Med Decis Making - Modeling the Effect of Herd Immunity and Contagiousness in Mitigating a Smallpox Outbreak.


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The smallpox antiviral tecovirimat has recently been purchased by the U.S. Strategic National Stockpile. Given significant uncertainty regarding both the contagiousness of smallpox in a contemporary outbreak and the efficiency of a mass vaccination campaign, vaccine prophylaxis alone may be unable to control a smallpox outbreak following a bioterror attack. Here, we present the results of a compartmental epidemiological model that identifies conditions under which tecovirimat is required to curtail the epidemic by exploring how the interaction between contagiousness and prophylaxis coverage of the affected population affects the ability of the public health response to control a large-scale smallpox outbreak. Each parameter value in the model is based on published empirical data. We describe contagiousness parametrically using a novel method of distributing an assumed R-value over the disease course based on the relative rates of daily viral shedding from human and animal studies of cognate orthopoxvirus infections. Our results suggest that vaccination prophylaxis is sufficient to control the outbreak when caused either by a minimally contagious virus or when a very high percentage of the population receives prophylaxis. As vaccination coverage of the affected population decreases below 70%, vaccine prophylaxis alone is progressively less capable of controlling outbreaks, even those caused by a less contagious virus (R0 less than 4). In these scenarios, tecovirimat treatment is required to control the outbreak (total number of cases under an order of magnitude more than the number of initial infections). The first study to determine the relative importance of smallpox prophylaxis and treatment under a range of highly uncertain epidemiological parameters, this work provides public health decision-makers with an evidence-based guide for responding to a large-scale smallpox outbreak.

Resumo Limpo

smallpox antivir tecovirimat recent purchas us strateg nation stockpil given signific uncertainti regard contagi smallpox contemporari outbreak effici mass vaccin campaign vaccin prophylaxi alon may unabl control smallpox outbreak follow bioterror attack present result compartment epidemiolog model identifi condit tecovirimat requir curtail epidem explor interact contagi prophylaxi coverag affect popul affect abil public health respons control largescal smallpox outbreak paramet valu model base publish empir data describ contagi parametr use novel method distribut assum rvalu diseas cours base relat rate daili viral shed human anim studi cognat orthopoxvirus infect result suggest vaccin prophylaxi suffici control outbreak caus either minim contagi virus high percentag popul receiv prophylaxi vaccin coverag affect popul decreas vaccin prophylaxi alon progress less capabl control outbreak even caus less contagi virus r less scenario tecovirimat treatment requir control outbreak total number case order magnitud number initi infect first studi determin relat import smallpox prophylaxi treatment rang high uncertain epidemiolog paramet work provid public health decisionmak evidencebas guid respond largescal smallpox outbreak

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