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Home Front: WoT
Toddler Contracts Rare Smallpox Infection from Soldier Dad
2007-03-17
Full disclosure: the child is being treated at the institution where I work.
In the first case of its kind in years, a 2-year-old boy is being treated in Chicago for a rare and life-threatening infection that he contracted from his father, a U.S. Army soldier recently vaccinated against smallpox. The Indiana boy is in critical condition with eczema vaccinatum, an unusual side effect of the smallpox vaccine that can affect people who receive the shot or their close contacts.
CDC link on eczema vaccinatum, with pics, is here.
Doctors also said the boy appears to have passed the infection to his mother, who has a much milder case of the virus in the smallpox vaccine, which is also called vaccinia. The virus is not smallpox, though it is similar enough to offer protection from that deadly disease, which was declared eradicated in 1980.

The mother and child are being treated at the University of Chicago's Comer Children's Hospital, which withheld their names at the family's request. There is no infection risk for the general population, government officials say, since the vaccine virus can spread only through close physical contact.
Correct. No cause for alarm.
But the boy's diagnosis last week has prompted a frenzy of activity and daily conference calls involving the federal Centers for Disease Control and Prevention, the U.S. Department of Defense, and the state and city public health departments. The U.S. Food and Drug Administration gave emergency authorization for the hospital to treat the boy with ST-246, an experimental drug for smallpox that is untried as a therapy in humans.

The smallpox vaccine fell out of general use in the 1970s, but the case could be a lesson for the U.S. military, which has vaccinated 1.2 million personnel against smallpox since 2002 amid fears of bioterrorism.
We vaccinate the soldiers because we don't quite trust the thugs and dictators of the world not to possess a stock of smallpox. This is an unfortunate, though fortunately rare, complication.
It's unclear why the father was allowed to have contact with his son, who had a history of eczema, shortly after the vaccination. The skin condition is a well-known risk factor for eczema vaccinatum, and official guidelines warn that people with eczema should avoid contact with vaccinees.
That's also correct, and the investigation is necessary.
"We are looking into how this could have happened," said U.S. Army spokesman Paul Boyce.

Officials say the general population could receive smallpox vaccinations in the event of a bioterrorist attack or other unforeseen exposure. For that reason, experts want to study the Indiana family to learn more about treatment and transmission of the vaccinia infection. "There certainly are also conceivable insights into smallpox infection," said Dr. Inger Damon, chief of the CDC's poxvirus and rabies branch. Damon has been involved in the daily conference calls on the boy's treatment.

Experts said they knew of no cases of eczema vaccinatum since at least 1990, when the military last had a program of smallpox vaccination.

The father of the Indiana boy received the vaccine in late January before a planned military deployment. The Army delayed his departure and permitted him to visit his family in mid-February. Two weeks later, a rash broke out on the boy's skin. He came to the U. of C. on March 3 after being transferred from St. Catherine's Hospital in East Chicago. Doctors first identified his widespread rash as a different form of eczema, but it worsened in his first few days at the U. of C.

His mother developed sores after she and her son arrived at the Chicago hospital. Doctors believe she contracted the disease from the boy because of their lengthy close contact.

A pediatric dermatologist, Dr. Sarah Stein, noticed the boy's lesions had changed to look like round blisters with a dimple in the middle--a potential sign of vaccinia infection. The medical team took scrapings from the lesions, which they analyzed and sent to the Illinois Department of Public Health's Chicago office for further testing.
Kudos to my colleague for recognizing this -- I'm not sure the average good dermatologist would have twigged to this diagnosis right off. I'm comfortably certain that I would not have.
Rapid tests by the state and further tests at the CDC confirmed the boy had the vaccinia virus, officials at those agencies said. The hospital also sent the CDC photos of the boy's lesions.

The hospital already was using infection precautions with the boy, but staffers then added such measures as gloves and face masks. They also placed the boy in a room with negative pressure so the air would always blow inward, keeping the virus inside.

