Modeling potential responses to smallpox as a bioterrorist weapon, Emerging Infectious Diseases

We constructed a mathematical model to describe the spread of smallpox after a deliberate release of the virus. Assuming 100 persons initially infected and 3 persons infected per infectious person, quarantine alone could stop disease transmission but would require a minimum daily removal rate of 50 % of those with overt symptoms. Vaccination would stop the outbreak within 365 days after release only if disease transmission were reduced to <0.85 persons infected per infectious person. A combined vaccination and quarantine campaign could stop an outbreak if a daily quarantine rate of 25 % were achieved and vaccination reduced smallpox transmission by>33%. In such a scenario, approximately 4,200 cases would occur and 365 days would be needed to stop the outbreak. Historical data indicate that a median of 2,155 smallpox vaccine doses per case were given to stop outbreaks, implying that a stockpile of 40 million doses should be adequate. Recent papers have speculated about the use of smallpox as a biological weapon (1-5). If we assume such a risk, there is concern about the need for preparations to limit and prevent the spread of smallpox after a deliberate release of the virus. Studies of smallpox control and eradication efforts (6-8) identified two available types of interventions: vaccination of those at risk from infection, quarantine, or both. Some studies have provided estimates of the potential numbers that could be infected (1,3,5) and the number of vaccine doses that should be stockpiled (1); however, they did not provide details of how these estimates were calculated. Further, none of these article