Transmission potential of smallpox: estimates based on detailed data from an outbreak.
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Recent discussions on the use of variola virus by bioterrorists have rekindled interest in the parameters that govern the transmissibility of smallpox. Here, the authors estimate by maximum likelihood the parameters of the spread of smallpox from historical data on an epidemic in 1967 in the town of Abakaliki, Nigeria, afflicting a religious group that refused vaccination. According to the authors' estimates, 79.9% (95% confidence interval (CI): 63.6, 87.9) of the infectious contacts occurred within the compounds of the cases and 93.3% (95% CI: 80.6, 98.8) among compound members and other close contacts. Each case had 0.164 (95% CI: 0, 1.31) sufficiently close contacts on average during the fever period that preceded the rash and 6.87 (95% CI: 4.52, 10.1) sufficiently close contacts during the whole course of infectivity. These results support the widely held belief that smallpox spreads slowly, mainly among close contacts, and that infectivity before the onset of rash was negligible. (+info)
Case isolation and contact tracing can prevent the spread of smallpox.
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Fears that terrorist groups may have gained access to variola virus have led to widespread discussions on how to prevent the reintroduction of smallpox by vaccination and on the availability of sufficiently large amounts of vaccine. In this paper, the author examines how the spread of smallpox is affected by isolating overt cases and taking their contacts under close surveillance for up to 3 weeks. The author assumes that case detection gradually improves from initially 7 days to 3 days. This intervention should be accompanied by vaccination, but its outcome does not depend on the vaccine's efficacy. It may, therefore, be especially important in controlling outbreaks caused by pathogens whose immunologic properties have been modified by genetic engineering. Using stochastic computer simulations, the author demonstrates that contact tracing and case isolation can extinguish smallpox outbreaks in highly susceptible populations within less than half a year without causing totals of more than 550 secondary cases per 100 index cases. The author also derives simple approximate expressions that allow prognostication on how efficiently an outbreak can be controlled by the described measures alone and prediction of the expected number of cases in an outbreak and the number of people that must be taken under surveillance. (+info)
Biological warfare.
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The use of biological agents as controlled weapons of war is practical although uncertain. Three types of agents are feasible, including pathogenic organisms and biological pests, toxins, and synthetic hormones regulating plant growth. These agents may be chosen for selective effects varying from prolonged incipient illness to death of plants, man and domestic animals. For specific preventive and control measures required to combat these situations, there must be careful and detailed planning. The nucleus of such a program is available within the existing framework of public health activities. Additional research and expansion of established activities in time of attack are necessary parts of biological warfare defense. (+info)
Traffic-based feedback on the web.
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Usage data at a high-traffic web site can expose information about external events and surges in popularity that may not be accessible solely from analyses of content and link structure. We consider sites that are organized around a set of items available for purchase or download, consider, for example, an e-commerce site or collection of online research papers, and we study a simple indicator of collective user interest in an item, the batting average, defined as the fraction of visits to an item's description that result in an acquisition of that item. We develop a stochastic model for identifying points in time at which an item's batting average experiences significant change. In experiments with usage data from the Internet Archive, we find that such changes often occur in an abrupt, discrete fashion, and that these changes can be closely aligned with events such as the highlighting of an item on the site or the appearance of a link from an active external referrer. In this way, analyzing the dynamics of item popularity at an active web site can help characterize the impact of a range of events taking place both on and off the site. (+info)
Smallpox and bioterrorism.
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Smallpox was declared to be eradicated on 8 May 1980, during the Thirty-third World Health Assembly. However, concerns about the possible use of the virus as a weapon of bioterrorism have increased in recent years. Governments have responded by initiating selective vaccination programmes and other public health measures. This review uses historical data from 20th century outbreaks to assess the risks to current populations (which have declining immunity) from a deliberate release of virus. The data presented supports the conclusion of a previous reviewer (Mack) that "smallpox cannot be said to live up to its reputation. Far from being a quick-footed menace, it has appeared as a plodding nuisance with more bark than bite." Its R value (the average number of secondary cases infected by a primary case) is lower than that for measles, human parvovirus, chickenpox, mumps, rubella, and poliomyelitis; only the value for severe acute respiratory syndrome (SARS) is lower. Like SARS, close person-to-person contact is required for effective spread of the disease, and exposure to the virus in hospitals has played an important role in transmission for both viruses. In the present paper the dangers of mass vaccination are emphasized, along with the importance of case isolation, contact tracing, and quarantine of close contacts for outbreak control. The need for rapid diagnosis and the continued importance of maintaining a network of electron microscopes for this purpose are also highlighted. (+info)
Respiratory medical societies and the threat of bioterrorism.
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Respiratory medical societies throughout the world have an important role in helping governments to develop public policy to counter the threat of bioterrorism. (+info)
Initial experience with mass immunization as a bioterrorism countermeasure.
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Anthrax vaccine was administered to approximately 5000 individuals at a deployed location near Iraq in a 1-week period. This report describes the planning and administrative process to initiate such a program, with a snapshot view of the first week of immunization. Compliance with this program was important to best protect troops in this high-threat region. The authors share their experience and detail the process of handling refusals, as these are most likely to reveal themselves at the beginning of an immunization program. The program resulted in a compliance rate of 98%. With increased terrorist threats and widespread availability of biologic agents of mass destruction, experiences with such immunization programs should be described in the literature and analyzed in anticipation of similar programs in the future. (+info)
Antibiotic susceptibility of 65 isolates of Burkholderia pseudomallei and Burkholderia mallei to 35 antimicrobial agents.
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OBJECTIVES: Fifty isolates of Burkholderia pseudomallei and 15 isolates of Burkholderia mallei were tested for their susceptibilities to 35 antimicrobial agents, including agents not previously tested against these bacteria. METHODS: MICs were determined by agar dilution in Mueller-Hinton medium. RESULTS: Among the antibiotics tested, lower MICs were obtained with imipenem, ceftazidime, piperacillin, piperacillin/tazobactam, doxycycline and minocycline. Fluoroquinolones and aminoglycosides had poor activities. A single clinical isolate of B. pseudomallei was resistant to ceftazidime, co-amoxiclav and doxycycline but remained susceptible to imipenem. CONCLUSIONS: Although B. mallei MICs are often lower, the overall results underline the importance of resistance in both species. The susceptibilities measured are consistent with the current recommendations for the treatment of B. pseudomallei and B. mallei infections. (+info)