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Report on infectious diseases 2002. Scaling up the response to infectious diseases. A way out of poverty.
Geneva, Switzerland, WHO, 2002. 101,  p.In December 2001, the Commission on Macroeconomics and Health presented the results of its two-year work to the World Health Organization in a publication titled Macroeconomics and Health: Investing in Health for Economic Development. The Commissioners present a new global blueprint for health that is both compassionate and cost-effective. Millions of deaths occur each year in the developing world due to conditions which can be prevented or treated. The Commissioner's outline a plan of action to save millions of these lives every year at a small cost relative to the vast improvements in health and increased prosperity. The Report shows that just a few conditions are responsible for a high proportion of the avoidable deaths in poor countries — and that well-targeted measures, using existing technologies, could save around 8 million lives per year and generate economic benefits of more than $360 billion per year, by 2015–2020. The aggregate cost of scaling up essential health interventions in low-income countries would be around $66 billion per year, with the costs roughly divided between high income donor countries and low-income countries. Thus, the economic benefits would vastly outstrip the cost. Scaling Up the Response to Infectious Diseases: A way Out of Poverty takes up the Commission's challenge. It outlines how increased investment in health can be well spent, stressing how interventions, health system strengthening and behaviour change together can help achieve the goals we are setting ourselves. This report takes forward the Commission's action agenda. It will help decision makers see how we can turn increased investment in health into concrete results. (excerpt)
CARIBBEAN HEALTH. 1999 Oct; 2(3):9-11.The Directing Council of Pan American Health Organization approved a resolution concerning the formal inauguration of the Expanded Programme on Immunization (EPI) in the Americas in October 1977. Subsequently, the EPI entered full implementation in those countries that were members of the Caribbean Epidemiology Center (CAREC) during 1978-80. All 19 CAREC Member Countries (CMC) were conducting routine immunization with diphtheria, pertussis, tetanus, poliomyelitis, measles and BCG vaccines by 1980. The establishment of the program in these countries resulted in focused activities, including training and the development of operational guidelines. Health education has been primarily used to encourage mothers to have their children vaccinated at optimum age, and to advise parents and guardians about adverse reaction to vaccines. Great efforts have been made in immunization coverage in all the CMCs for the six vaccine preventable diseases. The eradication of poliomyelitis, the interruption of measles transmission (8 years measles-free), and the implementation of strategies for the elimination of rubella and CRS have presented many challenges to public health practitioners in the region. The success of all these initiatives is a reflection of the deep commitment and strong partnerships, which have been developed between the governments, health practitioners, and people of the region. Moreover, technical and financial support from both international agencies and service clubs played a major role in the success of the program.
WORLD HEALTH FORUM. 1992; 13(4):356-62.The article examines the rationale for establishing national health technology assessment programs, offers a structure for such programs, discusses the phases of assessment, and outlines how they might be conducted. The transfer of health technologies from developed to developing countries has often been disappointing, mostly because of failure to recognize factors or other deficiencies in advance. In one country in the Americas it was discovered that 44% of the technological research institutions did not have a maintenance engineer or technician. In North America, Western Europe, and Japan, noncommunicable diseases are more prevalent than communicable diseases as causes of mortality, whereas in the developing world the reverse is true. In the developing world more emphasis on disease control is desirable and could prove economically beneficial in the long run. For many illnesses, life- saving treatment costs twice as much per patient as do individual preventive measures. In developing countries there are seldom adequate funds for the creation of a separate entity for health technology. However, by relying on personnel and material resources already present in government and private institutions, a national program for health technology can be established. The creation of a clearing-house is also essential for information on both the state of the national health system and the use of technology. The data collected by the technology planning group is compiled. A procedure is needed for obtaining information from care sites and research institutions. Information is shared with other governments through the setting up of a regional clearing-house. Once the structure and mechanism for health technology assessment are in place, and basic information on the status of the national health system has been gathered, individual health technologies can be assessed. The cost of operating and maintaining equipment is often much higher in developing countries than in the industrialized world.
