An attempt at a new analysis of the mortality caused by smallpox and of the advantages of inoculation to prevent it
An attempt at a new analysis of the mortality caused by smallpox and of the advantages of inoculation to prevent it
复制标题
DOI：
10.1002/rmv.443
复制
发表时间：
2004-09-01
影响因子：
11.1
通讯作者：
Blower, S
中科院分区：
文献类型：
--
作者：
Blower, S
一般人群是否应该接种天花疫苗（天花）？大规模接种疫苗的好处是否大于风险？大规模接种天花疫苗会导致多少人死亡？天花疫苗接种的数学模型可以用来决定卫生政策吗？虽然天花在1979年被世界卫生组织宣布根除，但这些问题最近都在争论，前提是天花可能被用作生物恐怖主义的武器。因此，最近发表了一系列分析，使用数学模型试图确定在发生此类袭击时最有效的公共卫生反应[1-4]。然而，这些同样有争议的公共卫生问题在18世纪天花流行时就有争议，《医学病毒学评论》在1902年和1913年发表了两篇描述天花自然史的经典论文，以帮助这些讨论[5，6]。我们现在发表了一篇更早的论文。1760年，世纪最伟大的科学家之一丹尼尔·伯努利（Daniel Bernoulli，1700-1782）对这个问题进行了数学分析，试图通过鼓励普遍接种天花疫苗来影响公共卫生政策;他的分析于1760年首次在巴黎的皇家科学院发表，后来于1766年发表[7]。在这里，我们重新发布和讨论的历史和当前意义伯努利的经典文件。迪茨和海斯特贝克[8]曾对伯努利分析的数学进行过详细的讨论。根据克雷顿[9]的说法，天花最早出现在世纪的英格兰。天花在中世纪的西欧就已为人所知，但在世纪早期出现了一种特别致命的毒株，病死率逐渐上升[10]。到了18世纪，天花已经成为地方病。伯努利计算出大约四分之三的人（在18世纪）感染了天花[7]。当时死亡人数的十分之一是由天花造成的，尽管由于流行病的爆发覆盖了地方性天花的死亡率，天花的死亡率每年都有相当大的变化。例如，在伦敦，在1761-1796年期间，每年死于天花的人数从3000到15000不等。在天花流行的地方，它几乎完全是一种儿童疾病，病死率为20%-30%;由于天花死亡的平均年龄估计为2.6岁[10]或4.5岁[11]。
INTRODUCTION Should the general population be vaccinated against smallpox (Variola Major)? Would the benefits of mass vaccination outweigh the risks? How many deaths would occur as the result of a mass vaccination campaign against smallpox? Can mathematical models of smallpox vaccination be used to determine health policy? Although smallpox was declared eradicated by the World Health Organization in 1979, these questions have all been recently debated based upon the premise that smallpox may be used as a weapon of bioterrorism. Hence, a series of analyses has recently been published that use mathematical models to try to determine the most effective public health response in the event of such an attack [1–4]. However, these same controversial public health questions were debated in the 18th century when smallpox was endemic and Reviews in Medical Virology has published two classic papers describing the natural history of smallpox in 1902 and 1913 to help inform these discussions [5, 6]. We now publish an even earlier paper. In 1760 Daniel Bernoulli (1700–1782), one of the greatest scientists of the 18th century, wrote a mathematical analysis of the problem in order to try to influence public health policy by encouraging the universal inoculation against smallpox; his analysis was first presented at the Royal Academy of Sciences in Paris in 1760 and later published in 1766 [7]. Here, we republish and discuss both the historical and the current significance of Bernoulli’s classic paper. A detailed discussion of the mathematics of Bernoulli’s analysis has previously been presented by Dietz and Heesterbeck [8].According to Creighton [9] smallpox first appeared in England in the 16th century. Smallpox was known in Western Europe in medieval times, but a particularly virulent strain emerged in the early 17th century and gradually the case fatality rate increased [10]. By the 18th century smallpox was endemic. Bernoulli calculated that approximately three quarters of all living people (in the 18th century) had been infected with smallpox [7]. One-tenth of all mortality at that time was due to smallpox, although there was considerable annual variation in smallpox mortality due to epidemic outbreaks overlaying the endemic smallpox mortality rate. For example, in London during the period 1761–1796 the annual number of deaths due to smallpox varied from 3000 to 15 000. Where smallpox was endemic it was almost wholly a disease of childhood, with a case-fatality rate of 20%–30%; the mean age of death due to smallpox has been estimated as 2.6 years [10] or 4.5 years [11].