The Reemerging Condition of Vaccinia: A Case Report and Brief Review of Monkeypox and Vaccinia Vaccines

BACKGROUND The emergence of the monkeypox virus (mpox) is causing a large-scale re-administration of vaccinia-based vaccines. Many physicians have not been exposed to the rare, but implicit, complications, revealing a glaring need for updated evidence and re-examination. We present a case of a Human Immunodeficiency Virus (HIV)-positive male patient who presented to the Emergency Department (ED) with vaccinia symptoms several days after receiving the JYNNEOS vaccine. CASE REPORT A 45-year-old man with a past medical history of well-controlled HIV presented to the ED for 5 days of nocturnal diaphoresis, chills, intermittent arthralgia, and myalgia that began shortly after receiving the JYNNEOS vaccine. The patient reported an intermittent fever of 101°F (38.3°C) but denied cough, chest pain, and dyspnea, and had otherwise normal vital signs. Serum lab test results were significant for elevated leukocytosis of 13.4 and CRP of 7.0, but were otherwise normal. The patient reported complete resolution of his symptoms after a 14-day follow-up via phone call. CONCLUSIONS Mpox is unfortunately spreading across the globe; therefore, many treatments and vaccines are being studied to address the outbreak. The latest generation of vaccines employ an attenuated vaccinia virus and are separated into replicating and non-replicating categories, and while generally safer than previous variola vaccines, they still are associated with rare complications and adverse effects. Generally, vaccinia symptoms are mild and self-resolving. Treatment is largely supportive and most patients can be discharged following general serum lab work-up and cardiopulmonary assessment.