Modeling potential responses to smallpox as a bioterrorist weapon. Emerg Infect Dis 2001; 7:959-69. (Also available at http://www.cdc.gov/ncidod/EID/vol7no6/meltzer.htm

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 out-break within 365 days after release only if disease transmission were reduced to>0.85 persons infected per infectious person. A combined vacci-nation 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 out-breaks, implying that a stockpile of 40 million doses should be adequate. Recent papers have speculated about the use of small-pox as a biological weapon (1-5). If we assume such a risk