title: Containing a large bioterrorist smallpox attack: a computer simulation approach.
abstract: BACKGROUND
  A bioterrorist release of smallpox is a constant threat to the population of the USA and other countries.
  
  
  METHODS
  A stochastic simulation model of the spread of smallpox due to a large bioterrorist attack in a structured population was constructed. Disease natural history parameter estimates, time lines of behavioral activities, and control scenarios were based on the literature and on the consensus opinion of a panel of smallpox experts.
  
  
  RESULTS
  The authors found that surveillance and containment, i.e., isolation of known cases and vaccination of their close contacts, would be sufficient to effectively contain a large intentional smallpox release. Given that surveillance and containment measures are in place, preemptive vaccination of hospital workers would further reduce the number of smallpox cases and deaths but would require large numbers of prevaccinations. High levels of reactive mass vaccination after the outbreak begins would further reduce smallpox cases and deaths to a minimum, but would require even larger numbers of vaccinations. Reactive closure of schools would have a minimal effect.
  
  
  CONCLUSIONS
  A rapid and well-organized response to a bioterrorist attack would be necessary for effective surveillance and containment to control spread. Preemptive vaccination of hospital workers and reactive vaccination of the target population would further limit spread, but at a cost of many more vaccinated. This cost in resources and potential harm due to vaccination will have to be weighed against the potential benefits should an attack occur. Prevaccination of the general population is not necessary.
authors.affiliation: Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., LE-400, PO Box 19024, Seattle, WA 98109-1024, USA. longini@scharp.org
authors.forename: Ira M
authors.initials: IM
authors.lastname: Longini
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Halloran
authors.forename: Azhar
authors.initials: A
authors.lastname: Nizam
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Shufu
authors.initials: S
authors.lastname: Xu
authors.forename: Donald S
authors.initials: DS
authors.lastname: Burke
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Epstein
mesh_terms: D023482:Bioterrorism; D003198:Computer Simulation; D004196:Disease Outbreaks / Q000517:prevention & control*; D006282:Health Personnel; D006801:Humans; D032541:Mass Vaccination; D017751:Safety Management; D012899:Smallpox / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*