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【medical-news】与接种天花疫苗的人性接触可以使
http://www.medscape.com/viewarticle/556050
May 4, 2007 — Vulvar vaccinia infection may follow sexual contact with a smallpox vaccinee, according to a case report in the May 4 issue of the Morbidity and Mortality Weekly Report.
On October 10, 2006, an otherwise healthy woman presented to a public health clinic in Alaska with vaginal tears that had become increasingly painful over 10 days, after having sex with a new male partner between September 22 and October 1, 2006. Her partner consistently used condoms, but a condom broke during vaginal intercourse on October 1.
An isolate from a labial swab specimen was identified by the U.S. Centers for Disease Control and Prevention (CDC) as a vaccine strain of vaccinia virus, and it came to light that the woman’s new sex partner was a U.S. military-service member who had been vaccinated for smallpox 3 days before beginning his relationship with the woman.
“Health-care providers should be aware of the possibility of vaccinia infection in persons with clinically compatible genital lesions who have had recent contact with smallpox vaccines,” write J. McLaughlin, MD, from the Alaska Section of Epidemiology, and colleagues.
The woman told health-care providers that she had not seen penile ulcers or other skin lesions on her partner; that she had no history of genital ulcers or sexually transmitted infections; and that her vaginal tears did not result from sexual violence or abuse. She had tested negative for human immunodeficiency virus approximately 3 months earlier, and she had no fever, itching, or dysuria.
Examination showed 2 shallow ulcerations — 1 on the upper left labia minora measuring 5 mm and the other on the lower right labia minora measuring 3 mm — mild bilateral labial erythema and induration, and vaginal discharge. Lymph nodes, cervix, uterus, adnexa, and anus appeared normal. Tests for gonorrhea and Chlamydia trachomatis infection were negative, and the presumed diagnosis was sexually transmitted infection. She was treated with an over-the-counter medication for secondary vulvovaginal candidiasis.
After 2 days of increased redness, swelling, and burning of the labia minora, she was diagnosed with cellulitis on October 10. The over-the-counter medication was discontinued, and she was prescribed a 7-day course of oral cephalexin. Her labial redness, induration, and pain resolved, and the ulcers healed completely by October 19.
Immunofluorescent antibody staining was negative for herpes simplex virus, and subsequent staining of the viral isolate was negative for herpes simplex virus and cytomegalovirus. The viral isolate was submitted on November 22 to a second reference laboratory, where it remained unidentified 1 month later; it was sent to CDC on January 9, 2007.
Two pathogen-discovery strategies — a pan-herpes virus polymerase chain reaction (PCR) test and a deoxyribonuclease sequence-independent single-primer amplification (DNase-SISPA) — were performed at CDC. Although the pan-herpes virus PCR assay was negative, DNase-SISPA produced unique and prominent DNA fragments in the unknown isolate but not in the control cells, and 8 of 9 sequenced clones of the bands matched vaccinia virus sequences. Additional PCR testing by the CDC Poxvirus Laboratory identified the isolate as being consistent with a vaccine strain of vaccinia virus.
On January 30, 2007, CDC notified the Alaska State Virology Laboratory of the results, which were immediately relayed to the Alaska Section of Epidemiology.
An accompanying editorial notes that unintentional transfer of vaccinia virus can occur from a vaccination site to a second site on the vaccinee (inadvertent autoinoculation) or to a close contact (contact transmission), particularly to the face, nose, mouth, lips, genitalia, anus, and eye.
“To prevent transfers, health-care providers should educate vaccinees regarding proper hand washing after bandage changes or other contact with the vaccination site,” the editorial states. “This general recommendation remains the most effective way to prevent genital vaccinia infections. Persons with any new genital lesion, including lesions suspected to have been caused by vaccinia infection, should avoid sexual contact and consult a health-care provider.”
Since March 8, 2007, CDC and the U.S. Department of Defense have received 4 reports of nongenital contact vaccinia transmitted by recently vaccinated service members, including 2 cases from Indiana and 1 case each from Alabama and New Mexico.
“Health-care providers and public health professionals should ask about any contact with recent smallpox vaccinees when evaluating patients with vesicular lesions compatible with vaccinia,” the editorial concludes. “Early identification of such contact can guide diagnostic tests, allow for timely contact tracing and clinical intervention, and facilitate prompt patient counseling to prevent further transmission of the virus.”
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作者:admin@医学,生命科学 2011-06-17 05:11
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