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Smallpox
Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives,
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 * About Smallpox
 * History of Smallpox
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Smallpox
Smallpox Home
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PREVENTION AND TREATMENT

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Prevention and Treatment
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Related Pages


This information is about preventing or responding to smallpox. For the latest
information about the current monkeypox outbreak, including information on
symptoms, prevention, and vaccines, please visit CDC’s Monkeypox site.

There are vaccines to protect people from smallpox. Currently, smallpox vaccines
are not recommended for the general public because smallpox has been eradicated.
If there were a smallpox outbreak, health officials would use smallpox vaccines
to control it. While some antiviral drugs may help treat smallpox disease, there
is no treatment for smallpox that has been tested in people who are sick with
the disease and proven effective.


SMALLPOX VACCINES

Smallpox can be prevented by smallpox vaccines, also called vaccinia virus
vaccines. The vaccines are made from a virus called vaccinia, which is a
poxvirus similar to smallpox, but less harmful. There are two licensed smallpox
vaccines in the United States and one investigational vaccine that may be used
in a smallpox emergency.

The replication-competent smallpox vaccines (ACAM2000 and APSV) can protect
people from getting sick or make the disease less severe if they receive the
vaccine either before or within a week of coming in contact with smallpox virus.
If you get the vaccine:

 * Before contact with the virus, the vaccine can protect you from getting sick.
 * Within 3 days of being exposed to the virus, the vaccine might protect you
   from getting the disease. If you still get the disease, you might get much
   less sick than an unvaccinated person would.
 * Within 4 to 7 days of being exposed to the virus, the vaccine likely gives
   you some protection from the disease. If you still get the disease, you might
   not get as sick as an unvaccinated person would.

Once you have developed the smallpox rash, the vaccine will not protect you.

Currently, smallpox vaccines are not available to the general public because
smallpox has been eradicated, and the virus no longer exists in nature. However,
there is enough smallpox vaccine to vaccinate every person in the United States
if a smallpox outbreak were to occur.

For more details about the vaccine, see Smallpox Vaccine Basics.


ANTIVIRAL DRUGS

 * In July 2018, the FDA approved tecovirimat (TPOXX) for treatment of smallpox.
   In laboratory tests, tecovirimat has been shown to stop the growth of the
   virus that causes smallpox and to be effective in treating animals that had
   diseases similar to smallpox. Tecovirimat has not been tested in people who
   are sick with smallpox, but it has been given to healthy people. Test results
   in healthy people showed that it is safe and causes only minor side effects.
   In addition to treating smallpox disease, tecovirimat could also be used
   under an investigational new drug (IND) protocol to treat adverse reactions
   from vaccinia virus vaccination.
 * In June 2021, the FDA approved brincidofovir (TEMBEXA) for treatment of
   smallpox. In laboratory tests, brincidofovir has been shown to stop the
   growth of the virus that causes smallpox and to be effective in treating
   animals that had diseases similar to smallpox. Brincidofovir has not been
   tested in people who are sick with smallpox, but it has been given to healthy
   people and people with other viral infections. Test results in people who
   received brincidofovir for bone marrow  transplants showed the most common
   side effects were diarrhea, nausea, vomiting, and abdominal pain.
 * In laboratory tests, cidofovir has also been shown to stop the growth of the
   virus that causes smallpox and to be effective in treating animals that had
   diseases similar to smallpox. Cidofovir  has not been tested in people who
   are sick with smallpox, but has been tested in healthy people and in those
   with other viral illnesses. This drug continues to be evaluated for
   effectiveness and toxicity. Cidofovir is not FDA-approved for the treatment
   of variola virus infections, but  could be used during an outbreak under an
   appropriate regulatory mechanism (such as an investigational new drug [IND]
   protocol or Emergency Use Authorization).

Because these drugs were not tested in people sick with smallpox, it is not
known if a person with smallpox would benefit from treatment with them. However,
their use may be considered if there is ever a smallpox outbreak.

