Med Decis Making - Stamping out fires! Controlling smallpox with targeted mass vaccination.

Tópicos

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Resumo

CKGROUND: More than 30 years have now passed since the last naturally occurring case of smallpox; however, the variola virus still exists in at least 2 locations. The possibility that any clandestine stocks could be used for bioterrorism is a continuing concern for the public health community.OBJECTIVE: . Mathematical modeling is used to assess the impact of mass vaccination following a smallpox release when either standard public health controls are failing or political/public opinion is urging more comprehensive methods. Two mass vaccination strategies are considered: a blanket nationwide campaign v. an approach targeted only at those geographic areas that experience smallpox cases. The study evaluates which intervention strategy results in the fewest combined disease and vaccine-related deaths.RESULTS: . Outbreaks that go unnoticed until up to 50 cases have occurred are optimally controlled with targeted mass vaccination of the affected administrative districts in the majority of scenarios considered. The number of people vaccinated is approximately two thirds fewer than when implementing a nationwide campaign. Similar results arise when contact tracing is either highly unsuccessful or reduced in favor of reallocating limited resources for a policy of mass vaccination.CONCLUSIONS: . Reactive nationwide mass vaccination remains a suboptimal strategy for controlling an expanding smallpox outbreak in all but the most extreme circumstances. Rather, targeted mass vaccination of affected areas is likely to result in fewer deaths. The vaccines administered are also likely to be much fewer because they would probably be distributed to a much smaller number of districts, thus relieving pressure on potentially stretched public health systems.

Resumo Limpo

ckground year now pass sinc last natur occur case smallpox howev variola virus still exist least locat possibl clandestin stock use bioterror continu concern public health communityobject mathemat model use assess impact mass vaccin follow smallpox releas either standard public health control fail politicalpubl opinion urg comprehens method two mass vaccin strategi consid blanket nationwid campaign v approach target geograph area experi smallpox case studi evalu intervent strategi result fewest combin diseas vaccinerel deathsresult outbreak go unnot case occur optim control target mass vaccin affect administr district major scenario consid number peopl vaccin approxim two third fewer implement nationwid campaign similar result aris contact trace either high unsuccess reduc favor realloc limit resourc polici mass vaccinationconclus reactiv nationwid mass vaccin remain suboptim strategi control expand smallpox outbreak extrem circumst rather target mass vaccin affect area like result fewer death vaccin administ also like much fewer probabl distribut much smaller number district thus reliev pressur potenti stretch public health system

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