Mortality and health issues in Asia and the Pacific: report of a seminar held at Beijing in collaboration with the Institute of Population Research, People's University of China from 22 to 27 October 1986.
New York, New York, United Nations, 1987. vi, 169 p. (Asian Population Studies Series No. 78.; ST/ESCAP/485.)The Seminar on Mortality and Health Issues was held at Beijing from 22 to 27 October 1986 as a cooperative venture between the UN Economic and Social Commission for Asia and the Pacific (ESCAP) and the Institute of Population Research, People's University of China, as part of the project, "Analysis of Trends and Patterns of Mortality in the ESCAP Region." Part 1 of the report includes a summary of the Beijing recommendations on health and mortality and the report of the seminar. Part 2 contains papers on a comparative analysis on trends and patterns of mortality in the ESCAP region, an overview of the epidemiological situation in the region, health for all by the year 2000, and inequalities in health.
BULLETIN OF THE PAN AMERICAN HEALTH ORGANIZATION. 1984; 18(2):188-92.Outbreaks of yellow fever in recent years in the Americas have prompted concern about the possible urbanization of jungle fever. Vaccination, using the 17D strain of yellow fever virus, provides an effective, practical method of large scale protection against the disease. Because yellow fever can reappear in certain areas after a 2-year dormancy period, some countries maintain routine vaccination programs in areas where jungle yellow fever is endemic. The size of the endemic area (approximately half of South America), transportation and communication difficulties, and the inability to ensure a reliable cold chain are problems facing these programs. In addition, the problem of reaching dispersed and isolated populations has been addressed by the use of mobile teams, radio monitoring, and educational methods. During yellow fever outbreaks, many countries institute massive vaccination campaigns, targeted at temporary workers and migrants. Because epidemics in South America may involve extensive areas, these campaigns may not effectively address the problem. The ped-o-jet injector method, used in Brazil and Colombia, should be used in outbreak situations, as it is effective for large-scale vaccination. Vaccine by needle, suggested for maintenance programs, should be administered to those above 1 year of age. An efficient monitoring method to avoid revaccination, and to assess immunity, should be developed. The 17D strain produces seroconversion in 95% of recipients, and most is prepared in Brazil and Colombia. But, problems with storage methods, instability in seed lots, and difficulties in large-scale production were identified in 1981 by the Pan American Health Organization and WHO. The group recommended modernization of current production techniques and further research to develop a vaccine that could be produced in cell cultures. Brazil and Colombia have acted on these recommendations, modernizing vaccine production and researching thermostabilizing media for yellow fever vaccine.
WORLD HEALTH. 1988 Mar; 4-8.A global epidemic was well under way by the time acquired immune deficiency syndrome (AIDS) was recognized and named in 1981. The epidemic may be considered 3 intertwined global epidemics, the 1st being the epidemic of infection with the AIDS virus itself, human immunodeficiency virus (HIV), starting in the mid- to late 1970s. The 2nd epidemic is the disease of AIDS, which follows HIV infection with a delay of several years. The 3rd epidemic is the social, political, and cultural reaction to HIV infection and AIDS. The 3 epidemics constitute a worldwide emergency. In response, WHO's Global Program on AIDS (GPA) has designed a plan based on the concepts that enough is known of AIDS to stop its spread; education is the key to prevention and control; AIDS control requires a longterm commitment; AIDS prevention and control must be integrated into national systems; both national AIDS programs and strong international leadership, coordination, and cooperation are required. The GPA plan has 3 objectives: to prevent HIV transmission, to care for AIDS victims, and to unify national and international efforts against AIDS. National programs are being established rapidly throughout the world with collaboration of the GPA. The ultimate scope of the AIDS epidemic cannot be predicted, but action is necessary now to meet the challenge.
