Analyzing bioterror response logistics: the case of smallpox

被引:69
作者
Kaplan, EH
Craft, DL
Wein, LM
机构
[1] Yale Univ, Sch Med, Yale Sch Managment, New Haven, CT 06520 USA
[2] Yale Univ, Sch Med, Dept Epidemiol & Publ Hlth, New Haven, CT 06520 USA
[3] MIT, Ctr Operat Res, Cambridge, MA 02139 USA
[4] Stanford Univ, Grad Sch Business, Stanford, CA 94305 USA
关键词
bioterror response logistics; contact tracing; queueing; traced vaccination; mass vaccination; smallpox;
D O I
10.1016/S0025-5564(03)00090-7
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
To evaluate existing and alternative proposals for emergency response to a deliberate smallpox attack, we embed the key operational features of such interventions into a smallpox disease transmission model. We use probabilistic reasoning within an otherwise deterministic epidemic framework to model the 'race to trace', i.e., attempting to trace (via the infector) and vaccinate an infected person while (s)he is still vaccine-sensitive. Our model explicitly incorporates a tracing/vaccination queue, and hence can be used as a capacity planning tool. An approximate analysis of this large (16 ODE) system yields closed-form estimates for the total number of deaths and the maximum queue length. The former estimate delineates the efficacy (i.e., accuracy) and efficiency (i.e., speed) of contact tracing, while the latter estimate reveals how congestion makes the race to trace more difficult to win, thereby causing more deaths. A probabilistic analysis is also used to find an approximate closed-form expression for the total number of deaths under mass vaccination, in terms of both the basic reproductive ratio and the vaccination capacity. We also derive approximate thresholds for initially controlling the epidemic for more general interventions that include imperfect vaccination and quarantine. (C) 2003 Elsevier Inc. All rights reserved.
引用
收藏
页码:33 / 72
页数:40
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