Smallpox Treatment: Antivirals, Care & Prevention

How is Smallpox Diagnosed?

Suspected cases of smallpox need to be urgently referred to an infectious disease specialist and public health authorities since smallpox is classified as a medical emergency. Laboratory confirmation is primarily based on Polymerase Chain Reaction (PCR) testing in specialised high-containment laboratories. Other specialised techniques and methods, such as genetic sequencing and electron microscopy, may also be used in authorised reference laboratories.

Smallpox has been eradicated in the world. Thus, any suspected cases require urgent public health investigations.

How is Smallpox Treated Based on Severity?

Smallpox management depends on the severity of symptoms experienced and any complications present. Since smallpox has been eradicated throughout the world, these recommendations are made based on emergency preparedness measures and the available information:

Severity	Treatment
Mild	A person with a mild illness would require being isolated, staying hydrated, reducing fever, better nutrition, and watching for any complications.
Moderate	A moderate case may require hospital care with intravenous fluids, wound care, pain management, and treatment of secondary bacterial infection if present.
Severe	Severe smallpox cases, including haemorrhagic and malignant forms, require intensive care with antiviral drugs and treatment for any complications.

Types of Smallpox and Their Treatment

The treatment for smallpox depends on the clinical form of the disease and the severity of its complications:

Types of Smallpox	Treatment
Ordinary Smallpox (Variola Major)	The main treatment is supportive therapy along with isolation, hydration, and complication control.
Modified Smallpox	This variant is a milder form of smallpox, which needs only supportive treatment and observation of the development of the condition.
Flat-Type (Malignant) Smallpox	Intensive supportive treatment will be needed because of the high mortality rate associated with this form.
Hemorrhagic Smallpox	Intensive care support and treatment of the complications of bleeding and shock will be necessary.
Variola Minor (Alastrim)	Supportive therapy and isolation will suffice, as this is a mild form of smallpox.

Topical Treatment for Smallpox

Topical treatment is meant for supporting skin care but does not cure the smallpox virus. These may include:

Antiseptic Skin Cleansers An antiseptic skin cleanser can be used to lower the chances of secondary infection through skin lesions.
Moisturising Creams and Emollients A moisturiser or emollient may help to reduce skin dryness.
Protective Dressings A protective dressing can be used to protect damaged skin from any irritation or infection.

Other Treatments for Smallpox

Other treatment options that can be used in the management of smallpox include the following:

Antiviral Therapy (Tecovirimat) Tecovirimat (TPOXX) is an antiviral drug used in the treatment of smallpox and is regarded as the preferred antiviral treatment for confirmed smallpox.
Antiviral Therapy (Brincidofovir) Brincidofovir (Tembexa®) is another antiviral treatment used for smallpox in certain cases.
Vaccinia Immune Globulin Intravenous (VIGIV) This treatment option for smallpox can be considered in certain cases for complications arising from vaccinia vaccination rather than the treatment of naturally occurring smallpox itself.
Intravenous Fluids and Supportive Treatment Severely ill patients may need intravenous fluids and nutrition along with close monitoring.
Intensive Care Support Patients who have developed severe complications, including respiratory failure, shock, or multiorgan involvement, may need intensive care.

Oral Medications for Smallpox Treatment

Medications that may be prescribed as supportive therapy for smallpox include:

Tecovirimat (TPOXX)
Brincidofovir (Tembexa)
Paracetamol (Acetaminophen)
Ibuprofen (for fever and pain relief, as prescribed)

Note: Because naturally occurring smallpox has been globally eradicated, these drugs are intended mainly for emergencies.

Home Care for Managing Smallpox

Smallpox is an extremely contagious disease that requires complete isolation. Any home treatment is limited to supportive care and must be carried out under the direction of public health authorities. Tips to manage smallpox at home include:

Drinking plenty of fluids to prevent dehydration.
Getting enough nutrition as you recover.
Keeping skin lesions clean and dry to avoid infections.
Do not scratch or pick at the skin lesions to avoid scarring and infection.
Isolating oneself completely to prevent the spread of the infection.
Seek immediate medical attention if experiencing difficulty breathing, confusion, heavy bleeding, or dehydration.

How Long Does Smallpox Treatment Take?

Since naturally occurring smallpox has been eradicated worldwide, treatment durations are based primarily on current antiviral recommendations and historical clinical observations:

Treatment	Duration
Tecovirimat (TPOXX®)	The recommended treatment time is 14 days.
Brincidofovir (TEMBEXA®)	The length of treatment will be decided by public health officials and medical specialists, depending on the clinical scenario and protocols available.
Supportive care and isolation	It is necessary to remain in quarantine until all scabs are separated, which happened about 3-4 weeks after rash appearance.
Hospitalisation	Patients suffering from smallpox may require hospitalisation and quarantine for their entire contagious period.
Intensive care support	The time frame will vary depending on complications like breathing problems, heavy blood loss, or organ dysfunction.

Smallpox Treatment Side Effects

Side effects resulting from smallpox treatment would be based mainly on antiviral drugs and supportive therapies employed. Common side effects may include:

Headache
Nausea and abdominal pain
Diarrhoea and vomiting
Liver enzyme alterations
Infection with infusion-related reactions from intravenous therapies
Complications from a prolonged stay at the healthcare facility or intensive care support

Lifestyle Changes for Managing Smallpox

Since smallpox is an eradicated infectious disease that requires isolation and specialist care, conventional lifestyle modifications have no established role in its treatment. Supportive measures that may assist recovery include:

Maintaining adequate hydration.
Ensuring sufficient nutritional intake.
Getting adequate rest.
Following isolation and infection control recommendations strictly.
Completing the prescribed antiviral treatment course if treatment is initiated.

Smallpox Treatment Cost

There is no standard treatment pathway or cost for smallpox in India, as naturally occurring smallpox has been eradicated worldwide. However, if a suspected or confirmed case were ever identified, the disease would be managed through specialised government public health systems instead of standard outpatient or hospital care.

Does Health Insurance Cover Smallpox Treatment in India?

In India, health insurance policies generally do not cover smallpox treatment, as naturally occurring smallpox has been eradicated worldwide. If a case is confirmed, future responses would likely be coordinated through government public health emergency systems.

FAQs

Q1. Is smallpox curable with treatment?

Ans: While supportive care and antiviral medicines may help, current treatment recommendations are based on emergency preparedness because smallpox has been eradicated worldwide.
Q2. What antiviral drug is used for treating smallpox?

Ans: TPOXX® (tecovirimat) is the preferred antiviral medicine included in emergency preparedness plans for the treatment of smallpox.
Q3. How long does smallpox treatment usually last?

Ans: The duration of treatment depends on the severity of the illness, but patients remain in isolation until all scabs have fallen off.
Q4. Does smallpox require hospitalisation?

Ans: Yes. Anyone with suspected or confirmed smallpox would require hospitalisation and strict isolation to prevent the spread of infection.
Q5. Can smallpox be treated at home?

Ans: No. Suspected or confirmed cases should receive immediate medical care and remain isolated in specialised healthcare facilities.
Q6. Are antibiotics used in smallpox treatment?

Ans: No. Antibiotics do not work against the smallpox virus, but they may be prescribed to treat secondary bacterial infections if they occur.
Q7. Is there any cream available for smallpox treatment?

Ans: Skin creams may help relieve irritation or discomfort, but they do not treat or eliminate the smallpox virus.
Q8. Is vaccination used in the treatment of smallpox?

Ans: Smallpox vaccination may be given after exposure in certain public health situations to help prevent illness, but it is not used to treat active smallpox infection.