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Geneva, Switzerland, WHO, 1999 May. 56 p. (WHO/CDS/CSR/ISR/99.1)These technical guidelines are part of a series developed by the Communicable Diseases Cluster (CDS) at the World Health Organization. The purpose of this series is to update current knowledge on diseases with epidemic potential, to help health officials detect and control outbreaks, and to strengthen the capacity for emergency response to an epidemic situation. These guidelines have been prepared jointly with the Health Technology and Pharmaceuticals Cluster (HTP). The contribution of the Government of Ireland to the production of this document is gratefully acknowledged. (excerpt)
The global eradication of smallpox. Final report of the Global Commission for the Certification of Smallpox Eradication, Geneva, December 1979.
Geneva, Switzerland, WHO, 1980. 122 p. (History of International Public Health No. 4)The Global Commission for the Certification of Smallpox Eradication met in December 1978 to review the program in detail and to advise on subsequent activities and met again in December 1979 to assess progress and to make the final recommendations that are presented in this report. Additionally, the report contains a summary account of the history of smallpox, the clinical, epidemiological, and virological features of the disease, the efforts to control and eradicate smallpox prior to 1966, and an account of the intensified program during the 1967-79 period. The report describes the procedures used for the certification of eradication along with the findings of 21 different international commissions that visited and reviewed programs in 61 countries. These findings provide the basis for the Commission's conclusion that the global eradication of smallpox has been achieved. The Commission also concluded that there is no evidence that smallpox will return as an endemic disease. The overall development and coordination of the intensified program were carried out by a smallpox unit established at the World Health Organization (WHO) headquarters in Geneva, which worked closely with WHO staff at regional offices and, through them, with national staff and WHO advisers at the country level. Earlier programs had been based on a mass vaccination strategy. The intensified campaign called for programs designed to vaccinate at least 80% of the population within a 2-3 year period. During this time, reporting systems and surveillance activities were to be developed that would permit detection and elimination of the remaining foci of the disease. Support was sought and obtained from many different governments and agencies. The progression of the eradication program can be divided into 3 phases: the period between 1967-72 when eradication was achieved in most African countries, Indonesia, and South America; the 1973-75 period when major efforts focused on the countries of the Indian subcontinent; and the 1975-77 period when the goal of eradication was realized in the Horn of Africa. Global Commission recommendations for WHO policy in the post-eradication era include: the discontinuation of smallpox vaccination; continuing surveillance of monkey pox in West and Central Africa; supervision of the stocks and use of variola virus in laboratories; a policy of insurance against the return of the disease that includes thorough investigation of reports of suspected smallpox; the maintenance of an international reserve of freeze-dried vaccine under WHO control; and measures designed to ensure that laboratory and epidemiological expertise in human poxvirus infections should not be dissipated.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1987; 65(4):425-34.Since May 1980 when the 33rd World Health Assembly declared the global eradication of smallpox, WHO has been developing a comprehensive system of surveillance aimed at maintaining the world permanently free from this disease. By 1984, all countries had ceased vaccinating the general public against smallpox, and had withdrawn the requirement for smallpox vaccination certificates from international travellers. A number of countries had also discontinued the vaccinating of military personnel. Until now WHO has maintained a stock of smallpox vaccine sufficient to vaccinate 300 million persons, but considering that 10 years have elapsed since the last endemic case of smallpox, maintenance of this reserve is no longer indicated. WHO continues to monitor rumors and coordinate the investigation of suspected cases, all of which have actually been misdiagnosed chickenpox or some other skin disease, or other errors in recording or reporting. Variola virus is now kept in only 2 WHO Collaborating Centers which possess high security containment laboratories. Since the variola virus gene pool has been cloned in bacterial plasmids which provide sufficient material to solve future research and diagnostic problems, there is no need to retain stocks of viable variola virus any longer. The results of a special program for the surveillance of human monkeypox have confirmed that the disease does not pose any significant health problem. In addition to testing human and animal specimens, WHO collaborating laboratories have made progress in the analysis of DNA of orthopoxviruses and in the development of reliable serological tests. (author's modified)
WHO CHRONICLE. 1982; 36(3):87-91.This article summarizes the major findings and recommendations of the Committee on Orthopoxvirus Infections, established by the World Health Assembly to advise on posteradication policy. Although smallpox has been eradicated, there remains a need for the monitoring of vaccination practices, investigation of rumored smallpox cases, verification of virus and vaccine storage conditions, and surveillance of the other orthopoxviruses, including monkeypox. Routine vaccination for smallpox has been officially discontinued in 150 of the 158 Member States and Associate Members of the World Health Organization (WHO); Egypt and Kuwait continue to immunize, while the present status of vaccination remains unknown in 6 other countries. WHO is taking further steps to encourage all countries to cease this practice and is contracting laboratories that continue to produce smallpox vaccine to request that they cease commercial vaccine distribution. Since 1979, 124 rumors of smallpox cases from 55 countries have been investigated, most of which were misdiagnosed cases of chickenpox, measles, and other skin diseases; none has been smallpox. At present, variola virus is being stored in 4 laboratories, 3 of which are WHO collaborating centers. WHO will continue to inspect these laboratories to ensure that requirements for containment are being met. Programs for the surveillance of human monkeypox in west and central Africa are being initiated, although present data indicate that this disease is not of public health importance. The total number of known cases of human monkeypox since 1970 stands at 63. Important studies for the postsmallpox surveillance program include the development of simple and reliable screening tests for orthopoxvirus antibody and of reliable tests for antibody specific to monkeypoxvirus. Plans are underway to publish a book dealing with all aspects of the smallpox eradication campaign.