The Scottish Government

« Previous | Contents | Next »

Listen

Smallpox vaccination of Regional Response Groups

Treatment of complications ofsmallpox vaccination

Symptomatic treatment of complications

Complications will sometimes occur following smallpox vaccination despite rigorous exclusion of those for whom vaccination is contra-indicated. Many such complications do not necessarily cause severe illness and can be treated symptomatically. For example mild generalised vaccinia and eczema vaccinatum are usually self limiting and the symptoms can be treated with anti inflammatory analgesics and supportive care.

Reactive rashes such as erythema multiforme, often respond poorly to vaccinia immunoglobulin (VIG), and should be treated with emollients, antihistamines and analgesics as required.

For more serious complications or for those which progress rapidly or are life threatening, VIG can be used. However, VIG should not be used unless it is definitely indicated. Where there is doubt about progress of a condition, vaccines may be observed for up to 3 days to allow for a decision on specific treatment to be made.

Vaccinia immunoglobulin (VIG)

VIG for intramuscular use was produced to WHO standards from the late 1960s onwards, using plasma harvested from recently-immunised individuals. It was validated and standardised by performing virus neutralisation tests. Although there are very few controlled trials of its use, it is likely that it has some beneficial effects in both prophylaxis and treatment of adverse effects of vaccination.

Therapeutic use of VIG

Descriptive studies and trials suggest that VIG can influence the course of complications, especially those that may be driven by viraemia. The best effects seem to be reported for eczema vaccinatum and generalised vaccinia, while vaccinia necrosum is less likely to respond (though some successes have been reported). There is doubt whether VIG is useful in treating post-vaccinial encephalitis and therefore is not recommended. The success rate of VIG treatment is low for reactive rashes and erythemas, and any cases should be discussed on an individual basis with the infectious disease expert.

Recommendations for therapeutic use of VIG

• VIG should be used for the treatment of:

  • eczema vaccinatum with more than 6-10 pocks, or which is progressing, with new lesions for more than 3 days after onset;

  • generalised vaccinia if new lesions continue to occur more than 2 weeks after vaccination, if lesions are extensive in more than one body site, or if conjunctival or mucosal lesions are present;

  • progressive or necrotic vaccinia which is not severe or life-threatening (but antiviral therapy should also be considered if VIG does not arrest the disease);

Obtaining supplies of VIG

Obtaining VIG

VIG is available from:

The Vaccines Division
HPA, Colindale
61 Colindale Avenue
London NW9 5EQ
Telephone: 020 8200 6868

In Scotland contact SCIEH/HPS 0141-300 1100 (out of hours 0141-211 3600 ask for SCIEH/HPS) who will, in turn, contact 'the duty doctor' at CDSC who will confirm the need for VIG (if necessary arranging consultation with a UK national smallpox expert). If VIG is indicated, the HPA, Colindale will arrange for delivery by courier to the requesting doctor.

Summary of complications of smallpox vaccination and their treatmentand their treatment

Table 3

VIG: vaccinia immunoglobulin
*Some evidence that it may exacerbate inflammation

« Previous | Contents | Next »