General
Clinical materials suspected of containing vaccinia should
be forwarded to an appropriate laboratory in the CDC-sponsored
Laboratory Response Network (LRN) for evaluation. Such laboratories
have standardized protocols for assessment of such samples
and vaccinated staff who can perform these studies. LRN laboratories
include local and state public health laboratories with special
security and bio-containment capability. Consult your local
and state health departments for the closest LRN laboratory
with vaccinia capability.
Diagnostic Tests
We recommend that expert consultation with the CDC be undertaken
in serious complications to obtain the best advice as to diagnosis
in specific situations.
In most instances, differentiation of an adverse event after
vaccination from other infectious or non-infectious diseases
must be accomplished. In those cases the appropriate diagnostic
tests for the alternative diseases, such as chickenpox, should
be employed simultaneously with tests for vaccinia virus.
A comprehensive algorithm has been developed by CDC for the
evaluation of rash illness suspected to be poxvirus in origin.
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Laboratory
diagnosis of infectious complications consists of rapid diagnostic
tests and traditional culture techniques. Tests for varicella
include special stains of smears of lesions, direct and indirect
immunofluorescent methods, the polymerase chain reaction and
culture. Electron microscopy of lesion material can be useful
in differentiating herpesviruses from poxviruses such as vaccinia,
but a limited number of centers have this capability. Vaccinia
can be readily grown in routine cell culture and definitively
identified by referral to a specialty laboratory in the LRN
and/or CDC. A polymerase chain reaction assay configured to
detect vaccinia is under evaluation for deployment to the
LRN.
In all instances the LRN laboratory should be consulted immediately
to determine the appropriate test for the clinical circumstances
and the correct method for collection of specimens and transport
to the laboratory.
Immunologic studies are suggested for serious complications
to better understand the pathogenesis of adverse events. Tests
for the presence of HIV antibody and flow cytometry to determine
degree of immunodeficiency in HIV-positives is indicated.
Workup for hematologic malignancy or lymphoma may be appropriate.
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