Mass Vaccination and Surveillance/Containment in the Eradication of Smallpox

  • J. M. Lane
Part of the Current Topics in Microbiology and Immunology book series (CT MICROBIOLOGY, volume 304)

Abstract

The Smallpox Eradication Program, initiated by the WHO in 1966, was originally based on mass vaccination. The program emphasized surveillance from the beginning, largely to track the success of the program and further our understanding of the epidemiology of the disease. Early observations in West Africa, bolstered by later data from Indonesia and the Asian subcontinent, showed that smallpox did not spread rapidly, and outbreaks could be quickly controlled by isolation of patients and vaccination of their contacts. Contacts were usually easy to find because transmission of smallpox usually required prolonged face-to-face contact. The emphasis therefore shifted to active searches to find cases, coupled with contact tracing, rigorous isolation of patients, and vaccination and surveillance of contacts to contain outbreaks. This shift away from mass vaccination resulted in an acceleration of the program’s success.

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References

  1. Bozzette SA, Boer R, Bhatnagar V, Brower JL, Keeler EB, Morton SC, Stoto MA (2003) A model for a smallpox-vaccination policy. N Engl J Med 348:416–425PubMedCrossRefGoogle Scholar
  2. Dixon CW (1948) Smallpox in Tripolitania, 1946; an epidemiological and clinical study of 500 cases, including trials of penicillin treatment. J Hygiene 46:35–77Google Scholar
  3. Downie AW, Meikeljohn M, St Vincent L, Rao AR, Sundara Babu BV, Kempe CH (1965) The recovery of smallpox virus frompatients and their environment in a smallpox hospital. Bull World Health Org 33:615–622PubMedGoogle Scholar
  4. Eichner M (2003) Case isolation and contact tracing can prevent the spread of smallpox. Am J Epidemiol 158:118–128PubMedCrossRefGoogle Scholar
  5. Eichner M, Dietz K (2003) Transmission potential of smallpox: estimates based on detailed data from an outbreak. Am J Epidemiol 158:110–117PubMedCrossRefGoogle Scholar
  6. Eubank S, Guclu H, Kumar VS. Marathe MV, Srinivasan A, Toroczkai Z, Wang N (2004) Modelling disease outbreaks in realistic urban social networks. Nature 429:180–184PubMedCrossRefGoogle Scholar
  7. Fenner F, Henderson DA, Arita I, Jezek Z, Ladnyi ID (1988) Smallpox and its Eradication. World Health Orgianization, GenevaGoogle Scholar
  8. Foege WH (1996) Commentary: Smallpox eradication in West and Central Africa revisited. Bull World Health Org 76:233–235Google Scholar
  9. Foege WH, Millar JD, Lane JM (1971) Selective epidemiologic control in smallpox eradication. Am J Epidemiol 94:311–315PubMedGoogle Scholar
  10. Foege WH, Millar JD, Henderson DA (1975) Smallpox eradication in West and Central Africa. Bull World Health Org 52:209–222PubMedGoogle Scholar
  11. Foster SO (1977) Smallpox eradication: lessons learned in Bangladesh. WHO Chronicle 31(6):245–247PubMedGoogle Scholar
  12. Gani R, Leach S (2001) Transmission potential of smallpox in contemporary populations. Nature 414:748–751PubMedCrossRefGoogle Scholar
  13. Glasser J, Foster SO, Millar JD, Lane JM (2005) Evaluating public health responses to reintroduced smallpox via dynamic, socially structured, and spatially distributed meta-population models. Am J Epidemiol (in press)Google Scholar
  14. Halloran ME, Longini IM Jr, Nizam A, Yang Y (2002) Containing bioterrorist smallpox. Science 298:1428–1433PubMedCrossRefGoogle Scholar
  15. Henderson RH, Yekpe M (1969) Smallpox transmission in southern Dahomey. A study of a village outbreak. Am J Epidemiol 90:423–428PubMedGoogle Scholar
  16. Henderson RH, Davis H, Eddins DL, Foege WH (1973) Assessment of vaccination coverage, vaccination scar rates, and smallpox scarring in five areas of West Africa. Bull World Health Org 48:183–194PubMedGoogle Scholar
  17. Heiner GG, Fatima N, McCrumb FR (1971) A study of intrafamilial transmission of smallpox. Am J Epidemiol 94:316–26PubMedGoogle Scholar
  18. Hopkins DR (1985) Control of yaws and other endemic trepanematoses: implementation of vertical and/or integrated programs. Rev Infect Dis 7S:338–342Google Scholar
  19. Hopkins DR, Lane JM, Cummings EC, Thornton JN, Millar JD (1971) Smallpox in Sierra Leona II: the 1968–69 eradication program. Am J. Trop Med and Hyg 20:697–704Google Scholar
  20. Imperato PJ, Sow O, Benitieni F (1973) The persistence of smallpox in remote unvaccinated villages during eradication programme activities. Acta Tropica 30:261–268PubMedGoogle Scholar
  21. Kaplan EH, Craft DL, Wein LM (2002) Emergency repose to a smallpox attack: The case of mass vaccination. Proc Nat Acad Sci USA 99:10935–10940PubMedCrossRefGoogle Scholar
