Novel Treatment of a Vaccinia Virus Infection From an Occupational Needlestick

San Diego, California, 2019

Erin R. Whitehouse, PhD; Agam K. Rao, MD; Yon C. Yu, PharmD; Patricia A. Yu, MPH; Margaret Griffin, MPH; Susan Gorman, PharmD; Kristen A. Angel, MPH; Eric C. McDonald, MD; Anna Liza Manlutac; Marie A. de Perio, MD; Andrea M. McCollum, PhD; Whitni Davidson, MPH; Kimberly Wilkins; Eddy Ortega; Panayampalli S. Satheshkumar, PhD; Michael B. Townsend, PhD; Marcia Isakari, MD; Brett W. Petersen, MD


Morbidity and Mortality Weekly Report. 2019;68(42):943-946. 

In This Article

Abstract and Introduction


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