Monkeypox infection in a smallpox-vaccinated patient

Research Letter: Monkeypox in Patient Immunized with ACAM2000 Smallpox Vaccine During 2022 Outbreak. Image Credit: Dotted Yeti / Shutterstock

A recent study from the Madigan Army Medical Center evaluated the characteristics of monkeypox infection in a patient who had had a smallpox vaccination. The findings were published in the journal Emerging Infectious Diseases.

The US-wide outbreak of monkeypox infections led to the Centers for Disease Control and Prevention (CDC) launching an emergency response in the summer of 2022. Additionally, on June 28, 2022, the US Department of Health and Human Services (HHS) announced a nationwide immunization program against the monkeypox virus.

Patient characteristics

The researchers in the current study described a patient who lived in Washington, USA, and had the monkeypox virus. Nevertheless, he had received the ACAM2000 smallpox vaccine safely eight years prior.

A 34-year-old man who was the patient admitted to having intercourse with guys. He entered a sexually transmitted diseases clinic with a two-day history of four painless penile lesions and a four-day history of malaise, exhaustion, and headache. Two days before to his clinic visit, the patient underwent an evaluation at a nearby emergency room. He did not test positive for the herpes simplex virus, Neisseria gonorrhea, or Chlamydia trachomatis. Over the following two days, his constitutional symptoms got better, but his penile ulcers turned into white papular sores.

The patient disclosed a history of N and syphilis. 2017 saw gonorrhea that was treated and cleared up. There was no history of HIV infection or any other immune-compromising disorders in his military medical records. He had previously been advised to take emtricitabine/tenovir every day as a pre-exposure preventative strategy for HIV. But he stopped this treatment on his own, a year before he went to the doctor. The patient reported having receptive oral and penetrative anal sex with 13–14 new partners within the previous 90 days without the use of a condom. When he engaged in unprotected anal-insertive sexual intercourse with a lone partner at a nearby Pride event, his most recent sexual experience was recorded 11 days before he sought medical attention.

The patient was given a smallpox vaccination with the ACAM2000 vaccine in March 2014 because of his military service. He also denied having recently left Washington or interacted with sick people.

RELATED: Vaccines used to prevent monkeypox


The patient had four ulcerated penile lesions, which had developed into a patch on the foreskin, according to the study’s findings. Two days after the patient first experienced constitutional problems, this patch was noticed. There was no visible drainage, and the lesions weren’t uncomfortable. He also has a scar from a vaccination on his right deltoid and a sore right inguinal lymph node.

The medical team reported that the patient’s polymerase chain reaction test for non-variola orthopoxvirus was positive (PCR). Testing done afterwards revealed that the infection was brought on by the clade II strain. However, the patient’s tests for syphilis, HIV-1/2 antigen, and hepatitis C came back negative.

RELATED: The maternal and perinatal outcomes of pregnancies complicated by monkeypox infection

For the treatment of constitutional symptoms, which subsided 10 days after the beginning of symptoms, the patient merely needed supportive care and the administration of oral acetaminophen. Six days following the onset of the constitutional symptoms, the rash developed, consolidated, and advanced into a pustule. On day 16, the lesion developed into an ulcer before disappearing without leaving any lasting scarring.

Overall, the study demonstrated that while immunization was crucial for preventing infectious diseases, it may not be enough to protect against monkeypox infection. Therefore, according to the researchers, vaccination should support public health initiatives that aim to reduce the use of high-risk health behaviors rather than replace them.


YOUTUBE VIDEO: Europe eyes smallpox vaccine for monkeypox | ANC

By: Miss Cherry May Timbol – Independent Reporter

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