Vaccinia Medication

Updated: Oct 01, 2019
  • Author: Nikesh A Patel; Chief Editor: John L Brusch, MD, FACP  more...
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Medication Summary

VIG is available for amelioration of some vaccinia-related complications. VIG is produced from pooled human sera taken from vaccinia-immunized individuals and is available only from the CDC. VIG has been effective when administered early in cases of vaccinia necrosum and eczema vaccinatum. VIG has not been effective in cases of encephalopathy. The use of VIG for generalized vaccinia reactions is usually unnecessary. Vaccinia immune globulin, intravenous (VIGIV) has recently been approved by the US Food and Drug Administration.

The first antiviral for the treatment of smallpox disease, tecovirimat (TPOXX), was approved by the US Food and Drug Administration (FDA) in July 2018. [10]

Cidofovir, a nucleotide analogue of cytosine, has demonstrated antiviral activity against certain orthopoxviruses in cell-based in vitro and animal model studies. Tecovirimat and cidofovir are available from the US government’s Strategic National Stockpile (SNS).


Immune globulins

Class Summary

These agents are used for passive immunity. Therapy consists of administration of immunoglobulin pooled from serum of immunized subjects.

Vaccinia immune globulin intravenous (VIGIV, CNJ-016)

Derived from human plasma and manufactured from pooled plasma donors who received booster immunizations with smallpox vaccine. Contains increased antibody levels against vaccinia virus. Indicated to treat rare adverse reactions caused by vaccinia virus, including aberrant infections (eg, accidental implantation in the eyes, mouth, other potentially hazardous areas), eczema vaccinatum, progressive vaccinia, severe generalized vaccinia, and vaccinia infections in immunocompromised individuals.


Antivirals, Other

Class Summary

The first antiviral, tecovirimat (TPOXX), for treatment of smallpox disease was approved by the US Food and Drug Administration (FDA) in July 2018.

Cidofovir is currently approved for the treatment of cytomegalovirus (CMV) infections, but not for smallpox. However, animal models support the potential usefulness of this agent in smallpox.

Tecovirimat (TPOXX)

Antiviral agent; targets and inhibits the activity of the orthopoxvirus VP37 protein (encoded by and highly conserved in all members of the orthopoxvirus genus) and blocks its interaction with cellular Rab9 GTPase and TIP47, which prevents the formation of egress-competent enveloped virions necessary for cell-to-cell and long-range dissemination of virus. It is approved by the FDA and indicated for treatment of human smallpox disease caused by variola virus in adults and children who weigh at least 13 kg.


Not licensed for use as a treatment for smallpox. Currently approved for treatment of CMV retinitis in AIDS. Cidofovir is the first member of a group of antivirals known as acyclic phosphonate nucleotide analogs. Cidofovir diphosphate, the active intracellular metabolite of cidofovir, inhibits herpes virus polymerases at concentrations that are 8- to 600-fold lower than those needed to inhibit human cellular DNA polymerases alpha, beta, and gamma. Incorporation of cidofovir into the growing viral DNA chain results in reductions in the rate of viral DNA synthesis.


Vaccines, Live, Viral

Class Summary

Before the eradication of smallpox disease, live vaccinia virus smallpox vaccine was administered routinely in all pediatric age groups, including neonates and infants. It is now used only as routine vaccination for laboratory personnel who directly handle cultures or animal care personnel whose occupations place them at risk for exposure to vaccinia and other orthopoxviruses, including recombinant vaccinia viruses. [2]

Smallpox (vaccinia) vaccine, live (ACAM2000)

Indicated for routine active immunization against smallpox disease for persons determined to be at high risk for smallpox infection.

Smallpox (vaccinia) and monkeypox vaccine, live, nonreplicating (Jynneos)

Vaccine is derived from a vaccinia virus, a virus that is closely related to, but less harmful than, variola or monkeypox viruses and can protect against both of these diseases. It is indicated for prevention of smallpox and monkeypox disease in adults who are at high risk for smallpox or monkeypox infection. It is administered as a 2-dose series administered 4 weeks apart.