The global eradication of smallpox

Strassburg, Marc A.

doi:10.1016/0196-6553(82)90003-7

Cited by 143 publications

(93 citation statements)

References 8 publications

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“…One of the earliest applications of ring vaccination was in Nigeria, when a smallpox outbreak developed among a religious sect. Faced with limited resources and vaccine supplies, staff learned to isolate infected individuals and identify and vaccinate their contacts, leading to successful containment of the outbreak (Hopkins 1988; Strassburg 1982). In the case of smallpox, the vaccine can prevent both infection and disease in persons who have already been infected, meaning that ring vaccination could be particularly effective despite delays in identifying index cases.…”

Section: Introductionmentioning

confidence: 99%

Impact of Imitation Processes on the Effectiveness of Ring Vaccination

et al. 2011

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Ring vaccination can be a highly effective control strategy for an emerging disease or in the final phase of disease eradication, as witnessed in the eradication of smallpox. However, the impact of behavioural dynamics on the effectiveness of ring vaccination has not been explored in mathematical models. Here, we analyze a series of stochastic models of voluntary ring vaccination. Contacts of an index case base vaccinating decisions on their own individual payoffs to vaccinate or not vaccinate, and they can also imitate the behaviour of other contacts of the index case. We find that including imitation changes the probability of containment through ring vaccination considerably. Imitation can cause a strong majority of contacts to choose vaccination in some cases, or to choose non-vaccination in other cases—even when the equivalent solution under perfectly rational (non-imitative) behaviour yields mixed choices. Moreover, imitation processes can result in very different outcomes in different stochastic realizations sampled from the same parameter distributions, by magnifying moderate tendencies toward one behaviour or the other: in some realizations, imitation causes a strong majority of contacts not to vaccinate, while in others, imitation promotes vaccination and reduces the number of secondary infections. Hence, the effectiveness of ring vaccination can depend significantly and unpredictably on imitation processes. Therefore, our results suggest that risk communication efforts should be initiated early in an outbreak when ring vaccination is to be applied, especially among subpopulations that are heavily influenced by peer opinions.

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Section: Introductionmentioning

confidence: 99%

Impact of Imitation Processes on the Effectiveness of Ring Vaccination

et al. 2011

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“…It is commonplace to read of transplants, reconstructive surgery, breakthroughs in treatments and accessibility of care. The prevailing climate can be interpreted by the layman as the omnipotence of medicine (8,9). In addition, the Patient's Charter makes the point that the confidence is timely and high quality treatment are a perfectly reasonable expectation of a citizen of the United Kingdom.…”

Section: The Casualty Factormentioning

confidence: 99%

Trauma Management on the Battlefield: A Modern Approach

Hawley

1996

J R Army Med Corps

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With the development of British Army doctrine it is necessary to review the concepts underlying medical support to the modern battlefield. In particular, the provision of timely and balanced resuscitation to the high intensity battle is an issue requiring an understanding of both the tactical and the clinical demands. The wholesale application of civilian techniques and approaches to trauma management is not possible given the austerity of the battlefield clinical environment. The commitment to excellence and quality of care implicit in modern mainstream practice is of continuing relevance to the battlefield. A doctrinal approach involving the definition of desired clinical outcome and the constraints of operational feasibility, is proposed. Specifically, the introduction of a triad approach to trauma management is offered. The triad comprises readily available Battlefield Advanced Trauma Life Support (BATLS) skills, Surgical Resuscitation deployed forward and the provision of Field Intensive Care. Such an approach would marry together the clinically ideal with the tactically.

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“…To address the latter issue, the U.S.A. has an established stockpile of vaccinia virus available for vaccination and a series of guidelines for mass vaccination in the event of an outbreak [5, 6]. Despite the efficacy to induce effective immunity against the far more pathogenic smallpox variola virus by both the current Dryvax formulation derived from the New York City Board of Health vaccinia strain [7] and by the Lister strain used for the global eradication program [8], adverse reactions following vaccinia immunization have been noted. These may be life-threatening and include inadvertent inoculation, ocular or generalized vaccinia, eczema vaccinatum, progressive vaccinia and post-vaccinial encephalitis [9].…”

Section: Introductionmentioning

confidence: 99%

The heterogeneity of human antibody responses to vaccinia virus revealed through use of focused protein arrays

Duke‐Cohan

Wollenick

Witten

et al. 2009

Vaccine

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The renewed interest in strategies to combat infectious agents with epidemic potential has led to a re-examination of vaccination protocols against smallpox. To help define which antigens elucidate a human antibody response, we have targeted proteins known or predicted to be presented on the surface of the intracellular mature virion (IMV) or the extracellular enveloped virion (EEV). The predicted ectodomains were expressed in a mammalian in vitro coupled transcription/translation reaction using tRNA lys precharged with lysine-ε-biotin followed by solid phase immobilization on 384 well neutravidin-coated plates. The generated array is highly specific and sensitive in a microELISA format. By comparison of binding of vaccinia-immune sera to the reticulocyte lysateproduced proteins and to secreted post-translationally-modified proteins, we demonstrate that for several proteins including the EEV proteins B5 and A33, proper recognition is dependent upon appropriate folding, with little dependence upon glycosylation per se. We further demonstrate that the humoral immune response to vaccinia among different individuals is not uniform in specificity or strength, as different IMV and EEV targets predominate within the group of immunogenic proteins. This heterogeneity likely results from the diversity of HLA Class II alleles and CD4 T helper cell epitopes stimulating B cell antibody production. Our findings have important implications both for design of new recombinant subunit vaccines as well as for methods of assaying the human antibody response utilizing recombinant proteins produced in vitro.

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The global eradication of smallpox

Cited by 143 publications

References 8 publications

Impact of Imitation Processes on the Effectiveness of Ring Vaccination

Impact of Imitation Processes on the Effectiveness of Ring Vaccination

Trauma Management on the Battlefield: A Modern Approach

The heterogeneity of human antibody responses to vaccinia virus revealed through use of focused protein arrays

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