title: Surveillance and control measures during smallpox outbreaks.
abstract: We reviewed historical data from 2 smallpox outbreaks in Liverpool and Edinburgh during the early and middle years of the 20th century to assess their contribution to developing modern strategies for response to a deliberate release of smallpox virus. Reports contemporaneous to these outbreaks provide detail on the effectiveness of public health interventions. In both outbreaks, extensive contact tracing, quarantine, and staged vaccination campaigns were initiated, and the outbreaks were controlled within 15 months and 3 months, respectively. In Edinburgh, the number of fatalities associated with vaccination exceeded the number of deaths from the disease. In Liverpool, ambulatory, vaccine-modified cases and misdiagnosis as chickenpox resulted in problems with outbreak control. The relatively slow spread of smallpox, as exemplified by the report from Liverpool, allowed for effective implementation of targeted intervention methods. Targeted surveillance and containment interventions have been successful in the past and should be explored as alternatives to mass vaccination.
authors.affiliation: Centre for Emergency Preparedness and Response, Health Protection Agency, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK. emma.kerrod@hpa.org.uk
authors.forename: Emma
authors.initials: E
authors.lastname: Kerrod
authors.forename: Alasdair M
authors.initials: AM
authors.lastname: Geddes
authors.forename: Martyn
authors.initials: M
authors.lastname: Regan
authors.forename: Steve
authors.initials: S
authors.lastname: Leach
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012899:Smallpox / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D012900:Smallpox Vaccine / Q000008:administration & dosage; D006113:United Kingdom / Q000453:epidemiology; D014611:Vaccination / Q000379:methods; D012901:Variola virus / Q000254:growth & development* / Q000276:immunology
chemical_list: D012900:Smallpox Vaccine