[Acquired immunodeficiency syndrome (AIDS): WHO meeting and consultation on the safety of blood and blood products] Syndrome d'immunodeficit acquis (SIDA): reunion et consultation de l'OMS sur la securite du sang et des produits sanguins.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1986 May; 61(18):138-40.The World Health Organization (WHO) convened a meeting of experts on April 14-16, 1986, to review the available information on the safety of blood and blood products in relation to acquired immunodeficiency syndrome (AIDS). It was attended by over 100 participants from 34 countries and followed by a consultation which took into consideration previous recommendations, new information, and many different circumstances which exist regarding AIDS at the global level. This discussion reports the main conclusions and recommendations of the consultation. Tests to detect antibody to the AIDS virus now are available to assist in the elimination of potentially infectious units of blood and plasma, yet it is important to recognize that information and education remain crucial elements in any AIDS prevention program and that they continue to be relevant to the safety of blood and blood products. In that respect, measures to limit the transmission of LAV/HTLV-III by whatever means will be most effective in communities which are as well informed as possible about the disease, how it is transmitted, and how donors can assist in assuring a safe blood supply by being alert to donor suitability criteria. In some countries risk factors for AIDS have been identified in homosexual and bisexual men, intravenous drug abusers, and their sexual partners. Self-exclusion systems in which persons with risk factors refrain from giving blood, and blood screening programs for virus antibody have been effective in contributing to a safe blood supply. Experience also has shown that frequently when persons infected with the AIDS virus have donated blood, risk factors could later be identified, but many of those donors may not have recognized or acknowledged that they carried a risk. The value of specific screening and control measures which have been found useful in many developed countries should be assessed by other countries in the context of their overall health programs and the availability of human and material resources. Well-accepted general principles concerning the use of blood and blood products need to be emphasized since they can contribute to the control of AIDS. The most important principles are: strategies of health services such as improved antenatal care can reduce the demand for blood and should be encouraged; when appropriate and safer components and derivatives can be produced and are available, they are preferable to whole blood or plasma; and whole blood or plasma should be transfused only when medically justified. Decisions to institute laboratory screening of donors should be made with full awareness that there are several essential components of such a program. Information and education for donors about AIDS, its risk factors, and blood transmission is one of the basic considerations. Exclusion based on a current history of possible exposures to known risk factors as well as symptoms can help to reduce the number of infected donors.
WORLD HEALTH. 1987 Aug-Sep; 8-11.The implications of the fact that it was concerted global effort that eradicated smallpox are discussed. The primary reason why the effort succeeded is that specific measurable goals and time deadlines were built in. The 10-year goal was met in 9 years 9 months 26 days. Universal political commitment, including provision of funds by WHO and by constituent countries, was required. A strategy of 80% vaccination and surveillance and containment of outbreaks, followed by certification of eradication, was adhered to. Whether the smallpox campaign could be used as a template for eradicating other diseases is discussed. The biology of smallpox makes it a unique candidate for eradication, while no other disease shares all of its qualifications, such as having only a human host. Lessons have been learned for control of other diseases, however. With regard to the concept of primary health care for all, the smallpox effort showed that finite, specific programs are better supported than basic health services. The eradication demonstrated the power of good leadership and common goals supported by an international institution.
WORLD HEALTH. 1987 Aug-Sep; 18-21.The possibility that smallpox could be released to infect the world again is considered from the viewpoint of theoretical situations as well as the mechanisms in place to keep the virus out of circulation. Theoretically, smallpox could be stolen from a laboratory, found unknowingly in a lab freezer, manufactured for biological warfare, newly generated by mutation from another virus, emerge from the environment, or be reactivated from the system of a former victim. Laboratory sources have all been destroyed, except for cloned DNA kept in Atlanta and Moscow, which without the virus coat cannot be transmitted. There is no animal reservoir of a virus similar to smallpox. Smallpox is a type of DNA virus that has never been known to be reactivated from people who had the disease. After the publication of the Global Commission for the Certification of Smallpox Eradication in 1979, the WHO maintains an International Rumor Register in Geneva to investigate possible cases of smallpox. All suspected cases have been either chickenpox or measles. There were 2 cases in Britain in 1978 due to a laboratory accident, and 3 incidents of unwitting storage of virus in laboratory freezers. These stocks were immediately destroyed, and it is decreasingly likely that more smallpox virus will be found.