The boy's rash had spread to cover 80 percent of his body, said Dr. Madelyn Kahana, chief of pediatric intensive care medicine at the U. of C. He was going into sepsis, a devastating, systemwide infection rarely seen with viral cases. "In the later stages of [eczema vaccinatum], it can look like smallpox," said Damon of the CDC. The boy needed a ventilator to help his breathing because of the powerful pain medication he needed for the lesions.
This is very serious, and the strongest supportive care is required. As it turns out, the Comer Hospital is virtually brand new -- built two years ago. The pediatric ICU (I've been there) is very modern and has the negative-pressure rooms, isolation gear, etc, to treat this young lad. It's absolutely state of the art.
The boy received the primary treatment for eczema vaccinatum, a drug called vaccinia immune globulin, or VIG. The drug came from a stockpile the CDC keeps in case widespread vaccination ever becomes necessary. He also got an antiviral drug called cidofovir and the experimental drug ST-246, which has been shown to protect laboratory animals from exposure to smallpox. The drug recently entered preliminary human trials but had never been used in a sick patient.

U. of C. officials said the boy has shown signs of improvement since hitting a low point last weekend. His mother's health was never in serious danger, but she has remained in his hospital room to keep others from being exposed. Health officials in Chicago and Indiana have tracked all of the family's contacts and found no additional cases so far.

Kahana said the boy probably will lose 20 percent of his outer skin layer, but she hopes he will recover without the need for skin grafts. She believes the case should be a lesson to the military, which must educate service members about the risks of the vaccines it requires them to take. "I think the information simply wasn't disseminated properly or impressed in a manner that was understood," Kahana said, "because I don't think anyone would knowingly expose their child to this."
I think that's exactly right. You have a rare but extremely serious complication, and a one-time mistake in the post-vaccination protocol. 99.999% of the time it won't matter, but the one time it does, this is what happens. Prayers for the lad and his family.
Posted by:Steve White

#7  In this case, Steve correct me if I'm wrong, close contact means actual touching of the smallpox vaccination site. Normally you're told about this.

I hope that the skin comes back, and as a youngster he has a better chance than others might. Still, smallpox is a scarring disease and I would expect its relatives to be also. Race is a factor since some races tend to form scars called keltoids and a much higher rate than others.
Posted by: Chuck Simmins   2007-03-17 20:42  

#6  Told ya you can't trust them nurses.
Posted by: Mohamar QadaffiKhadaffi Kadaffy   2007-03-17 20:28  

#5  I'm very happy to see that this child is having everything possible done for him. I'll just wryly note how I wish our returning soldiers could receive even one tenth the quality of care that this kid is getting.

Another round of applause for Dr. Steve on bringing the facts behind this incident to light.
Posted by: Zenster   2007-03-17 18:38  

#4  wow Dr Steve. Thank You for sharing with us this tragic yet fascinating case.

The poor kid must be suffering like hell gauging from those images. It really hit home after looking thru the cases you provided with the link.

Heart breaking and to think of the torture the father and mother must be going through, jeeze I sure hope they have all the support they can get.

Dr. Steve is the smallpox vaccine used today any different that the vaccine us old super studs were vacinated with back in the 50s and 60s?

1) You have a pool of vacinees ie, 1.2 million service personal [not counting civilians] who have had the *new* smallpox vaccine.

2) You have one case of eczema vaccinatum.

3) Any 2 year old kid is going to have very close contact with his mom and pop.

4) Can one make the leap then that it isn't the fault of the father, or our vaccination program but that it was most probably fate that poor kid had a vulnerability, a compromised immune system which left him open to the life threatening condition?

The boy needed a ventilator to help his breathing because of the powerful pain medication he needed for the lesions.

Before I first saw the pics I was hoping against hope that at least the poor kid wasn't suffering, wishful thinking.. sounds way way bad, what medicines are they likely giving him to relieve his pain Dr. Steve?
Posted by: RD   2007-03-17 17:26  

#3  Where else but the 'Burg could one read that story and get the "rest of the story?" I read it elsewhere earlier and was clueless.
Thanks, Dr. Steve.
Posted by: Glenmore   2007-03-17 16:18  

#2  mine as well, thx Dr. Steve
Posted by: Frank G   2007-03-17 15:44  

#1  The boy needed a ventilator to help his breathing because of the powerful pain medication he needed for the lesions

My fervent wish is that he is off the ventilator and climbing out of the pit.

Posted by: Shipman   2007-03-17 14:49  

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