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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.
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1985; (728):1-113.This document represents the work of a World Health Organization (WHO) Expert Committee on the Control of Schistosomiasis which met in Geneva in 1984. Chapters in this volume focus on epidemiology, disease due to schistosomiasis, methods of control, progress in national control programs, and a strategy for morbidity control. At present, the aim is to control the morbidity due to schistosomiasis rather than to control its transmission. The simplicity of diagnostic techniques, the safety and ease of administering oral antischistosomal drugs, the use of snail control measures based on specific epidemiologic criteria, and precise methods of data collection and analysis mean that control activities can be adapted to suit any level of the health care delivery system. Drug treatment reduces the prevalence and intensity of infection, prevents or reduces pathologic manifestations in infected persons, and is generally the most cost-effective way of achieving schistosomiasis control. On the basis of the severity of schistosomiasis in the area, its priority rating as a public health problem, and available resources, those operational approaches most suited to a particular area should be identified. Active community participation is necessary to ensure that the maximum benefits are derived from chemotherapy. Maintenance of transmission control by the primary health care system, through monitoring of both parasitologic indexes and clinical signs and measurements, is essential. In most endemic areas, schoolchildren are regarded as the most appropriate target group for monitoring. The WHO Expert Committee has recommended that schistosomiasis control programs be integrated into primary health care and noted the need for greater administrative and managerial expertise in schistosomiasis control. Improvement in socioeconomic conditions in endemic areas provides the longterm solution to schistosomiasis control.