PUBLIC HEALTH REPORTS. 1980 Sep-Oct; 95(5):422-6.The implications of the eradication of smallpox in the context of epidemiology are presented. Eradication of disease has been conceived since the 1st smallpox vaccination was developed in the 18th century. Since then, attempts to eradicate yellow fever, malaria, yaws and smallpox have been instituted. Most public health professionals have been rightfully skeptical. Indeed, the success with smallpox was fortuitous and achieved only by a narrow margin. It is unlikely that any other disease will be eradicated, lacking the perfect epidemiological characteristics and affordable technology. The key to success with smallpox was the principle of surveillance. This concept has a vigorous developmental history in the discipline of epidemiology, derived from the work of Langmuir and Farr. It involves meticulous data collection, analysis, appropriate action and evaluation. In the case of smallpox, only these techniques permitted the key observations that smallpox vaccination was remarkably durable, and that effective reporting was fundamental for success. The currently popular goal of health for all, through horizontal programs, is contrary to the methods of epidemiology because its objective is vague and meaningless, no specific management structure is envisioned, and no system of surveillance and assessment is in place.
SCIENTIFIC AMERICAN. 1976 Oct; 235(4):25-33.The key events in the eradication of smallpox worldwide are related. Smallpox virus was spread by droplets, only from the appearance of the rash until scabs form, 4 weeks later. It only infected humans, making it a potential disease for eradication. It had been endemic in populous areas, largely China and India in ancient times, appearing in Europe in the 6th century and in America in 1520. Smallpox vaccination was known as variolation before the modern practice of vaccination with cowpox (Vaccinia) was demonstrated in 1796. Success of the 10 year long world eradication campaign depended on production of heat-stable vaccines and a reusable pronged needle that used little material. The U.S.S.R. suggested the campaign in 1959, but the current campaign began in 1976. The 1st strategy was intensive vaccination, with moderate success. Subsequent strategies involved surveillance and containment, along with improved reporting methods. The concept of an infected village was introduced, and house to house searches were instituted. Victims were put under guard and all villagers were vaccinated. The last case of virulent smallpox occurred in Bangladesh in October 1975, and of mild smallpox in Ethiopia in August 1976. The cost of the entire 10-year global eradication was $83 million for foreign assistance, and about $160 million spent by the individual countries. This is small compared to an estimated $2 billion yearly spent to control smallpox. It is ironic that smallpox became an epidemic pestilence upon the growth of populations, yet it played a major role in preventing population growth until variolation and vaccination became common.
