title: Evaluating public health responses to reintroduced smallpox via dynamic, socially structured, and spatially distributed metapopulation models.
abstract: The risk of smallpox reintroduction has motivated preparations in potential target countries. After reproducing the spatiotemporal pattern after the 1972 importation into Yugoslavia via coupled, biologically realistic systems of ordinary differential equations, we developed dynamic population models with current US age distributions and typical spatially distributed social structures. Surveillance and containment (S&C) coupled with vaccination of 95% of hospital-based health care workers (HCWs) within 2 days after the first diagnosis (estimated to be 18 days after aerosol release) were modeled after simulated exposure of 10, 50, or 10,000 people in various settings. If 90% of patients were isolated within days after symptom onset and 75% of contacts were vaccinated and monitored, S&C would reduce cases by 82%-99%. Preemptive immunization of HCWs, closing of schools, and even vaccination of as many as 80% within 1 week would have small marginal benefits. Preparations should emphasize stockpiling vaccine, training HCWs, improving laboratory capacity, and fostering an understanding of S&C.
authors.affiliation: Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. jglasser@cdc.gov
authors.forename: John W
authors.initials: JW
authors.lastname: Glasser
authors.forename: Stanley O
authors.initials: SO
authors.lastname: Foster
authors.forename: J Donald
authors.initials: JD
authors.lastname: Millar
authors.forename: J Michael
authors.initials: JM
authors.lastname: Lane
mesh_terms: D023482:Bioterrorism / Q000517:prevention & control*; D018672:Community Health Planning; D004189:Disaster Planning / Q000379:methods*; D004196:Disease Outbreaks / Q000266:history / Q000517:prevention & control*; D049673:History, 20th Century; D006801:Humans; D032541:Mass Vaccination / Q000379:methods; D008962:Models, Theoretical; D011790:Quarantine; D012899:Smallpox / Q000453:epidemiology / Q000266:history / Q000517:prevention & control*; D012900:Smallpox Vaccine / Q000600:supply & distribution*; D012939:Social Planning; D014481:United States; D015022:Yugoslavia
chemical_list: D012900:Smallpox Vaccine