Tecovirimat approved in Europe for the treatment of orthopoxvirus disease
The European Medicines Agency has recommended that the antiviral drug tecovirimat be approved for the treatment of smallpox, monkeypox, and cowpox in adults and children with body weight at least 13 kg. It is also indicated to treat complications due to replication of vaccinia virus following smallpox vaccination.
Tecovirimat is a synthetic small antiviral molecule which inhibits orthopoxvirus peripheral membrane protein (VP37) activity. Its effectiveness was predicted from studies that showed improved survival in animals. The most common adverse effects are headache and nausea.
Although naturally occurring smallpox was eradicated in 1980, there have been long standing concerns that the variola virus could be used as a bioweapon. Cases of monkeypox have been reported in various countries over the last few years, with 3 cases reported in the UK this year.
Tecovirimat is approved in the US for the treatment of smallpox.
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever
- vesicular rash
- oropharynx and tongue enanthem
- lymphadenopathy
Other diagnostic factors
- headache
- backache
- pharyngitis
- vomiting
- diarrhoea
- delirium
- convulsions
Risk factors
- contact with laboratory (smallpox)
- bioterrorism (smallpox)
- close contact with known case (smallpox)
- contact with monkeypox in animals or humans
Diagnostic investigations
1st investigations to order
- vesicle specimen PCR
- FBC
- urea and electrolytes
- LFTs
- venous lactate
- clotting screen
Treatment algorithm
Contributors
Authors
Tom Blanchard, DTM&H, PhD, FRCP
Consultant in Infectious Diseases
Department of Infectious Diseases and Tropical Medicine
North Manchester General Hospital
Manchester
UK
Disclosures
TB is the principal investigator on an MRC/Wellcome/Newton Fund grant to make a Zika vaccine based on recombinant modified vaccinia Ankara.
Peer reviewers
Jimmy Whitworth, MD, FRCP
Professor of International Public Health
London School of Hygiene & Tropical Medicine
London
UK
Disclosures
JW declares that he has no competing interests.
Ashley Styczynski, MD, MPH
Epidemic Intelligence Service Officer
Poxvirus and Rabies Branch
Centers for Disease Control and Prevention
Atlanta
GA
Disclosures
AS declares that she has no competing interests.
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