Vaccinia virus infections in martial arts gym, Maryland, USA, 2008

Abstract

Vaccinia virus is an orthopoxvirus used in the live vaccine against smallpox. Vaccinia virus infections can be transmissible and can cause severe complications in those with weakened immune systems. We report on a cluster of 4 cases of vaccinia virus infection in Maryland, USA, likely acquired at a martial arts gym.

Figure 1

Timeline of the vaccinia cluster, Maryland, USA, 2008. The photo of case-patient 1’s skin lesions was taken on ≈day 8 of illness (courtesy of R. Reddy). The photo of case-patient 2’s skin lesions was taken ≈3 weeks after lesion onset (courtesy of K. Russo). Blue shading, case-patient 1; yellow shading, case-patieint 2; green shading, case-patient 3. CDC, Centers for Disease Control and Prevention; Ig, immunoglobulin; DHMH, Department of Health and Mental Hygiene.

Figure 2

Partial DNA sequence alignment of the hemagglutinin gene. Case-patient 1’s isolate sequence is displayed at the top (2008–025). Dots in the alignment indicate identical nucleotides at that position. The reference sequences shown: current smallpox vaccine strain (VACV_ACAM2000), a commonly used laboratory vaccinia strain (VACV_WR), Dryvax vaccinia strains (VACV_Duke and VACV_3737), natural Brazilian vaccinia isolates (VACV_BeAn and VACV_Cantagalo), a 2003 US monkeypox outbreak isolate (MPXV_US03), and a variola virus isolate (VARV_SOM). Reference GenBank accession nos., AY313847, NC_006998, DQ439815, DQ377945, DQ206442, AF229247, DQ011157, and DQ437590, respectively.