Background:An infectious disease outbreak such as smallpox would have disastrous outcomes for the United States. Smallpox is highly contagious, with 30% fatality rate. Although 23% of the US population live in rural areas and 97% of the US landmass is classified as a rural area, rural populations are extremely vulnerable with limited medical and emergency resources. Having no hospital, only two EMS vehicles, other limitations to resources and being surrounded by four cities of high population, Clay County,NC is the geographical location chosen to model a smallpox outbreak.

Objectives:This study aims to address the need for the development of a mitigation plan in the case of a smallpox outbreak in a rural area of the US. We will present various scenarios of an outbreak and explain the effects of a smallpox epidemic to Clay County if no interventions were in place, and the how prevention and management implementation will positively affect the outcome.

Methods:Using Clay County as the area of study, we use compartmental modeling method based on ordinary differential equations. Numerical simulations show the possible impact to this rural area if no intervention is made. Furthermore, our simulation explains how the mortality rate decreases with various preventive measures.

Results:An optimal planning model will increase the effectiveness of an emergency response force, with the ability and reliability of resources in place. Using the simulation modeling, a preparation and management plan will decrease the morality rate, economic and social impacts to the population in the rural area of Clay County, NC.