Vaccinia immunoglobulin (VIG)
Intravenous VIG is licensed in some countries for the treatment of complications due to vaccinia vaccination (i.e., eczema vaccinatum, progressive vaccinia, severe generalised vaccinia, vaccinia infection in people with skin conditions, aberrant infections induced by vaccinia virus). It is unknown whether people exposed to monkeypox or with severe infection would benefit from VIG. It should be used only in a clinical research context with prospective data collection. In the US, VIG can be used for the treatment of monkeypox under an expanded access protocol in the context of an outbreak. It can also be considered for post-exposure prophylaxis in an exposed person with severe immunodeficiency in T-cell function for which smallpox vaccination following exposure to monkeypox is contraindicated. See Prevention. VIG may be stockpiled in countries for use during an outbreak.
NIOCH-14, an analogue of tecovirimat, is an investigational oral antiviral agent with in vitro and in vivo activity against orthopoxviruses. Animal challenge studies showed a significant reduction in virus production in the lungs of infected animals when compared with controls. However, the clinical efficacy for the treatment of monkeypox is uncertain.
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