Smallpox vaccine, ACAM2000: Sites and duration of viral shedding and effect of povidone iodine on scarification site shedding and immune response

Phillip R. Pittman, Patrick M. Garman, Sung Han Kim, Trevor J. Schmader, William J. Nieding, Jason G. Pike, Ryan Knight, Sara C. Johnston, John W. Huggins, Mark G. Kortepeter, Lawrence Korman, Manmohan Ranadive, Xiaofei Quinn, Mitchell S. Meyers

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The U.S. Department of Defense vaccinates personnel deployed to high-risk areas with the vaccinia virus (VACV)-based smallpox vaccine. Autoinoculations and secondary and tertiary transmissions due to VACV shedding from the vaccination site continue to occur despite education of vaccinees on the risks of such infections. The objectives of this study were to investigate, in naïve smallpox vaccinees, (a) whether the vaccination site can remain contagious after the scab separates and (b) whether the application of povidone iodine ointment (PIO) to the vaccination site inactivates VACV without affecting the immune response. These objectives were tested in 60 individuals scheduled to receive smallpox vaccine. Thirty individuals (control) did not receive PIO; 30 subjects (treatment) received PIO starting on post-vaccination day 7. Counter to current dogma, this study showed that VACV continues to shed from the vaccination site after the scab separates. Overall viral shedding levels in the PIO group were significantly lower than those in the control group (p=0.0045), and PIO significantly reduced the duration of viral shedding (median duration 14.5 days and 21 days in the PIO and control groups, respectively; p= 0.0444). At least 10% of control subjects continued to shed VACV at day 28, and 3.4% continued to shed the virus at day 42. PIO reduced the proportion of subjects shedding virus from the vaccination site from day 8 until days 21-23 compared with control subjects. Groups did not differ significantly in the proportion of subjects mounting an immune response, as measured by neutralizing antibodies, IgM, IgG, and interferon-gamma enzyme-linked immunospot assay. When applied to the vaccination site starting on day 7, PIO reduced viral shedding without altering the immune response. The use of PIO in addition to a semipermeable dressing may reduce the rates of autoinoculation and contact transmission originating from the vaccination site in smallpox-vaccinated individuals.

Original languageEnglish (US)
Pages (from-to)2990-2996
Number of pages7
JournalVaccine
Volume33
Issue number26
DOIs
StatePublished - Jun 12 2015

Fingerprint

Smallpox Vaccine
Virus Shedding
ointments
Povidone-Iodine
viral shedding
Ointments
iodine
immune response
Vaccination
vaccines
Vaccinia virus
vaccination
duration
Smallpox
United States Department of Defense
ACAM2000
Enzyme-Linked Immunospot Assay
Control Groups
Bandages
interferon-gamma

Keywords

  • ACAM2000
  • Contact transmission
  • Military
  • Povidone iodine ointment
  • Smallpox vaccine
  • Vaccinia virus shedding

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Pittman, P. R., Garman, P. M., Kim, S. H., Schmader, T. J., Nieding, W. J., Pike, J. G., ... Meyers, M. S. (2015). Smallpox vaccine, ACAM2000: Sites and duration of viral shedding and effect of povidone iodine on scarification site shedding and immune response. Vaccine, 33(26), 2990-2996. https://doi.org/10.1016/j.vaccine.2015.04.062

Smallpox vaccine, ACAM2000 : Sites and duration of viral shedding and effect of povidone iodine on scarification site shedding and immune response. / Pittman, Phillip R.; Garman, Patrick M.; Kim, Sung Han; Schmader, Trevor J.; Nieding, William J.; Pike, Jason G.; Knight, Ryan; Johnston, Sara C.; Huggins, John W.; Kortepeter, Mark G.; Korman, Lawrence; Ranadive, Manmohan; Quinn, Xiaofei; Meyers, Mitchell S.

In: Vaccine, Vol. 33, No. 26, 12.06.2015, p. 2990-2996.

Research output: Contribution to journalArticle

Pittman, PR, Garman, PM, Kim, SH, Schmader, TJ, Nieding, WJ, Pike, JG, Knight, R, Johnston, SC, Huggins, JW, Kortepeter, MG, Korman, L, Ranadive, M, Quinn, X & Meyers, MS 2015, 'Smallpox vaccine, ACAM2000: Sites and duration of viral shedding and effect of povidone iodine on scarification site shedding and immune response', Vaccine, vol. 33, no. 26, pp. 2990-2996. https://doi.org/10.1016/j.vaccine.2015.04.062
Pittman, Phillip R. ; Garman, Patrick M. ; Kim, Sung Han ; Schmader, Trevor J. ; Nieding, William J. ; Pike, Jason G. ; Knight, Ryan ; Johnston, Sara C. ; Huggins, John W. ; Kortepeter, Mark G. ; Korman, Lawrence ; Ranadive, Manmohan ; Quinn, Xiaofei ; Meyers, Mitchell S. / Smallpox vaccine, ACAM2000 : Sites and duration of viral shedding and effect of povidone iodine on scarification site shedding and immune response. In: Vaccine. 2015 ; Vol. 33, No. 26. pp. 2990-2996.
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