376/Ocular_complications_in_the_Department_of_Defense_Smallpox_Vaccination_Program_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(04)00824-3 DB - PRIME DP - Unbound Medicine ER -