  22. Kennedy JS, Frey SE. Yan L, Rothman AL, Cruz J, Newman FK, Orphin L, Belshe RB, Ennis FA (2004) Induction of human T cell-mediated immune responses after primary and secondary smallpox vaccination. J Infect Dis 190:1286–1294PubMedCrossRefGoogle Scholar
  23. Lane JM, Goldstein J (2003) Evaluation of 21st-century risks of smallpox vaccination and policy options. Annals of Int Med 138:488–493Google Scholar
  24. Legrand J, Vibound C, Boelle PY, Valleron AJ, Flahault A (2004) Modeling responses to a smallpox epidemic taking into account uncertainty. Epidemiol Infect 132:19–25PubMedCrossRefGoogle Scholar
  25. Mack TM (1972) Smallpox in Europe 1950–1971. J Infect Dis 125:161–169PubMedGoogle Scholar
  26. Mack TM (2003) A different view of smallpox and vaccinia. New Engl J Med 348:460–463PubMedCrossRefGoogle Scholar
  27. Mack TM, Thomas DB, Ali A, Khan MM (1972) Epidemiology of smallpox in West Pakistan I acquired immunity and the distribution of disease. Am J Epidemiol 95:157–168PubMedGoogle Scholar
  28. Massoudi, MS, Barker L, Schwartz B (2003) Effectiveness of postexposure vaccination for the prevention of smallpox: results of a Delphi analysis. J Infect Dis 188:973–976PubMedCrossRefGoogle Scholar
  29. Meltzer MI, Damon I, LeDuc JW, Millar JD (2001). Modeling potential responses to smallpox as a bioterrorist weapon. Emerg Infect Dis 7:959–969PubMedCrossRefGoogle Scholar
  30. Meyer HM, Hostetler DD, Bernheim BC, Rogers NG, Lambin P, Chassary A, Labusquiere R, Smadel JE (1964) Response of Volta children to live attenuated measles vaccine. Bull World Health Org 30:769–781PubMedGoogle Scholar
  31. Millar JD, Foege WH (1969) Status of eradication of smallpox (and control of measles) in West and Central Africa. J Infect Dis 120:725–732PubMedGoogle Scholar
  32. Millar JD, Roberto RR, Wulff H, Wenner HA, Henderson DA (1969) Smallpox vaccination by intradermal jet injection. I Introduction, background, and results of pilot studies. Bull World Health Org 41:749–760PubMedGoogle Scholar
  33. Morley DC, Martin WJ, Allen I (1967) Measles in West Africa. West Afr Medl J Nigerian Pract 16:24–31Google Scholar
  34. Mukherjee MK, Sarkar JK, Mitra AS (1974) Pattern of intrafamilial transmission of smallpox in Calcutta, India. Bull World Health Org 51:219–215PubMedGoogle Scholar
  35. National Institute of Communicable Diseases of India (1968) Evaluation of the National Smallpox Eradication Program in Karnal District, Haryana. New DelhiGoogle Scholar
  36. Neff JM, Millar JD, Roberto RR, Wulff Hl (1969) Smallpox vaccination by intradermal jet injection. III Evaluation in a well vaccinated population Bull World Health Org 41:771–778Google Scholar
  37. Porco TC, Holbrook KA, Fernyak SE, Portnoy DL, Reiter R, Aragon TJ (2004) Logistics of community smallpox control through contact tracing and ring vaccination: a stochastic network model. BMC Publ Health 4:34CrossRefGoogle Scholar
  38. Rao AR, Jacob ES, Kamalakshi S, Appaswamy S, Bradbury (1968) Epidemiological studies of smallpox. A study of intrafamilial transmission in a series of 254 infected families. Ind J Med Res 56:1826–1854Google Scholar
  39. Rey M, Cantrelle P, Lafaix C, Mar ID, Sow A, Agboton Y (1968) Lessons of an experimental campaign of vaccination against measles in the urban environment. (in French) Bulletin de la Societe Medicale d Afrique Noire de Langue Francaise. 13:291–231PubMedGoogle Scholar
  40. Roberto RR, Wulff H, Millar JD (1969) Smallpox vaccination by intradermal jet injection. II Cutaneous and serological responses to primary vaccination in children. Bull World Health Org 41:761–769PubMedGoogle Scholar
  41. Sommer A, Foster SO (1974) The 1972 Smallpox outbreak in Khulna municipality, Bangladesh 1. Methodology and epidemiologic findings. Am J Epidemiol 99:291–302PubMedGoogle Scholar
  42. Thomas DB, McCormack WM, Arita I, Khan MM, Islam S, Mack TM (1971) Endemic smallpox in rural East Pakistan. I. Methodology, clinical and epidemiological characteristics of cases and intravillage transmission. Am J Epidemiol 93:361–372PubMedGoogle Scholar
  43. Thompson D, Foege WH (1968) Faith Tabernacle Smallpox Epidemic, Abakaliki, Nigeria. WHO/SE/68.3Google Scholar
  44. Tomori O (2002) Yellow fever in Africa: public health impact and prospects for control in the 21st century. Biomedica 22:178–210PubMedGoogle Scholar
  45. World Health Organization (1964) WHO expert committee on smallpox First Report Technical Report Series No. 283Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2006

Authors and Affiliations

  • J. M. Lane
    • 1
  1. 1.AtlantaUSA

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