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Myopericarditis Associated With Smallpox Vaccination Among US Army Personnel – Fort Hood, Texas, 2018

Published online by Cambridge University Press:  15 March 2021

Anna M. Mandra ,
Michael J. Superior ,
Sarah Anne J. Guagliardo ,
Elisabeth Hesse ,
Laura A. Pacha ,
Ralph A. Stidham ,
Debra C. Colbeck ,
David E. Hrncir ,
Noemi Hall  and
Brett W. Petersen
...Show all authors
Anna M. Mandra*
Affiliation:
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA Epidemic Intelligence Service, CDC, Atlanta, GA, USA
Michael J. Superior
Affiliation:
Army Public Health Center, United States Army, Aberdeen Proving Ground, MD, USA
Sarah Anne J. Guagliardo
Affiliation:
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA Epidemic Intelligence Service, CDC, Atlanta, GA, USA
Elisabeth Hesse
Affiliation:
Epidemic Intelligence Service, CDC, Atlanta, GA, USA Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
Laura A. Pacha
Affiliation:
Regional Health Command – Central, United States Army, San Antonio, TX, USA
Ralph A. Stidham
Affiliation:
Public Health Command – Central, United States Army, San Antonio, TX, USA
Debra C. Colbeck
Affiliation:
Army Public Health Center, United States Army, Aberdeen Proving Ground, MD, USA
David E. Hrncir
Affiliation:
Immunization Healthcare Branch, Defense Health Agency, Falls Church, VA, USA
Noemi Hall
Affiliation:
Epidemic Intelligence Service, CDC, Atlanta, GA, USA Texas Department of State Health Services, Austin, TX, USA
Brett W. Petersen
Affiliation:
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
Agam K. Rao*
Affiliation:
Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
*
Corresponding author: Anna M. Mandra, Email: Anna.M.Mandra.mil@mail.mil. Agam Rao, Email: ige4@cdc.gov.
Corresponding author: Anna M. Mandra, Email: Anna.M.Mandra.mil@mail.mil. Agam Rao, Email: ige4@cdc.gov.
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Abstract

Objective:

In March 2018, the US Department of Defense (DOD) added the smallpox vaccination, using ACAM2000, to its routine immunizations, increasing the number of persons receiving the vaccine. The following month, Fort Hood reported a cluster of 5 myopericarditis cases. The Centers for Disease Control and Prevention and the DOD launched an investigation.

Methods:

The investigation consisted of a review of medical records, establishment of case definitions, causality assessment, patient interviews, and active surveillance. A 2-sided exact rate ratio test was used to compare myopericarditis incidence rates.

Results:

This investigation identified 4 cases of probable myopericarditis and 1 case of suspected myopericarditis. No alternative etiology was identified as a cause. No additional cases were identified. There was no statistically significant difference in incidence rates between the observed cluster (5.23 per 1000 vaccinated individuals, 95% CI: 1.7–12.2) and the ACAM2000 clinical trial outcomes for symptomatic persons, which was 2.29 per 1000 vaccinated individuals (95% CI: 0.3–8.3).

Conclusions:

Vaccination with ACAM2000 is the presumptive cause of this cluster. Caution should be exercised before considering vaccination campaigns for smallpox given the clinical morbidity and costs incurred by a case of myopericarditis. Risk of myopericarditis should be carefully weighed with risk of exposure to smallpox.

Keywords

ACAM2000myopericarditissmallpox vaccinevaccinia virus
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 3 , June 2022 , pp. 1022 - 1028
Copyright
© Society for Disaster Medicine and Public Health, Inc. 2021

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