NATIONAL GEOGRAPHIC. 1978 Dec; 154(6):796-805.The story of the defeat of smallpox is told from the end back to high points in the effort. In April 1979, the case of the last natural victim of smallpox, a Somalian cook, was documented. Unfortunately there were 2 subsequent cases, due to laboratory exposure in Birmingham, England. The more severe Asian strain killed 20-30% of persons it attacked, and left the survivors scarred and sometimes blinded. A concerted world effort to eradicate smallpox, rather than merely control it, began with WHO in 1959, but succeeded with the WHO campaign instigated in 1966. In 1966 there were 44 countries with uncontrolled smallpox. The number fell to 19 nations in 1972, 5 in 1975, and none in 1978. Asian smallpox was contained in 1976, leaving only variola minor endemic in Ethiopia and Somalia. The 1st plan was mass vaccination. After a shortage of supplies in Nigeria, the strategy of surveillance and containment was found to be far superior and cost effective. In this technique, suspected cases were quarantined under guard, while all contacts and everyone within a 5-mile radius were vaccinated. New stable vaccines and a special needle that saved vaccine material permitted field workers to vaccinate inaccessible populations. Workers used charm, guile, shame or intimidation to get universal cooperation. This feat in world-wide teamwork, creative problem-solving and heroic leadership under severe odds and admonitions of the experts demonstrated that the chain of transmission of a dread disease could be broken.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1985; 63(2):241-8.The WHO memorandum outlines the present situation regarding pertussis vaccines, discusses ways to evaluate candidate vaccines, and identifies future research needs. Most existing whooping cough vaccines are whole-cell vaccines, combined with diphtheria and tetanus toxoid adsorbed on an aluminum or calcium carrier. As whole bacterial cells, they contain a complex array of at least 7 toxins and antigens, and display a narrow margin between potency and toxicity. The Japanese introduced an acellular vaccine, admittedly sometimes less potent, called the Precipitated Purified Pertussis Vaccine, in 1981. This material contains far less bacterial mass, notably less endotoxin, and consequently produces less fever, erythema and induration. WHO has not yet established minimum requirements for standardization; even the mouse potency assay may not be suitable. There are techniques, however, which will measure amounts of component antigens and toxicity. Conflicting results on assays of potency and immunogenicity will have to be resolved. Besides the obvious need for large clinical trials of defined vaccines, a whole range of research needs were suggested, from genetic studies of the organism to specific details of the host response. It is generally agreed that a less reactogenic and more effective pertussis vaccine is needed and feasible.
BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1975; 52(2):209-22.The history of smallpox eradication in the 20 countries of West and Central Africa from Mauritania to Zaire is recounted, including background, evolution of strategy, assessment, maintenance, costs, and significance of the campaign. Smallpox was endemic in these countries, peaking each year at the end of the spring dry season, usually occurring in isolated villages only periodically. The average case fatality was 14.5%, but twice as high in infants and older adults. Clinical exams showed that those with actual vaccination scars rarely got smallpox. The campaign was made feasible because of lyophilized heat-stable vaccine and bifurcated needles or jet injectors. The initial strategy called for mass vaccination and assessment of achieved vaccination. Between 1967 and 1969 100 million persons were vaccinated at collecting points; by 1972, 28 million more children had been protected. In 1966 an outbreak of 34 cases in Nigeria was blocked within 3 weeks of initiation of surveillance and containment. This effort also demonstrated that actual smallpox transmission was slow and relatively ineffective, and further that vaccination of contacts even after exposure was effective. The strategy was replaced by surveillance-containment begun in the seasonal low. The results were that smallpox disappeared within 5 months in an area of 12 million, and within 1 year in 19 of the 20 countries. Maintenance vaccination to prevent importation of the virus is continuing. The cost of the program was $15 million to the U.S. sponsors, or 1/10 the yearly price of smallpox control in the U.S.
In: Quest for the killers, [by] June Goodfield. Boston, Massachusetts, Birkhauser, 1985. 191-244. (Pro Scientia Viva Title)This article relates the final phase of the campaign to eradicate smallpox from Bangladesh in the early 1970s under the leadership of Donald Henderson. The article is based on informal interviews with many of the participants in this campaign who shared their recollections of the drama and problems of these years. Bangladesh was the last country in the world to be free of smallpox. In retrospect, those involved in the campaign agreed that an unfortunate defect of the campaign was that the rapid importation of international advisors did not allow the slow build-up of national staffs. If was not a developmental effort, and organizers were forced to initiate activities that could not be sustained. On the other hand, the campaign's success achieved a number of very important ends over and above the eradication of a disease. It particularly boosted the authority of health ministries in Bangladesh and contributed to the society's understanding of disease control. The episodes in this campaign are a moving testimony to the power of international cooperation.
