Transmission patterns of smallpox: systematic review of natural outbreaks in Europe and North America since World War II

Bhatnagar, Vibha; Stoto, Michael A.; Morton, Sally C.; Boer, Rob; Bozzette, Samuel A.
January 2006
BMC Public Health;2006, Vol. 6 Issue 1, p126
Academic Journal
Background: Because smallpox (variola major) may be used as a biological weapon, we reviewed outbreaks in post-World War II Europe and North America in order to understand smallpox transmission patterns. Methods: A systematic review was used to identify papers from the National Library of Medicine, Embase, Biosis, Cochrane Library, Defense Technical Information Center, WorldCat, and reference lists of included publications. Two authors reviewed selected papers for smallpox outbreaks. Results: 51 relevant outbreaks were identified from 1,389 publications. The median for the effective first generation reproduction rate (initial R) was 2 (range 0-38). The majority outbreaks were small (less than 5 cases) and contained within one generation. Outbreaks with few hospitalized patients had low initial R values (median of 1) and were prolonged if not initially recognized (median of 3 generations); outbreaks with mostly hospitalized patients had higher initial R values (median 12) and were shorter (median of 3 generations). Index cases with an atypical presentation of smallpox were less likely to have been diagnosed with smallpox; outbreaks in which the index case was not correctly diagnosed were larger (median of 27.5 cases) and longer (median of 3 generations) compared to outbreaks in which the index case was correctly diagnosed (median of 3 cases and 1 generation). Conclusion: Patterns of spread during Smallpox outbreaks varied with circumstances, but early detection and implementation of control measures is a most important influence on the magnitude of outbreaks. The majority of outbreaks studied in Europe and North America were controlled within a few generations if detected early.


Related Articles

  • World War II (Book Review). Gabel, Christopher R. // Journal of Military History;Jan2001, Vol. 65 Issue 1, p240 

    Reviews the book `World War II,' by Loyd E. Lee.

  • World War II (Book Review). Lee, Loyd E. // Journal of Military History;Jan2001, Vol. 65 Issue 1, p242 

    Reviews the book 'World War II: Variants and Visions,' edited by Thomas O. Kelly II.

  • Reviews: History. Otte // Book Report;Sep/Oct99, Vol. 18 Issue 2, p72 

    Reviews the book `World War II: A Student Companion,' by William O'Neill.

  • Book Reviews: Reference. Ellis, Mark E.; Hoffert, Barbara // Library Journal;3/1/1999, Vol. 124 Issue 4, p76 

    Reviews the book `World War II: An Encyclopedia of Quotations,' edited by Howard J. Langer.

  • Book reviews: Reference. Puffer, R.L. // Library Journal;2/1/1992, Vol. 117 Issue 2, p82 

    Reviews the book `World War II: America at War, 1941-1945,` by Norman Polmar and Thomas B. Allen.

  • Smallpox from the grave. Cole, Jack E.; M.O.R. // Cortlandt Forum;10/25/95, Vol. 8 Issue 10, p114 

    Determines whether smallpox virus can be transmitted from an exhumed or dead body. Safety in the assumption that smallpox had been eradicated.

  • Book Reviews. Spiller, Ronald L. // Journal of Military History;Oct99, Vol. 63 Issue 4, p1006 

    Reviews the book `World War II: A Student Companion,' by William O' Neill.

  • Book Reviews. Wells, Anne Sharp // Journal of Military History;Apr2000, Vol. 64 Issue 2, p594 

    Reviews the book `World War II: An Encyclopedia of Quotations,' compiled and edited by Howard J. Langer.

  • World War II Writings. Brier, Peter // Magill Book Reviews; 

    As war correspondent for The New Yorker, A. J. Liebling, one of the most gifted and influential American journalists of the twentieth century, left a matchless legacy.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics