Fillmore Gary L, Ward Thomas P, Bower Kraig S, Dudenhoefer Eric J, Grabenstein John D, Berry G Keith, Madigan William P
Ophthalmology Service, Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Ophthalmology. 2004 Nov;111(11):2086-93. doi: 10.1016/j.ophtha.2004.04.027.
The purpose of this case series was to present an overview of the nature and frequency of ocular complications in the Department of Defense (DoD) Smallpox Vaccination Program.
Retrospective, noncomparative case series.
The authors retrospectively evaluated data collected on individuals with an ophthalmologic complaint after receiving smallpox vaccination or after contact with a recently immunized individual. The vaccinee and contact cases occurred secondary to inoculations given between December 13, 2002 and May 28, 2003 as part of the DoD Smallpox Vaccination Program.
Data were collected primarily from reports to military headquarters or to the Vaccine Adverse Event Reporting System and individual medical records.
The incidence, types, and timing of ocular complications were evaluated. Diagnostic and treatment considerations also were reviewed.
Between December 13, 2002 and May 28, 2003, 450,293 smallpox vaccinations were given. We identified 16 confirmed or probable cases of ocular vaccinia, with an incidence of 3.6 per 100,000 inoculations. Of these cases, 12 (75%) were seen in the vaccinees, and 4 (25%) in close contacts. Of the 12 self-inoculation cases, 7 (58.3%) were seen in individuals receiving the vaccine for the first time (primary vaccination), and 3 (25.0%) were seen in individuals previously vaccinated (revaccination); the vaccination status in 2 cases was unknown. Clinical manifestations included lid pustules, blepharitis, periorbital cellulitis, conjunctivitis, conjunctival ulcers, conjunctival membranes, limbal pustules, corneal infiltrates, and iritis, with onset of symptoms 3 to 24 days after inoculation or contact. Five of 9 tested cases were culture or polymerase chain reaction positive for vaccinia. Treatment for most cases was topical trifluridine 1% (Viroptic; King Pharmaceuticals, Inc., Bristol, TN). Vaccinia immune globulin was used in 1 case. In all patients, recovery occurred without significant visual sequelae.
When compared with historical data on the ocular complications of smallpox vaccination, the incidence of ocular complications during the DoD Smallpox Vaccination program has been low. In addition, the severity of disease seems to be less than during other vaccination periods. These findings perhaps are the result of improved screening of vaccinees, prevaccination counseling, postvaccination wound care, and the suggested efficacy of trifluridine in the treatment of ocular vaccinia.
本病例系列的目的是概述美国国防部天花疫苗接种计划中眼部并发症的性质和发生率。
回顾性、非对照病例系列。
作者回顾性评估了在接种天花疫苗后或与近期接种疫苗者接触后出现眼科疾病主诉的个体所收集的数据。疫苗接种者和接触者病例是2002年12月13日至2003年5月28日期间作为美国国防部天花疫苗接种计划一部分进行接种后的继发情况。
数据主要从上报给军事总部或疫苗不良事件报告系统的报告以及个人医疗记录中收集。
评估眼部并发症的发生率、类型和发生时间。还对诊断和治疗方面的考虑因素进行了审查。
在2002年12月13日至2003年5月28日期间，共进行了450,293次天花疫苗接种。我们确定了16例确诊或可能的牛痘性眼病病例，每100,000次接种的发生率为3.6例。在这些病例中，12例（75%）发生在疫苗接种者中，4例（25%）发生在密切接触者中。在12例自我接种病例中，7例（58.3%）发生在首次接种疫苗（初种）的个体中，3例（25.0%）发生在先前接种过疫苗（复种）的个体中；2例的接种状态未知。临床表现包括眼睑脓疱、睑缘炎、眶周蜂窝织炎、结膜炎、结膜溃疡、结膜膜、角膜缘脓疱、角膜浸润和虹膜炎，症状在接种或接触后3至24天出现。9例检测病例中有5例牛痘培养或聚合酶链反应呈阳性。大多数病例的治疗是局部使用1%的三氟尿苷（Viroptic；King制药公司，布里斯托尔，田纳西州）。1例使用了牛痘免疫球蛋白。所有患者均康复，未出现明显的视力后遗症。
与天花疫苗接种眼部并发症的历史数据相比，美国国防部天花疫苗接种计划期间眼部并发症的发生率较低。此外，疾病的严重程度似乎低于其他接种时期。这些发现可能是由于对疫苗接种者的筛查改善、接种前咨询、接种后伤口护理以及三氟尿苷治疗牛痘性眼病的建议疗效所致。