DEVELOPMENT FORUM. 1987 Mar; 15(2):1, 6.The author presents arguments to refute what he considers alarmist, unsupported generalizations about the origin and soread of AIDS (acquired immune deficiency syndrome) in Africa. The first myth is that AIDS originated in Africa, after a green monkey bit a man. There is no concrete evidence to support this theory. Moreover, if it were true, AIDS would have been known for years; there would be effective herbal remedies and folk traditions about the danger of green monkey bites. The syndrome is so distinctive, for example the oral candidiasis and striking wasting disease, called "slim" disease, that it would have been recognized long ago. Finally, numbers of cases have peaked in America first, a few years ago, and are now beginning to surge in some areas of Africa. A second myth is that countries are not reporting cases out of embarrassment. The author claims that reports to the WHO show far more cases of AIDS in the U.S. and Europe, and even if the 1000 cases in Africa as of 1986 were 1000-fold underestimated, they would be nowhere near the 5 or 10 million often printed. The third myth, that AIDS is out of control in Africa, is unsupported when the efforts of countries like Uganda are considered. Uganda has an extensive media campaign, significant funds relegated to fighting AIDS, foreign experts called in, blood testing equipment on order and in use in 2 hospitals. AIDS is only a problem in a few urban areas.
[Expanded Programme on Immunization: stability of freeze dried measles vaccine] Programme Elargi de Vaccination: stabilite du vaccin antirougeoleux lyophilise.
Weekly Epidemiological Record / Releve Epidemiologique Hebdomadaire. 1981 Jun 12; 56(23):177-9.This report brings up to date those data summarized previously regarding the stability of freeze-dried measles vaccine and is based on information obtained from the London School of Hygiene and Tropical Medicine. The World Health Organization (WHO) intends to establish a requirement for the stability of freeze-dried measles vaccine, and a draft of such a requirement is represented along with an analysis of how such a requirement would influence WHO acceptance of the vaccine included in this report. A plaque assay method was used to determine the potency of measles vaccine which had been stored in a freeze-dried state at 37 degrees Centigrade for varying intervals. Vaccine containers were exposed at 37 degrees Centigrade in a water bath and duplicate samples transferred to -70 degrees Centigrade at intervals ranging from 1 to 28 days. The residual infectious virus was determined by the plaque assay method in parallel with vaccine that had not been incubated. The results from 16 patches produced by 9 manufacturers are summarized in a table, which includes recent data a well as the results from the previous report. 2 criteria of stability are included: the number of days required for the live virus titer to drop to an acceptable minimum level when stored at 37 degrees Centigrade (Criterion 1); and the loss of live virus titer when stored for 7 days at 37 degrees Centigrade (Criterion 2). Neither criterion is sufficient on its own. A quite unstable vaccine might still have the required potency after being stored for a week at 37 degrees Centigrade if the vaccine had a high virus titer initially. Yet, a product with satisfactory stability might still fail the potency requirement if its initial virus titer was borderline. A figure shows how the vaccines would be rated according to the proposed requirements. The proposed requirement for the stability of freeze-dried measles vaccine will be presented to the Expert Committee on Biological Standardization during its meeting in September 1981. If accepted, it would become effective by March 1982.
Geneva, Switzerland, WHO, 1985. 110 p.3 World Health Organization (WHO) Scientific Groups have examined different technical aspects of the problem of sexually transmitted diseases and their reports have been published in the Technical Report Series. This book has been prepared following the meeting of a scientific working group that was held in Washington in April 1982 to discuss the formulation of appropriate strategies and programs for the control of this group of diseases. This book emphasizes the need for such programs to be integrated into general programs for the control of communicable diseases and for the gynecologcal, obstetric, pediatric, and urological services to play an active and dynamic part. A control activity for sexually transmitted diseases is any activity which minimizes the adverse health effects of this group of diseases. Control activities may reduce the incidence of the disease; the duration of the disease; the effects of each case, including both the physical complications and psychosocial consequences; or the cost of achieving certain outcomes, i.e., increase the efficiency of services. Many different control activities, for example, clinical services, screening, and contact tracing, can reduce the effects of sexually transmitted diseases. A control program is composed of various control activities. Priorities are established, various options for control are examined, and appropriate methods are adopted. Control programs for sexually transmitted diseases define the population to be covered and specify the control activities related to that group. The 1st section of this book covers initial planning steps, focusing on estimating the public health importance of sexually transmitted diseases, priority groups, and sociological aspects of control. The section devoted to intervention strategies deals with health promotion, disease detection, national treatment programs, contact tracing and patient counseling, and clinical services. The 4 chapters that make up the support components section discuss centers for prevention of sexually transmitted diseases, information systems, professional training, and laboratory services. The 2 chapters devoted to implementation examine program management and evaluation of control programs. This book may appear to suggest that the disease control process should be highly systematic, comprehensive, and compartmentalized. Yet, in practice, many activities take place simultaneously and in a manner that is far from systematic, sequential, and ordered.
