EPIDEMIOLOGY OF SMALLPOX IN WEST PAKISTAN

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Abstract
Mack, T. M. (Harvard Univ. Sch. of Public Health, Boston, Mass. 02115), D. B. Thomas and M. M. Khan. Epidemiology of smallpox in West Pakistan. II. Determinants of intravillage spread other than acquired immunity. Am J Epidemiol 95: 169–177, 1972.–The outbreaks resulting from 121 identifiable village introductions of variola major within a Punjabi district during a 12-month period were studied. Cases resulting from spread within and between compounds were separately analyzed. Transmission appeared to take place in the home of the transmitter, and the high relative risk among older children was attributed to their propensity for visiting other compounds. Although sociologic determinants of spread between compounds were demonstrated, the most important identifiable determinant of propagation was the severity of the transmitter case. Seasonal variation in incidence was mostly due to transmission within the village, and was attributed at least in part to seasonal variation in the ambient survival time of emitted virus. In light of these findings, primary vaccinations, resulting in the prevention of severe cases, are felt to deserve high priority compared with revaccina-tions. It is suggested that emphasis in outbreak control be placed on isolation of infected houses from visitors rather than on restrictions upon the movements of identified contacts.

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