730. Eczema Vaccinatum: an Investigation of Potential Fomites in the Home Environment
Session: Poster Session: Viruses
Saturday, October 6, 2007: 12:00 AM
Room: Poster Halls G-H
Background:
On February 16, 2007, an active duty soldier on furlough returned home 21 days after receiving a smallpox vaccination. On March 3, his 2-year-old son was hospitalized with eczema vaccinatum, a rare and life-threatening complication of Orthopoxvirus vaccinia infection. The soldier’s wife was also hospitalized with O. vaccinia infection. Two other children, one with eczema, were removed from the home until an investigation was performed.
Methods:
10 days after the child was hospitalized, an environmental investigation was performed at the home. Specimens (swabs) were obtained from furniture, clothing and topical medications and were analyzed with quantitative orthopoxvirus generic real time polymerase chain reaction (PCR) assay. PCR positive specimens were cultured in BSC-40 cells.
Results:
Eight of 25 environmental samples from furniture surfaces and the child’s belongings were positive by PCR; three of the eight yielded viable O. vaccinia in cell culture. Quantitative-PCR of cell lysate confirmed that the cytopathic effect observed was due to viral replication.
Conclusions:
Environmental evaluation confirmed the presence of infectious O. vaccinia in the home environment 10 days after both infected family members were removed from the home. This is the first environmental investigation to evaluate personal items other than linen or vaccination dressings as potential fomites for O. vaccinia transmission. Our results support disinfection of the home environment especially in the setting of 1) extensive skin involvement and viral shedding (e.g. eczema vaccinatum) and 2) susceptible household members.
Susan Gerber, MD1, Victoria Olson, PhD2, Wayne Staggs, MS3, Christine Hughes, MPH2, Donna Allen, RN3, Edith Lederman, MD4, Inger Damon, MD, PhD4, John Openshaw, MS4, John Marcinak, MD5, Limone Collins, MD6, Mary Reynolds, PhD4, Pam Diaz, MD4, Rodrigo Panares, MD7, Roque Miramontes, PA, MPH2, Russell Regnery, PhD4, Stephen Weber, MD, MS, Surabhi Vora, MD9 and  E.R. Lederman, None; R. Miramontes, None; J. Openshaw, None; V. Olson, None; J. Marcinak, None; R. Panares, None; W. Staggs, None; D. Allen, None; S. Weber, None; S. Vora, None; S. Gerber, None; C. Hughes, None; R. Regnery, None; L. Collins, None; P. Diaz, None; M. Reynolds, None; I. Damon, None., (1)Chicago Department of Health, Chicago, IL, (2)CDC, Atlanta, GA, (3)Indiana Department of Public Health, Atlanta, GA, (4)Centers for Disease Control and Prevention, Atlanta, GA, (5)University of Chicago, Wilmette, IL, (6)Walter Reed Vaccine Healthcare Center, Atlanta, GA, (7)Hammond City Health Department, Atlanta, GA, (8)University of Chicago, Atlanta, GA


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