Chronicles. 1983 Jun; 3(1):5-6.Explores the factors leading to the world-wide eradication of smallpox through immunization. At one time, smallpox was one of the most feared diseases. About 1 of every 4 victims died and many survivors were left blind or permanently scarred. In the late 19th century, a mild strain of the disease developed which had all the characteristics of the more prevalent type, but killed less than 1 out of every 100 victims. In 1796, Edward Jenner discovered that deliberate infection with a relatively mild virus, cowpox, could make people immune to smallpox. His discovery provided the 1st truly safe, effective control measure. In the early 1950's, a freeze-dried smallpox vaccine was developed which made it possible to carry the vaccine throughout the world. The World Health Organization (WHO) adopted a resolution in 1966 calling for the eradication of the disease within 10 years. At the time, 44 countries still had smallpox and it was endemic in 33 of them. The smallpox eradication program began in Jan. 1967. Its main strategy was to mass vaccinate populations in the remaining endemic countries to raise the proportion of immune persons to about 80 or 90%. Jet injectors were used which allowed 1 person to vaccinate up to 1000 persons per hour. During the program, discoveries reduced the target population to less than 5%. And in 1968, a new needle was developed which gave excellent vaccinations, was easily sterilized, inexpensive, required no maintenence or spare parts, and allowed health workers to be trained in only a few minutes, unlike the jet injectors. These bifurcated needles helped in the new surveillance-containment strategy. Smallpox began to be eradicated in some of the zones that had been designated as containing the most highly endemic countries in the world. There were some setbacks along the way, but finally, in Oct. 1977, East Africa and the world were freed of the disease. (summaries in SPA, POR, ARA)
REVIEWS OF INFECTIOUS DISEASES. 1983 May-Jun; 5(3):546-53.Control of measles in tropical Africa has been attempted since 1966 in 2 large programs; recent evaluation studies have pinpointed obstacles specific to this area. Measles epidemics occur cyclically with annual peaks in dry season, killing 3-5% of children, contributing to 10% of childhood mortality, or more in malnourished populations. The 1st large control effort was the 20-country program begun in 1966. This effort eradicated measles in The Gambia, but measles recurred to previous levels within months in other areas. The Expanded Programme on Immunization initiated by WHO in 1978 also included operational research, technical assistance, cooperation with other groups such as USAID, and development of permanent national programs. Cooperative research has shown that the optimum age of immunization is 9 months, and that health centers are more efficient at immunization, but mobile teams are more cost-effective as coverage approaches 100%. 53 evaluation surveys have been done in 17 African countries on measles immunization programs. Some of the obstacles found were: rural population, underdevelopment of infrastructure, and exposure of unprotected infants contributing to the spread of measles. Measles surveillance is so poor that less than 10% of expected cases are reported. People are apathetic or unaware of the importance of immunization against this universal childhood disease. Vaccine quality is a serious problem, both from the lack of an adequate cold chain, and lack of facilities for testing vaccine. The future impact of measles control from the viewpoint of population growth and health of children offers many fine points for discussion.