Ocular vaccinia following exposure to a smallpox vaccinee.
OBJECTIVE
To describe the presentation and management of the first identified case of ocular vaccinia infection associated with the current smallpox vaccination program.


METHODS
Case report.


METHODS
Vaccinia virus was isolated by cell culture of a conjunctival swab. Direct staining with fluorescein isothiocyanate-labeled vaccinia antibody and polymerase chain reaction testing confirmed the diagnosis.


RESULTS
In February 2003, a 26-year-old woman developed right preseptal cellulitis and blepharoconjunctivitis following contact with a vaccinated member of the military. The preseptal cellulitis resolved with antibacterial therapy, and the conjunctival infection was treated successfully with a 14-day course of topical trifluridine and a single dose of intravenous vaccinia immune globulin.


CONCLUSIONS
To facilitate rapid diagnosis and appropriate treatment, clinicians must maintain a high index of suspicion for ocular smallpox vaccine-associated adverse reactions in vaccine recipients and their close contacts.
Hu
Gang
G
Ocular Inflammatory Disease Center, Jules Stein Eye Institute and Department of Ophthalmology, Los Angeles, California 90095-1688, USA. dpegues@mednet.ucla.edu
Wang
Marcus J
MJ
Miller
Marjorie J
MJ
Holland
Gary N
GN
Bruckner
David A
DA
Civen
Rachel
R
Bornstein
Lee A
LA
Mascola
Laurene
L
Lovett
Michael A
MA
Mondino
Bartly J
BJ
Pegues
David A
DA
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001762:Blepharitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003228:Conjunctiva / Q000821:virology; D003236:Conjunctivitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018562:Disease Transmission, Infectious; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008889:Military Personnel; D016133:Polymerase Chain Reaction; D012900:Smallpox Vaccine / Q000009:adverse effects*; D014271:Trifluridine / Q000627:therapeutic use; D014611:Vaccination / Q000009:adverse effects; D014615:Vaccinia / Q000635:transmission*; D014616:Vaccinia virus / Q000302:isolation & purification
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D012900:Smallpox Vaccine; D014271:Trifluridine