Treatment

Seek expert advice.

Early recognition and appropriate management of initial cases is key to rapid implementation of outbreak containment measures

Consult Smallpox Diagnostic Experts (SDE). Whilst waiting for the SDE, the referring clinician should remain at the scene, isolate the patient as best as possible, and try and ensure that close contacts of the patient remain close by or record details of those who have left or have to leave. Transfer to ICU should be avoided in order to contain the infection (1)

Smallpox care is mainly supportive and has three main components:

• clinical care and support for the sick patients
• maintenance of infection control during the infectious period
• providing adequate healthcare input to ensure continued care until the patient is convalescent

There is evidence that cidofovir and other compounds have antiviral action against some orthopox virus strains but these drugs are toxic and difficult to administer and the effectiveness of the drug against established smallpox disease is unknown. (2)

Antibiotics should be considered for secondary infections (2)

Vaccination is highly effective in the first 4 days of incubation period and can modify the course of the disease and reduce mortality by about 50% (3)

Post exposure prophylaxis

• vaccine within 3days of exposure
• monitor for fever and symptoms for 16 days (2)

Reference:

• (1) Department of health (DH) 2010. Guidelines for Smallpox Response and Management in the Post-Eradication Era
• (2) Health Protection Agency (HPA) 2011. Unusual Illness, including Deliberate or Accidental Releases: Cardinal Signs and Tips for Key Biological Agents
• (3) Health Protection Agency (HPA) 2010. Smallpox (Deliberate Releases). Guidance. Clinical Management and Sampling