Smallpox

Immediately contact your regional infectious disease unit if there is a clinical suspicion of smallpox. This will trigger procedures to be activated for the safe transfer of the patient to a negative-pressure isolation facility and the notification of the public health team. It is important to keep records of everyone who has been in close contact with the symptomatic patient (e.g., household contacts, paramedical and medical staff). All suspected cases should be managed by experts, including public health officials, to prevent a potential emergency situation.

Management is primarily supportive with attention to fluid balance, oxygenation, nutrition, symptom relief (e.g., analgesia, anti-emetics), prompt treatment of additional secondary bacterial infections with antibiotics, and management of complications (e.g., sepsis) and prevention of long-term sequelae. Aggressive intravenous fluid replacement may be required. Blood products may be necessary, especially in rare haemorrhagic variants of smallpox.

Antiviral therapy (e.g., tecovirimat, brincidofovir, cidofovir) may also be recommended. Guidance on the use of antiviral therapy will be provided by public health authorities in the event of a public health emergency involving smallpox.

Detailed guidance on the management of smallpox is currently beyond the scope of this topic as smallpox no longer exists as a naturally occurring disease. In the event of a smallpox outbreak, you should consult your local public health authority for guidance on management as new guidance is likely to be published.