Tecovirimat and cidofovir are currently stockpiled by the Assistant Secretary
for Preparedness and Response (ASPR) Strategic National Stockpile, which has
medicine and medical supplies to protect the American public if there is a
public health emergency, including one involving smallpox.

Antiviral Drugs for the Treatment of Smallpox Disease Drug FDA approved for
smallpox treatment? Available through IND protocol for smallpox treatment?
Available in Strategic National Stockpile? Tecovirimat Yes Not applicable Yes
Cidofovir No Yes Yes Brincidofovir Yes Not applicable No


Page last reviewed: August 8, 2022
Content source: Centers for Disease Control and Prevention, National Center for
Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence
Pathogens and Pathology (DHCPP)
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homeSmallpox
 * About Smallpox
 * History of Smallpoxplus icon
   * Spread and Eradication of Smallpox
 * Transmission
 * Signs and Symptoms
 * Prevention and Treatment
 * Smallpox Vaccine Basicsplus icon
   * Vaccine Safety
   * Side Effects of Vaccination
   * Who Should Get a Smallpox Vaccination?
 * Bioterrorismplus icon
   * The Threat
   * Preparedness
   * Detection and Response
 * Bioterrorism Response Planningplus icon
   * Community-Based Planning for a Smallpox Emergencyplus icon
     * Build Community Partnerships
     * Identify Resources and Needs
     * Help People with Functional, Language, or Cognitive Needs
   * Public Health Response Activitiesplus icon
     * Identify, Diagnose, and Isolate Cases
     * Enhanced Surveillance and Case Reporting
     * Epidemiological Investigation
     * Vaccination Strategies
     * Ring Vaccination
     * Community-Wide (Mass) Vaccination
     * Maxi-Vac and Maxi-Vac Alternative 2.0
     * Communicationplus icon
       * Sample Alert Messages for Healthcare Providers
       * Sample Alert Messages for the Community
     * Information Management
   * Healthcare Facility Response Activitiesplus icon
     * Protect and Care for Smallpox Patients
     * Vaccinate Your Staff
     * Care for Your Staff
     * Prevent Spread of Disease
 * Research
 * For Cliniciansplus icon
   * Transmission
   * Clinical Disease
   * Diagnosis & Evaluationplus icon
     * Evaluating Patients for Smallpox
   * Treatment
   * Vaccinationplus icon
     * Vaccines
     * Contraindications to Vaccination
     * Vaccine Administration
     * Expected Vaccine Reactions
     * Vaccine “Take” Evaluation
     * Vaccine Adverse Events
     * Medical Management of Adverse Reactions
     * Comparison of Reactions for First-Time Vaccinees and Revaccinees
     * Examples of Major or “Take” Reactions to Smallpox Vaccination
     * Vaccine Adverse Reaction Images
   * Administering ACAM2000 Smallpox Vaccine Videos
 * Laboratory Personnelplus icon
   * Specimen Collectionplus icon
     * Specimen Collection and Transport Guidelines for Suspect Smallpox Cases
     * Specimen Collection and Transport Guidelines for Suspect Smallpox Vaccine
       Adverse Events
     * Specimen Collection Procedures
     * Negative Staining Electron Microscope Protocol for Rash Illness
   * Packaging and Transporting Infectious Substances
   * Rash Illness Protocolplus icon
     * Chart 1: Acute, Generalized Vesicular or Pustular Rash Illness Protocol
     * Chart 2: Laboratory Testing for Acute, Generalized Vesicular or Pustular
       Rash Illness
     * Chart 3: Laboratory Testing for Suspect Smallpox Vaccine Adverse Event
       (Vaccinia)
     * Chart 4: Laboratory Testing for Environmental Sample

Related Links
 * WHO Smallpox WebsiteExternal file_external
 * NIH Smallpox ResearchExternal file_external
 * CDC Poxvirus and Rabies Branch
 * Poxvirus Diseases


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