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smallpox vaccine; vaccinia vaccine (Dryvax, Arestvyr, Jynneos, Ankara-Bavarian Nordic vaccine, MVA-BN vaccine)

Tradename: Dryvax. Only Jynneos FDA-approved [10] Indications: - laboratory & healthcare personnel at risk for occupational exposure to orthopoxviruses Contraindications: - Jynneos: smallpox vaccination within past 3 years Pharmacokinetics: 1) vaccine is effective 3 days after exposure 2) immunity probably persists for life [4] Adverse effects: (see vaccinia) 1) severe reaction in 0.005% 2) eczema vaccinatum a) vesicular or pustular lesions may occur b) lesions do contain live vaccinia 3) encephalitis, meningitis 4) Bell's palsy 5) seizures 6) Guillain-Barre syndrome 7) myopericarditis, pericarditis [5,6] 8) death 9) pain, swelling & erythema at injection sit 10) myalgia/arthralgia (8%) [12] 11) headache (9%) [12] 12) gastrointestinal symptoms (4%) [12] 13) fatigue (18%) [12] 15) dyspnea (1%) [12] 16) palpitations (1%) [12] Toxicity: 1) vaccine antidote is available 2) vaccinia immune globulin helps for some adverse effects 3) cidofovir may be helpful Mechanism of action: 1) vaccine does NOT contain smallpox virus (Variola major) 2) vaccine contains vaccinia - modified vaccinia Ankara (MVA) replicates for one cycle in mammalian cells & is safe & immunogenic [11]

General

live virus vaccine

References

  1. Prescriber's Letter 9(12):72 2002
  2. Action Report, Medical Board of California, 85:6 (April) 2003
  3. http://www.cdc.gov/smallpox
  4. Frey SE et al Response to smallpox vaccine in persons immunized in the distant past. JAMA 289:3295, 2003 PMID: 12824212
  5. Halsell JS et al Myopericarditis following smallpox vaccination among vaccinia- naive US military personnel. JAMA 289:3283, 2003 PMID: 12824210
  6. Casey CG et al, Adverse events associated with smallpox vaccination in the United States, JAMA 2005; 294:2734 PMID: 16333009 Sejvar JJ et al, Neurologic adverse events associated with smallpox vaccination in the United States, 2002-2004 JAMA 2005; 294:2744 PMID: 16333010
  7. Casey C, Vellozzi C, Mootrey GT, Chapman LE, McCauley M, Roper MH, Damon I, Swerdlow DL. Surveillance guidelines for smallpox vaccine (vaccinia) adverse reactions. MMWR Recomm Rep. 2006 Feb 3;55(RR-1):1-16. PMID: 16456528 Corresponding NGC guideline withdrawn Dec 2011 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5501a1.htm
  8. Physician's First Watch, March 14, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - McNeil DG Wary of Attack With Smallpox, U.S. Buys Up a Costly Drug http://www.nytimes.com/2013/03/13/health/us-stockpiles-smallpox-drug-in-case-of-bioterror-attack.html
  9. Petersen BW, Harms TJ, Reynolds MG, Harrison LH Use of Vaccinia Virus Smallpox Vaccine in Laboratory and Health Care Personnel at Risk for Occupational Exposure to Orthopoxviruses - Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2015 MMWR Weekly / March 18, 2016 / 65(10);257-262 http://www.cdc.gov/mmwr/volumes/65/wr/mm6510a2.htm - Petersen BW, Damon IK, Pertowski CA et al Clinical guidance for smallpox vaccine use in a postevent vaccination program. MMWR Recomm Rep. 2015 Feb 20;64(RR-02):1-26. PMID: 25695372 Free Article
  10. FDA News Release. Sept 24, 2019 FDA approves first live, non-replicating vaccine to prevent smallpox and monkeypox. https://www.fda.gov/news-events/press-announcements/fda-approves-first-live-non-replicating-vaccine-prevent-smallpox-and-monkeypox
  11. Pittman PR, Hahn M, Lee HS et al. Phase 3 efficacy trial of modified vaccinia Ankara as a vaccine against smallpox. N Engl J Med 2019 Nov 14; 381:1897 PMID: 31722150 https://www.nejm.org/doi/10.1056/NEJMoa1817307
  12. Deng L, Lopez LK, Glover C et al Short-term Adverse Events Following Immunization With Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) Vaccine for Mpox. JAMA. Published online May 5, 2023 PMID: 37145654 https://jamanetwork.com/journals/jama/fullarticle/2804849
  13. Centers for Disease Control & Prevention Monkeypox Vaccine Administration in the U.S. Data as of October 11 2022 https://www.cdc.gov/poxvirus/monkeypox/response/2022/vaccines_data.html