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Current Smallpox Vaccine Can Be Harmful to Eczema Patients

   Portland, Ore.

OHSU is part of a newly created atopic dermatitis research consortium aimed at reducing severe complications from smallpox vaccine

Millions of Americans are at risk for a potentially deadly complication from smallpox vaccine known as eczema vaccinatum, or EV. EV occurs almost exclusively among people with a history of atopic dermatitis, a chronic, itchy skin condition commonly referred to as eczema. To reduce the risk of EV, the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health, has launched the Atopic Dermatitis and Vaccinia Network (ADVN), an international research group dedicated to helping everyone acquire immunity to the smallpox virus without the life-threatening complications.

The ADVN comprises three integrated components: a clinical studies consortium, an animal studies consortium, and a statistical and data coordinating center. Oregon Health & Science University is one of six institutions collaborating on the clinical studies component.

The OHSU research team is led by Jon Hanifin, M.D., professor of dermatology in the OHSU School of Medicine, and Mark Slifka, Ph.D., assistant professor of molecular microbiology and immunology in the OHSU Vaccine and Gene Therapy Institute. In these studies, researchers will evaluate the immune responses of eczema patients after natural exposure to less harmful skin viruses such as varicella (the virus that causes chickenpox and shingles) and herpes simplex infection, or after immunization with live viruses such as the yellow fever vaccine.

"By evaluating a wide spectrum of immune responses from these patients, we hope to be able to predict and protect the segment of the population most likely to have problems with smallpox vaccine and determine why people with eczema are particularly susceptible," said Hanifin.

According to the NIAID, eczema vaccinatum can develop when eczema patients receive smallpox vaccine or come into close personal contact with people who recently have been vaccinated. If left untreated, EV can spread to internal organs and be fatal in 1 percent to 6 percent of those affected. In children younger than 2, EV is estimated to be fatal in up to 30 percent of cases.

"Previous studies suggest that both innate and adaptive immunity are impaired in patients with atopic dermatitis, but the specific defects that increase the likelihood of eczema vaccinatum have yet to be explained," said Daniel Rotrosen, M.D., director of NIAID's Division of Allergy, Immunology and Transplantation. "The information generated by this network will improve our understanding of the immune responses of these patients and should greatly influence the design of a safer smallpox vaccine."

"This consortium is a prime example of how biodefense funding is helping us to be better prepared against a potential bioterrorist threat while at the same time providing considerable insight into important clinical questions regarding how the human immune system functions, or in some cases, dysfunctions" said Slifka, "These studies will provide critical new information that will be useful for treating common skin disorders such as atopic dermatitis and for treating other microbes that infect the skin."

The Animal Studies Consortium component of the ADVN will establish animal models of eczema and investigate their immune responses to vaccinia -- the virus used in smallpox vaccine. The ADVN Statistical and Data Coordinating Center will support these clinical and animal studies by analyzing research data, coordinating trials and regulatory activities, and developing and maintaining a registry of eczema patients.

Six institutions are participating in the clinical studies component: National Jewish Medical and Research Center, OHSU, Children's Hospital Boston, University of California at San Diego, Johns Hopkins Asthma and Allergy Center, and the University of Bonn, Germany. Institutions participating in the Animal Studies Consortium component include: Children's Hospital Boston, National Jewish Medical and Research Center, Harvard Skin Diseases Research Center, University of Illinois at Chicago, and La Jolla Institute for Allergy and Immunology.

NIAID, a component of the NIH, is an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.


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