A STUDY OF INTRAFAMILIAL TRANSMISSION OF SMALLPOX1

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Abstract
Heiner, G. G. (Institute of International Medicine, Univ. of Maryland School of Medicine, Baltimore, Md. 21201), N. Fatima and F. R. McCrumb, Jr. A study of intrafamilial transmission of smallpox. Amer J Epidem 94: 316–326, 1971.—An epidemiologic study was conducted among the 464 family contacts of the first cases in 47 smallpox outbreaks in rural West Pakistan during the period 1968–1970. Secondary attack rates were 70.3% in unvaccinated and 4.8% in previously vaccinated contacts, with an overall rate of 19.6%. Variations in attack rates were significantly associated with differences in pre-exposure vaccination status of the contact, in exposure patterns and in age, vaccination status, and severity of illness of the index case. Previously vaccinated secondary cases experienced reduced mortality and morbidity. Results indicate that, under the conditions of intimate exposure of a village compound, the majority of contacts become infected, and that the development of overt disease in previously vaccinated contacts depends both upon the level of immunity of the contact and upon the intensity of the virus challenge.

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