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Wisconsin Protocols for Vaccinia Testing Related to Smallpox Vaccination

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Collect specimens from at least two vesicles or pustules. Wipe skin with alcohol and let dry 'De-roof' vesicle/pustule with scalpel or 26-gauge needle ... – PowerPoint PPT presentation

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Title: Wisconsin Protocols for Vaccinia Testing Related to Smallpox Vaccination


1
Wisconsin Protocols for Vaccinia Testing Related
to Smallpox Vaccination
  • David Warshauer, PhD.
  • Assistant Director, CDD
  • WSLH
  • (608) 265-9115
  • warshadm_at_slh.wisc.edu

2
Purpose
  • To provide laboratorians with Wisconsin-specific
    guidelines and protocols to respond to requests
    for vaccinia testing related to adverse vaccine
    reactions. Presenters will describe the
    indications and requirements for laboratory
    testing, specimen collection and transport, tests
    available at the WSLH, and result reporting.

3
National Smallpox Vaccination Plan
  • Phase 1
  • 500,000 volunteers---Smallpox response teams who
    evaluate and manage patients
  • Emergency room and ICU staff
  • General Medical Unit staff
  • Respiratory therapists, radiology technicians
  • Phase 2
  • 10 million emergency response workers
  • law enforcement, emergency medical personnel,
    firefighters

4
Smallpox Vaccination in Wisconsin
  • Phase 1
  • 4500-5000 Healthcare workers
  • 4700 military personnel

5
The Smallpox Vaccine
  • Vaccinia virus
  • Orthopoxvirus
  • Distinct from variola and cowpox
  • Origin of the present vaccine strain unknown
  • Not found in nature----an naturally extinct
    species of orthopox???????
  • 1967---One of two strains used for most vaccine
    production
  • New York City Board of Health strain
  • Lister strain---distributed by WHO

6
Vaccinia Adverse Effects
  • Eczema vaccinatum
  • Progressive vaccinia
  • Postvaccinial encephalitis
  • Fetal vaccinia
  • Generalized vaccinia
  • Inadvertent inoculation
  • MMWR January 24, 2003/Vol.52
  • www.bt.cdc.gov/training/smallpoxvaccine/reactions/
    default.htm

7
Inadvertent inoculation
8
Eczema vaccinatum
  • High fever
  • Generalized lymphadenopathy
  • Extensive vesicular and pustular eruption
  • High mortality rate
  • Multiple doses of VIG or cidofovir
  • Risk factor
  • History of eczema or atopic dermatitis

9
Eczema Vaccinatum
10
Generalized Vaccinia
  • Rash--maculopapular or vesicular
  • Onset 6-9 postvaccination
  • Nontoxic, with or without fever
  • Usually self-limited in immunocompetent
  • VIG usually not indicated

11
Eczema Vaccinatum
12
Progressive Vaccinia
  • In patient with immunodeficiencies
  • Nonhealing vaccination site
  • Progressive necrosis at the vaccination site
  • Occasional metastatic lesions in skin, bones, and
    viscera
  • Poor prognosis
  • VIG or cidofovir

13
Progressive vaccinia
14
Wisconsin Vaccinia Testing Protocol
  • Consult with the Wisc. Division of Public Health
    (DPH)
  • (608) 267-9003-------Mon-Friday, 745-430
  • (608) 258-0099-------After hours or weekends
  • Ask for epidemiologist on call

15
Wisconsin Vaccinia Testing Protocol
  • Contact WSLH when shipping specimens
  • (800) 862-1013-------Mon-Friday, 745-430
  • (608) 263-3280-------After hours or weekends
  • Contact name
  • Telephone number
  • Time when specimens should arrive at WSLH

16
Testing Protocol
  • Vaccinia PCR
  • VZV PCR
  • VZV DFA
  • Viral Culture
  • Herpes simplex
  • Enterovirus
  • Vaccinia
  • VZV

17
Specimens
  • 2 microscope slides
  • scrapings
  • touch-prep
  • 2 swabs
  • PCR
  • Viral culture

18
Specimen Collection
  • PPE per your facilitys protocols
  • gloves, gown, mask, eye protection
  • Collect specimens from at least two vesicles or
    pustules
  • Wipe skin with alcohol and let dry
  • De-roof vesicle/pustule with scalpel or
    26-gauge needle
  • Place in a dry, sterile screw-capped tube

