In the event of a smallpox attack, a mass vaccination policy would result in fewer deaths and faster disease eradication than alternative vaccination strategies, reports a team of researchers including a Yale professor.
Since the terrorist attacks of Sept. 11, the best response to a smallpox attack has been a topic of hot debate.
The new study, which uses a mathematical model to compare a number of different vaccination strategies on disease spread and death resulting from a smallpox attack on a large urban center, was published in July in the Proceedings of the National Academy of Sciences. The authors were Edward Kaplan, the William N. and Marie A. Beach Professor of Management Sciences at the School of Management, and his two colleagues from the Massachusetts Institute of Technology: David L. Craft of the Operations Research Center and Lawrence M. Wein of the Sloan School.
The current response plan by the Centers for Disease Control and Prevention (CDC), endorsed by the Advisory Committee on Immunization Practices on June 20, calls for isolation of confirmed smallpox cases and targeted vaccination of only those who have been in contact with infected individuals, with a mass vaccination effort to take place only if the initial vaccination and quarantine methods are unsuccessful.
The new mathematical model takes into account the number of people initially infected, the transmission rate, the fraction of potential contacts named by infected individuals and the resources available to track potential contacts and administer vaccinations, explains Kaplan, who is also a professor in the Department of Epidemiology and Public Health at the School of Medicine.
Under several different scenarios, the model predicted that mass vaccination would stop the spread of infection faster and result in fewer deaths than targeted vaccination or the CDC plan. In fact, the currently endorsed plan led to an estimated 4,120 additional deaths compared to a mass vaccination plan implemented from the beginning in a large attack on a city with 10 million inhabitants, notes Kaplan.
The researchers found that a pre-attack vaccination of a portion of the population lessened the gap between the different strategies. These results suggest that unless a pre-attack vaccination is used to increase immunity within the population, a mass vaccination strategy should be seriously considered, Kaplan says.
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