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Targeted smallpox vaccinations could be effective intervention against deliberate attack

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The investigators conducted 200 simulations for each proposed intervention within their model, using a statistical community of 2000 people based on the age distribution and approximate household sizes reported in the U.S. Census 2000. Each simulated community consisted of four neighborhoods, one high school, one middle school, two elementary schools, small play groups, and day care centers. Households had between one and seven people, and 33% of households consisted of single adults. The model assumed that in a deliberate smallpox attack, either one or five individuals already infected with smallpox would circulate through the community at the beginning of the infectious stage of their disease.

Drs. Halloran and Longini believe their model is more realistic than "deterministic" models that assume all individuals within a large, homogenous population interact randomly with others, concluding that an epidemic always follows the same course. The Emory study considered many different variables, including where transmission was likely to be highest (first within households, then schools, then neighborhoods, and lastly the community at large) and which individuals were likely to have residual immunity. For individuals vaccinated prior to 1972, the investigators assumed different levels of immunity ranging from zero to half the immunity level induced by a fresh vaccination. They also considered the three different stages of smallpox incubation (10 to 14 days); prodromal phase, (flu-like symptoms); and pox phase and the likelihood of interaction and transmission within a community each day following infection. Based on historical data, they assumed that smallpox is more likely to be transmitted through close contact than through casual contact on the streets or in a subway.

The model investigated two different scenarios of mass vaccination, either before an introduction of smallpox, with vaccine coverage levels of 30, 50, or 80%,
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Contact: Holly Korschun
hkorsch@emory.edu
404-727-3990
Emory University Health Sciences Center
14-Nov-2002


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