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On Friday, July 13, the United States Food and Drug Administration (FDA) approved the first drug to treat smallpox.

Smallpox Treatment

TPOXX is a small-molecule antiviral treatment. Until now, smallpox treatment consisted of managing symptoms and treatment with three antivirals that are not proven to treat the disease, but have been the best potential line of defense.

Studies were conducted in rabbits and non-human primates infected with viruses closely related to the virus that causes smallpox. TPOXX was then evaluated in 369 healthy human volunteers without a smallpox infection.

The results of the trial were published in the July 5 issue of the “New England Journal of Medicine.”

TPOXX will be available initially only through the U.S. government’s Strategic National Stockpile.

The U.S. Centers for Disease Control and Prevention (CDC) and the Russian State Centre for Research on Virology and Biotechnology are the only two labs in the world approved and known to have smallpox.

 The World Health Organization (WHO) had declared smallpox eradicated in 1980, but the U.S. governments fear smallpox could be used as a bioweapon.

The Stages of Smallpox

According to the CDC, the last natural outbreak of smallpox in the U.S. happened in 1949. The last naturally spread case in the entire world happened in 1977.

The disease is highly contagious. You get it mainly by breathing in the virus during close face-to-face contact with an infected person.

A person with smallpox goes through several stages as the disease progresses. Each stage has its own signs and symptoms:

1. Incubation period: This stage can last anywhere from seven to 19 days (although the average length is 10 to 14 days). During this period a person usually has no symptoms and feels fine.
2. Initial symptoms: This stage lasts anywhere from two to four days. The first symptoms include: high fever, head and body aches, overall discomfort, severe fatigue, severe back pain, and sometimes vomiting. People are usually too sick to carry on their normal activities.
3. Early rash: This stage lasts about four days. A rash starts as small red spots on the tongue and in the mouth. These spots change into sores that break open. Once the sores in the mouth start breaking down, a rash appears on the skin, starting on the face and spreading to the arms and legs and then to the hands and feet. Usually it spreads to all parts of the body within 24 hours. As this rash appears, the fever begins to decline, and the person may start to feel better. By the fourth day, the skin sores fill with fluid and often have a dent in the center. Once the skin sores fill with fluid, the fever may rise again and remain high until scabs form over the bumps.
4. Pustular rash and scabs: This stage lasts about 10 days. The sores become pustules. After about five days, the pustules begin to form a crust and then scab. By the end of the second week after the rash appears most of the sores have scabbed over.
5. Scabs fall off: This stage lasts about six days. The scabs begin to fall off, leaving marks on the skin. Three weeks after the rash appears most scabs will have fallen off.
6. No scabs: Four weeks after the rash appears all scabs should have fallen off. The person is no longer contagious.   

In the U.S. routine smallpox vaccination ended in 1972. This means most people born after that year are not vaccinated against smallpox.

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