19
Specimen Collection (2)
  • Scraping slide
  • Scrape base with applicator stick or shaft of a
    swab
  • Smear onto a microscope slide. Air dry
  • Touch prep
  • Apply slide to vesicle fluid multiple times to
    make 3 spots on the slide. Air dry

20
Swab specimens
  • Use dacron or rayon swabs
  • NOT cotton or calcium alginate
  • Swab base of lesion
  • One swab into empty screw-capped tube
  • One swab into viral transport medium (VTM)

21
Packaging
  • Tubes and slide holders in one or more zip-lock
    specimen bags.
  • Include absorbent material with VTM tube
  • Complete one Emergency Response-Vaccinia
    requisition.
  • Place in outer pocket of specimen bag.
  • Refrigerate until transport

22
WSLH Specimen Requisition Formfor Vaccinia
Testing

23
Specimen Packaging
  • Place the bagged specimens (and requisition form)
    in the screw-capped container included in the
    styrofoam mailer securely close the screw cap on
    the container.
  • Place the filled screw-capped specimen container
    inside the styrofoam box place 2-4 kool-packs
    around the screw-capped container to maintain
    refrigerator temperature during transit.
  • Attach "biohazard" label to the outside of the
    screw-capped container.
  • Replace the styrofoam lid on box tape flaps of
    cardboard box closed.

24
Specimen Shipping
  • Labeling
  • Address the package to
  • Wisconsin State Laboratory of Hygiene -
    Communicable Diseases Rapid Response
  • 465 Henry Mall
  • Madison, WI 53706
  • Attach the two "infectious substance" labels to
    the outside of the cardboard box.
  • On the small "infectious substance affecting
    humans" label, provide phone number of 24/7
    emergency contact at your institution.
  • Complete and attach two copies of "emergency
    contact form" to outside of cardboard box.

25
Specimen Shipping
  • Complete package preparation before courier
    arrives
  • Transport charges billed to the WSLH if following
    the instructions below
  • Contact Dunham Express office in your area 24/7

26
Specimen Shipping
  • Information to provide when you call
  • Confirm pick-up time request "Overnight
    Service" (available 7 days/week) if approved,
    "Rush (Stat)"
  • Give Dunham Express office the following info
  • WSLH Rapid Response account number name
  • Your name, phone number, pickup address
  • Destination State Lab - Communicable Diseases,
    465 Henry Mall, Madison, WI 53706
  • Shipment description Specimens for delivery
  • Instructions for driver if after-hours delivery
    to WSLH

27
Result Reporting
  • Results will be provided to Wisconsin Division of
    Public Health (WDPH)
  • WDPH will notify the healthcare provider
  • Written reports will be issued to submitter

28
CDC Website Resources
  • Broadcast, January 29, 2003, "Smallpox and
    Vaccinia Testing A National Laboratory Training
    Network Initiative", http//www.phppo.cdc.gov/PHTN
    /webcast/smallpox0129/default.asp
  • MMWR, January 24, 2003, Smallpox Vaccination and
    Adverse Reactions / Guidance for Clinicians,
    http//www.cdc.gov/mmwr/preview/mmwrhtml/di52cha1.
    htm
  • Smallpox Resource Kit Materials for Health
    Professionals http//www.bt.cdc.gov/agent/smallpox
    /reference/resource-kit.asp
  • Smallpox Information http//www.bt.cdc.gov/agent
    /smallpox/index.asp

29
Wisconsin Website Resources
  • Wisconsin Department of Health Family Services,
    http//www.dhfs.state.wi.us/dph_bcd/Bioterrorism/s
    mallpox/index.htm
  • Wisconsin State Laboratory of Hygiene (Protocol),
    http//www.slh.wisc.edu
  • Vaccination Reaction Guide
  • http//www.dhfs.state.wi.us/dph_bcd/Bioterrorism/s
    mallpox/SmallpoxVaccinationGuide.pdf

30
Vaccination Plan Questions
  • Wisconsin Division of Public Health, e-mail
    dphemergency_at_dhfs.state.wi.us
  • Presented 2/5/2003
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