Smallpox and Smallpox Vaccination

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Abstract
In the January 30 issue, a laudable attempt was made to come to grips with the many issues surrounding terrorist use of variola. An essential point remains unclear, however. How easily is variola transmitted? In the model of Bozzette et al.,1 no control measures are taken until 26 days after the initial infection, 11 days after the expected development of rash. Mack,2 however, argues persuasively that secondary spread takes place only after the characteristic rash is evident; thus, all infection takes place during those 11 days. Once the rash is evident, I presume that control procedures would be rapidly instituted, particularly in our era of heightened awareness and instantaneous transcontinental communication. This would decrease the number of days after the initial infection (T) in the model of Bozzette et al. to a number closer to 16 days and would drastically reduce the number of deaths expected from a smallpox attack predicted by their model. Can these views be reconciled?

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