Infectiousness of smallpox relative to disease age: estimates based on transmission network and incubation period.

This study investigated the infectiousness of smallpox relative to the onset of fever using a likelihood-based estimation procedure based on the observed transmission network (n=223) and on the distribution of the incubation period (n=379). Who-infected-whom information enabled us to back-calculate the infectiousness by disease age, employing a step function model for infectiousness. Frequency of secondary transmissions was highest between 3 and 6 days after onset of fever, yielding an expected daily frequency of 20.6% (95% CI 15.1-26.4) of the total number of secondary transmissions, which is consistent with previous observations. The estimated cumulative frequency suggests that 91.1% of secondary transmissions occurred up to 9 days after onset of fever. The proposed method appeared to be useful for diseases with an acute course of illness, where transmission was not hampered by depletion of susceptible contacts.