Containing bioterrorist smallpox
Containing bioterrorist smallpox
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DOI：
10.1126/science.1074674
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发表时间：
2002-11-15
期刊：
影响因子：
56.9
通讯作者：
Yang, Y
中科院分区：
文献类型：
--
作者：
Halloran, ME;Longini, IM;Yang, Y
对天花的故意引入的计划反应的需求最近变得紧迫。我们构建了天花在结构化群落中传播的随机模拟器，以比较大规模疫苗接种的有效性与密切接触案件的靶向疫苗接种的有效性。天花引入前的大规模疫苗接种或第一次病例之后立即在防止和含有流行病的靶向疫苗之前立即有效，如果没有先前的牛群免疫力（也就是说，人口中没有先前的免疫保护）。如果我们假设在1972年之前接种疫苗的成年人有剩余的免疫力，则针对后释放的有效性和质量疫苗接种量增加，但是靶向疫苗的有效性比批量疫苗接种的效力还要高。在所有情况下，有针对性的疫苗接种可阻止每剂疫苗的病例比大规模疫苗接种更多。尽管需要对大规模结构化模型进行进一步的研究，但我们的结果表明，增加的牛群免疫力，也许通过先发制人的自愿疫苗接种和对急救人员的疫苗接种的结合，可以提高攻击后干预的有效性。它还可以帮助有针对性的疫苗接种在预防和故意引入天花的情况下更具竞争力。
The need for a planned response to a deliberate introduction of smallpox has recently become urgent. We constructed a stochastic simulator of the spread of smallpox in structured communities to compare the effectiveness of mass vaccination versus targeted vaccination of close contacts of cases. Mass vaccination before smallpox introduction or immediately after the first cases was more effective than targeted vaccination in preventing and containing epidemics if there was no prior herd immunity (that is, no prior immunologic protection within the population). The effectiveness of postrelease targeted and mass vaccinations increased if we assumed that there was residual immunity in adults vaccinated before 1972, but the effectiveness of targeted vaccination increased more than that of mass vaccination. Under all scenarios, targeted vaccination prevented more cases per dose of vaccine than did mass vaccination. Although further research with larger-scale structured models is needed, our results suggest that increasing herd immunity, perhaps with a combination of preemptive voluntary vaccination and vaccination of first responders, could enhance the effectiveness of postattack intervention. It could also help targeted vaccination be more competitive with mass vaccination at both preventing and containing a deliberate introduction of smallpox.