Complications of smallpox vaccination and theirtreatment with vaccinia immune gamma globulin

Abstract

Summary Serious complications of smallpoxvaccination are rare. A survey is given of such complications, as well as of their icidence in Sweden. During a five-year period, there were two deaths from eczema vaccinatum, both unvaccinated infants, and two deaths from postvaccination encephalitis. The importance is stressed ofmaking a sharp distinction between generalized vaccinia, eczema vaccinatum, and gangrenous vaccinia. The clinical picture of fetal vaccinia resembles that of gangrenous vaccinia. Some cases of unusual complications and of vaccination combined with other illnesses are described. A brief survey of the possibilities of preventing complications is given. Specific gamma globulin, prepared on the lines given by Kempe, has recently been produced in Sweden. It is intended for prevention and treatment of complications of smallpox vaccination. It is known as immune globulin against vaccinia, and is distributed by the State Bacteriological Laboratory. The main indications for its use are listed. They are: prevention of spreading of vaccinia to eczema patients who have been in contact with newly vaccinated persons; treatment of newly vaccinated persons suffering from another serious disease, or contracting it; in cases of generalized vaccinia, eczema vaccinatum, and gangrenous vaccinia. The preparation should be tried when there is a risk of corneal lesions, as well as in postvaccination encephalitis, since specific therapy for these conditions is lacking. When a smallpox epidemic threatens, the preparation can presumably be used as an adjuvant in prophylaxis. It is suggested that if specific immunegamma globulin is not available, other gamma globulin preparations should be used. They should preferably be prepared from the blood of military personnel, who are generally vaccinated on induction. Large doses should be used. A report is given of a case of generalized vaccinia with hypogammaglobulinemia, in which gamma globulin partly deriving from such a source was successfully used.