CDC was notified about an unvaccinated laboratory worker with a needlestick exposure to VACV, who developed a lesion on her left index finger” Whitehouse et al (2019).
Vaccinia virus (VACV) is an orthopoxvirus used in smallpox vaccines, as a vector for novel cancer treatments, and for experimental vaccine research (1). The Advisory Committee on Immunization Practices (ACIP) recommends smallpox vaccination for laboratory workers who handle replication-competent VACV (1). For bioterrorism preparedness, the U.S. government stockpiles tecovirimat, the first Food and Drug Administration-approved antiviral for treatment of smallpox (caused by variola virus and globally eradicated in 1980*,†) (2). Tecovirimat has activity against other orthopoxviruses and can be administered under a CDC investigational new drug protocol. CDC was notified about an unvaccinated laboratory worker with a needlestick exposure to VACV, who developed a lesion on her left index finger. CDC and partners performed laboratory confirmation, contacted the study sponsor to identify the VACV strain, and provided oversight for the first case of laboratory-acquired VACV treated with tecovirimat plus intravenous vaccinia immunoglobulin (VIGIV). This investigation highlights 1) the misconception among laboratory workers about the virulence of VACV strains; 2) the importance of providing laboratorians with pathogen information and postexposure procedures; and 3) that although tecovirimat can be used to treat VACV infections, its therapeutic benefit remains unclear.
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Whitehouse, E.R., Rao, A.K., Yu, Y.C., Yu, P.A., Griffin, M., Gorman, S., Angel, K.A., McDonald, E.C., Manlutac, A.L., de Perio, M.A., McCollum, A.M., Davidson, W., Wilkins, K., Ortega, E., Satheshkumar, P.S., Townsend, M.B., Isakari, M. and Petersen, B.W. (2019) Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick – San Diego, California, 2019. MMWR. Morbidity and Mortality Weekly Report. 68(42), p.943-946. doi: 10.15585/mmwr.mm6842a2.