Targeted smallpox vaccinations could be effective intervention against deliberate attack

Targeted vaccination of the close contacts of infected individuals following a smallpox outbreak could rival the effectiveness of mass vaccination, given a sufficiently high level of immunity within the population, according to a new study by biostatisticians at Emory University. The research is published in the Nov. 15 issue of Science. Since targeted vaccinations would lead to fewer adverse vaccine reactions and would prevent more cases of smallpox per dose of vaccine, a targeted strategy would be desirable given an equally effective outcome, say the investigators. The existing immunity could be a combination of residual immunity from smallpox vaccinations received prior to 1972, new vaccinations of first responders, and voluntary vaccinations of other individuals, they suggest.

M. Elizabeth Halloran, M.D., D.Sc., and Ira M. Longini, Jr., Ph.D., professors of biostatistics at Emory University's Rollins School of Public Health, along with colleagues Azhar Nizam and Yang Yang, constructed a model that simulated the spread of smallpox deliberately introduced by infected individuals moving through a community. The model is based on the investigators' previous experience with modeling flu epidemics. It assumes that people interact primarily within known contact groups, including their own household, schools or daycare centers, their neighborhood and their community. The model differs from other recent models of smallpox epidemics that assume random mixing of individuals within a large, homogeneous population, with the conclusion that mass vaccination is the only way to sufficiently control an outbreak.

The Emory model simulated a range of scenarios for smallpox epidemics, based on different probabilities of how smallpox might spread, whether or not there was residual immunity from prior vaccinations, at what stage individuals might stay home during different stages of their disease, and the effectiveness of smallpox vaccines in different age

Contact: Holly Korschun
Emory University Health Sciences Center

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