Laboratory diagnosis in a case of fatal progressive vaccinia due to manifest immunologic deficiencies.

A case of progressive vaccinia is described, in a 21 years old man, diagnosed after 8 months of vaccinial lesion's evolution. The area of vaccination developed progressive necrosis and metastatic lesions evolved on various regions of the body. The vaccinia virus was isolated on the chorioallantoic membrane of embryonated eggs, from the cutaneous lesions, blood, internal organs and even from the apparently intact skin.--The serological tests indicated hypogammaglobulinemia with absence of neutralizing antibodies.--The death occured after 366 days. The progressive vaccinia described above represents the case with the most prolonged evolution known until now.

The role of vaccinia virus in the evolution of some human hemopathies.

Six cases of severe hemopathy, detected following smallpox revaccination are described. Their onset was favoured by vaccinia virus-induced suppression of cell-mediated and humoral immunity. In two leukemia patients humoral immunity was present, but insufficient to assure protection of the diseased organisms, the outcome being fatal. The pancytopenia syndrome recorded in 4 patients with anergy caused by autoimmune mechanisms had different outcomes: favourable in 2 cases and fatal in the other 2 patients, who died within 4 years.

Dynamics of anti-vaccinia HAI antibodies during the first month after smallpox revaccination at 20 years.

Anti-vaccina HAI antibody titers were dynamically followed up and correlated with the type of cutaneous reaction in 91 small pox revaccines aged 20-21 years. Serum samples collected at 2-day intervals for 14 days and on day 30 post inoculation (p.i.) were tested. Antibody titer rises began on days 4-6 and continued until day 14 p.i. On day 30 further rises were only recorded in the 9 vaccinees with primovaccinal reactions. The rhythm of antibody rises was almost the same in subjects with ambiguous and major cutaneous reactions.

The influence of modifications in the potency of smallpox vaccines on the immunological reactivity of the organism.

The possible influence of shipment and storage conditions upon the potency of smallpox vaccines was investigated by testing the direct effect of vaccine potency on the type of cutaneous reaction and on the level of serum antibodies. Vaccine no. 1--freshly prepared, shipped and stored at +4 degrees C--proved to be more potent than vaccine no. 2, at the limit of its efficiency, shipped and maintained under usual conditions. To maintain the initial potency of smallpox vaccines it is recommended either to improve the shipment and storage conditions, or to use a lyophilized vaccine.

[Immunopathological circumstances in the structure of complications appearing after smallpox vaccination]. / Circumstante imunopatologice în structura accidentelor survenite dupa vaccinarea antivariolica

Investigations were carried out concerning the dynamics of antivaccinal antibodies and the structure of serum proteins in relation to the clinical manifestations following upon smallpox vaccination. In general, immunity is not apparently influenced by postvaccinal complications may be associated with immunoprotein perturbations, manifested by an increase in the alpha2-globulin fraction and, inconstantly, in the gamma-globulin fraction. Immunoelectrophoretic determinations revealed a relatively constant IgM and IgG deficiency. Postvaccinal dysglobulinemia may accompany various clinical forms, suggesting a temporary deficient immunological response. In one case of agammaglobulinemia, revaccination produced a deep vaccinal ulcer, with extensive necrosis (giant necrotic vaccinia). In order to decipher the substrate of the reaction in the clinical forms with distal manifestations or generalized vaccinia, skin biopsies were performed. The lesional vasculoallergic substrate of the skin lesions does not exclude the local aggression of the vaccinal virus, which was isolated by viral determinations.

Transmission of vaccinia virus from vaccinated milkers to cattle.

An infection of cattle by transmission of vaccinia virus from milkers vaccinated against small pox is reported. Six vaccinia virus strains could be isolated from the vaccinal lesions localized on the nipples of the udder. Serological reactions with samples collected from diseased cows demonstrated the presence of HAI antibodies and made evident their kinetics at a 2-week-interval.

Investigations on allergic and serological reactions following inoculation of inactivated smallpox vaccines by cutaneous scarification.

A number of 154 young adults were given a smallpox vaccine inactivated by UV (103 subjects) or by 4degrees/00 formol (51 subjects). Inoculation induced an early cutaneous reaction in 75.4% of the revaccinated subjects. The incidence of positive HAI reactions in this group increased from 30.2% before vaccination to 63.8% after inoculation, while the geometric mean titer increased from 2.88 to 10.73. This would prove the early reactions to be allergic responses of organisms sensitized against smallpox vaccine, capable of stimulating antibody formation. No cutaneous reaction was recorded in the 7 persons vaccinated for the first time (without pre-existent cutaneous scars). These subjects developed neither cutaneous nor humoral response to the killed virus, as there was no previous sensitization to the respective antigen.

Comparative study of cutaneous scars and HAI antibodies after smallpox revaccination.

The number and aspect of cutaneous scars and the HAI antibody titer were recorded in 154 20-21-year-old subjects before smallpox revaccination, 30 and 300 days afterwards. In 38.3% of the vaccinees there were no postvaccinal scars 300 days after revaccination, but the absence of residual scars did not necessarily indicate a failure of immunization, since the increase in mean HAI antibody titer was significant in most of the cases.

[The action of the vaccinia virus upon placenta and fetus in revaccinated pregnants (author's transl)]. / Die Wirkung des Vaccinia-Virus auf die Placenta, den Fötus und auf den Schwangerschaftsverlauf bei revakzinierten Schwangeren

We studied 608 antivariolic revaccinated pregnants in spring 1972 at different ages of gestation. 60 presented spontaneous abortus; in 502 cases there has been performed therapeutical abortion, and 46 pregnants revaccinated after 2 1/2-3 months of gestation continued their pregnancy. Pregnancy and birth in revaccinated pregnants which did not abort, evolved without any difference against the witness-sample; the newborns presented in a higher percentage underweight. The absence of the vaccinia-virus and of Guarnieri-inclusions in the examined placentae and embryos as well as the moment of abortion, only after 20 days from the revaccination data, leads to the supposition that the placental lesions do not seem to be produced by the direct action of the virus by its replication, but probably by reactions of hypersensibility of the late type against the alergizin antigens of the antismallpox vaccine. The antivariolic revaccination of the sample of pregnants, showed that the vaccinia virus did not present a malformative action upon the embryo, but in change the abortive action was manifest in indirect proportion to the age of gestation.

The influence of smallpox revaccination upon the foetus.

Serological, virological, anatomo- and histopathological investigations were performed in pregnant women subjected to smallpox revaccination. Serological findings were normal; no vaccinia virus was isolated from 210 placentae collected upon therapeutical abortion. Anatomopathological investigation of 15 placentae showed various lesions, while the embryo were free from any histopathological changes. The data prove that smallpox immunization does not affect the embryo directly, but only through the placenta.