Containing a large bioterrorist smallpox attack: a computer simulation approach
Containing a large bioterrorist smallpox attack: a computer simulation approach
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DOI：
10.1016/j.ijid.2006.03.002
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发表时间：
2007-03-01
影响因子：
8.4
通讯作者：
Epstein, Joshua M.
中科院分区：
文献类型：
--
作者：
Longini, Ira M., Jr.;Halloran, M. Elizabeth;Epstein, Joshua M.
背景：生物恐怖分子释放天花是对美国和其他国家人口的持续威胁。设计：构建了结构性人口中因大规模生物恐怖袭击而传播天花的随机模拟模型。疾病自然史参数估计、行为活动的时间线和控制情景基于文献和专家小组的一致意见。结果：作者发现，监测和控制，即隔离已知病例和对其密切接触者接种疫苗，将足以有效地控制大规模的故意天花传播。鉴于监测和控制措施已经到位，医院工作人员先发制人接种疫苗将进一步减少天花病例和死亡人数，但需要进行大量预防接种。疫情开始后高水平的反应性大规模接种将进一步将天花病例和死亡人数减少到最低限度，但需要接种更多的疫苗。学校被动关闭的影响将是最小的。结论：对生物恐怖袭击的快速和有组织的反应对于有效的监测和遏制传播是必要的。医院工作人员的先发制人接种和目标人群的反应性接种将进一步限制传播，但代价是更多的人接种疫苗。接种疫苗造成的资源成本和潜在危害必须与发生攻击时的潜在好处进行权衡。没有必要对普通人群进行预接种。(C)2006年国际传染病学会。爱思唯尔有限公司出版。保留所有权利。
Background: A bioterrorist release of smallpox is a constant threat to the population of the USA and other countries.Design: A stochastic simulation model of the spread of smallpox due to a large bioterrorist attack in a structured population was constructed. Disease natural history parameter estimates, time lines of behavioral activities, and control scenarios were based on the literature and on the consensus opinion of a panel. of smallpox experts.Results: The authors found that surveillance and containment, i.e., isolation of known cases and vaccination of their close contacts, would be sufficient to effectively contain a large intentional smallpox release. Given that surveillance and containment measures are in place, preemptive vaccination of hospital workers would further reduce the number of smallpox cases and deaths but would require large numbers of prevaccinations. High levels of reactive mass vaccination after the outbreak begins would further reduce smallpox cases and deaths to a minimum, but would require even Larger numbers of vaccinations. Reactive closure of schools would have a minimal effect.Conclusion: A rapid and well-organized response to a bioterrorist attack would be necessary for effective surveillance and containment to control spread. Preemptive vaccination of hospital workers and reactive vaccination of the target population would further limit spread, but at a cost of many more vaccinated. This cost in resources and potential harm due to vaccination will have to be weighed against the potential benefits should an attack occur. Prevaccination of the general population is not necessary. (c) 2006 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.