Smallpox

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

How do health-care professionals diagnose smallpox?

When smallpox was common, an experienced clinician could make the diagnosis simply by looking at the rash and examining the patient. Any case that occurs now will likely be a result of bioterrorism or biological warfare. In that event, misdiagnosis or delays in diagnosis could cause the infection to spread. Thus, it is still important for clinicians to be able to diagnose smallpox. The CDC has developed an online tool (http://emergency.cdc.gov/agent/smallpox/diagnosis/evalposter.asp) to help clinicians assess the likelihood that a rash is due to smallpox.

What specialists treat smallpox?

If smallpox is considered as a possible diagnosis for any patient, public-health authorities should be notified immediately and their instructions on the protective measures for medical caregivers and others should be followed carefully. They can help determine if additional testing is warranted. Material from blisters, throat swabs, and blood samples may be tested for the presence of variola DNA or cultured. These tests are done at the CDC and require prior authorization. The person(s) obtaining the specimens should have a recent smallpox vaccination (within three years) or no contraindication to immediate vaccination. Infectious-disease specialists, emergency-medicine specialists, infection-control specialists, and experts who are trained in biological warfare are likely to be consulted. Other specialists like ophthalmologists may need to be consulted if complications develop.

Picture of smallpox in a child.
Figure 2: Picture of smallpox in a child. SOURCE: Dr. Jean Roy/CDC

What is the treatment for smallpox?

Treatment for smallpox is supportive, meaning that the patient should be kept hydrated, fever should be treated with acetaminophen (Tylenol) or a similar medication, and the patient should be closely monitoring to determine if there is a need for blood pressure support. Although there are no medications that have been proven to work against human infection, some medications have shown promise in the laboratory, including a derivative of the antiviral drug cidofovir (Vistide), its analogs and virus inhibitor ST-246. Also, intravenous vaccinia immunoglobulin (VIGIV) has been used in early acquired accidental contaminations of the eyes or mouth. If the patient is hospitalized, strict airborne and contact isolation procedures should be followed; the room should have negative air pressure and HEPA air filters.

Medically Reviewed by a Doctor on 9/7/2016

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