766. Eczema Vaccinatum in a child through contact transmission of Vaccinia virus; Successful outcome using laboratory monitoring and a novel therapeutic approach
Session: Poster Session: Viruses
Saturday, October 6, 2007: 12:00 AM
Room: Poster Halls G-H
Background: A 28 month-old child with history of severe atopic dermatitis developed Eczema Vaccinatum (EV) after exposure to his father, a member of the U.S. military who recently received smallpox vaccine.
Methods: The child, who initially presented with worsening eczema, fever and a vesicular rash, became critically ill, requiring intubation, vasopressor therapy and a prolonged course in the intensive care unit. Specific treatment included Vaccinia Immune Globulin Intravenous (VIGIV), administered for the first time in a pediatric patient, cidofovir, used for the first time in human vaccinia infection, and an investigational agent, ST-246. Vaccinia specific PCR assays confirmed the diagnosis. A second real time PCR assay, targeting the DNA polymerase gene, was used to quantitate viral load in tissues. Anti-orthopoxvirus IgM and IgG reactivity was measured in serum.
Results: Anti-orthopoxvirus IgM was present at diagnosis, but not IgG. Vaccinia DNA viral load was initially >2 million copies/ml. IgG response became detectable, then stabilized after multiple doses of VIGIV. Viral DNA in blood declined concordant with administration of one dose of cidofovir, multiple doses of ST-246, and rising IgG titers, until consistently undetectable after hospital day 17. Complications included pancytopenia, hypoalbuminemia, hypocalcemia, and hypomagnesiumemia. Cadaveric skin grafts were placed in areas where the skin denuded completely. The child recovered with no evident systemic sequelae and was discharged home on hospital day 48.
Conclusion: Although difficult to assess the contribution of each therapeutic component to the child’s recovery, VIGIV, cidofovir and ST-246, as well as the child’s own immune response, likely all played a synergistic role. New research in therapies for adverse events must proceed as long as the smallpox vaccination program continues.
EV Response Team, Dennis Hruby, PhD2, Edith Lederman, MD3, Inger Damon, MD, PhD3, John Marcinak, MD4, Madelyn Kahana, MD5, Stephen Weber, MD, MS, Surabhi Vora, MD6, Vincent Fulginiti, MD7 and  S. Vora, None; I. Damon, None; V. Fulginiti, None; D. Hruby, SIGA Technologies, Company / Companies, Employment; SIGA Technologies, Company / Companies, Management Position; S.G. Weber, None; M. Kahana, None; E. Lederman, None; J. Marcinak, None., (1)SIGA Technologies, Corvallis, OR, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)University of Chicago, Wilmette, IL, (4)Univ. of Chicago, Chicago, IL, (5)University of Chicago, Atlanta, GA, (6)Univ. of Arizona, Tucson, AZ

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