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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.
CONTRACEPTION. 1980 Feb; 21(2):121-34.A 7-country WHO (World Health Organization) field trial on hormonal drugs for males administered either by daily pill or monthly injection, is being undertaken. The trials, being conducted in Hong Kong, Bangkok, London, Mexico City, Santiago, Seoul, and Toronto, provide an opportunity to assess acceptability and effects on sexuality of these new male contraceptives. The research uses repeated interviews over a 15-month period, conducted by social and biomedical scientists. The respondents are asked to compare their evaluation of the method with previously-used male or female methods and to indicate whether they feel the method modified or interfered with sexual desire, feelings, and/or performance. Methodology of the trials is explained. The hormones used, numbers of volunteers participating, and other factors important for each trial site are tabulated. Preliminary results are available from some of the trial sites The new method, either pill or injectable, was ranked highest as to acceptability, followed by vasectomy and condoms. Respondents favored self-administered, reversible methods. In fact, irreversibility was found to be the most negative feature of vasectomy, indicating that a reversible form of sterilization would be acceptable. Respondents in all trial sites favored 3-month injectables the most and permanent methods the least. Effectiveness and ease of use were important in a contraceptive.
In: Wood C, Rue Y, ed. Health policies in developing countries. London, England, The Royal Society of Medicine, 1980. 167-72. (Royal Society of Medicine. International Congress and Symposium Series; No. 24)Research is the tool which can help accelerate control of filariasis including the most important, river blindness and elephantiasis. The principles for control include eliminating the vectors and changing the way of life of the people. However these methods do not take into account the different ecologies of the land, cultures of the people and technical and political differences of the endemic areas. The WHO Onchocerciasis Control Program in the Volta Basin has been highly successful, but reinvasion of vectors is possible and there is concern that unacceptable levels of pollution will occur. Several successful limited programs of control are cited, but the absence of suitable drugs to kill the parasites is evident. One of the areas of research is centering on the characterization of the parasites and their vectors. More studies of isoenzyme markers are needed to distinguish different species of filarial parasites. An important advance in the diagnosis of filariasis has been the application of membrane filtration techniques for detecting light infection. Some of the current vector research is noted. This is particularly important because the main vectors of filariasis in Africa are also the main vectors of malaria. WHO is encouraged to stimulate collaborative research in this area. Chemotherapy is currently the most encouraging aspect of research. WHO is supporting 4 major centers where old and new filaricides are being evaluated. Some experiments are indicating the possibility that resistance to the disease can be stimulated by using irradiated larvae as appear in a cat model. Testing is now underway in a bovine onchocerciasis model. The new laboratory developments must continue so they can be applied clinically.
Alexandria, World Health Organization (WHO), Regional Office for the Eastern Mediterranean, 1980. 133 p.An assessment of health progress in the Eastern Mediterranean Region (EMR) is provided through narration and photographs. The renewed threat of malaria and efforts to control it are discussed. Other traditional diseases of the area examined in today's terms are schistosomiasis, cholera, tuberculosis, trachoma and smallpox. Modern health problems, including cancer, heart diseases, mental disorders and occupational hazards are explored. Environmental problems, or "the fall-outs of technology," are discussed, along with urban sprawl, water shortages, air and marine pollution and desertification. It is stressed that changing times demand changing attitudes towards the environment. Specific areas that need to be addressed, particularly food safety, are pointed out. WHO's work with EMR countries in health manpower development includes planning, educational development and support, and the actual training of individuals. The need for more health personnel is documented. Nursing as a profession in the EMR is discussed, as is its growth; 1 problem in education of nurses is the lack of textbooks in Arabic. The prospects of health for all by the year 2000 are discussed. The importance of using appropriate technology in providing primary health care is stressed. Family health and planning is examined, including child care priorities such as newborn care, the critical weaning period, and immunization. Current biomedical research in the EMR is discussed, including health services research, efforts for diarrhea and streptococcal infection control, drug utilization studies, tropical disease studies and the search for a malaria vaccine. MEDLINE, the regional health literature service, is described. Technical cooperation among the countries of the EMR is discussed. Profiles showing the population, medical manpower and health facilities of each country in the EMR are provided.
Advances in Planned Parenthood. 1980; 15(3):77-81.In 1977 the PPAN (Planned Parenthood Association of Nashville) began providing minilaparotomy sterilization services on an outpatient basis. The experience of 218 women who received sterilizations at the clinic between 1977-1979 indicated that it was feasible and safe to provide this service on an outpatient basis. The historical development of the program, the procedures and instruments used to perform the sterilizations, and the sterilization outcomes for the 218 patients were described. Prior to program initiation, the Medical and Executive Directors of PPAN attended a workshop on outpatient female sterilizations conducted by AVS (Association for Voluntary Sterilization) and the Planned Parenthood Federation of America. Subsequently a protocol for minilaparotomy sterilization was submitted to the National Medical Office of the Federation by the PPAN. The protocol was approved and the program was implemented. Based on the success of the 1st 18 months of operation PPAN received a grant from AVS to train personnel from other clinics to provide similar services. During the 1st clinic visit patients are thoroughly counseled and given a pelvic examination. During the 2nd visit the patient is given a complete physical examination and laboratory tests, including a pregnancy test, are performed. During the 3rd visit the patient receives additional counseling and the sterilization is then performed. A modified Pomeroy procedure is performed under local anesthesia. Patients were discharged 2 hours after surgery. 96% of the patients returned for suture removal and 50% returned for a later recommended check-up. A follow-up survey indicated that more than 90% of the patients were satisfied with the service. For 4 of the 218 patients the sterilization was not completed. In 2 cases the round ligament was mistaken for the tube and sterilization was not achieved, in 1 case the patient became upset and the procedure was halted, and in another case adhesions prevented ligation. At the time of the operation it was discovered that 2 patients had luteal phase pregnancies. There were no major immediate complications but there were 1) 2 cases of subcutaneous hematomas; 2) 1 brief episode of postoperative thrombophlebitis, 3) 2 cases of wound abscesses; and 4) 3 cases of mild cystitis and endometritis.
Activities of the Special Program of Research, Training and Development in Human Reproduction, World Health Organization in the field of long acting contraceptives.
In: Bangladesh Fertility Research Program. Workshop on Injectable Contraceptives: Noristerat, Dacca, Bangladesh, April 25, 1980. [Dacca, Bangladesh, BFRP, 1980]. 70-80.Following a brief introduction to the World Health Organization (WHO) Special Program of Research, Development and Research Training in Human Reproduction, established in 1972, focus is on what has been achieved thus far with long-acting injectable fertility regulating agents based on steroidal hormones and possessing a duration of action of at least 1 month. Over the last 20-year period, several estrogen-progestin combinations have been developed as monthly injectable contraceptives. The Special Program has initiated a series of clinical pharmacological studies aimed at developing new and improved estrogen progestin injectable formulations. 1 preparation, composed of norethisterone enanthate (50 mg) plus 5 mg of estradiol valerate, has shown promise in preliminary clinical studies. 3 progestogen only preparations with a duration of action of several months have been tested clinically: clormadinone acetate, depo-medroxyprogesterone acetate and norethisterone-enanthate. The 1st clinical trials utilizing the heptanoic acid ester of norethisterone raised considerable hopes, for no pregnancies were observed in 70 highly fertile women given the drug every 90 days. In a WHO trial preliminary data on Depo-Provera (DMPA) bleeding irregularities were responsible for the discontinuation of 9.3 subjects/100 women-years; prolonged amenorrhea accounted for the termination of 11.5 subjects/100 women years. There are several ongoing studies to evaluate the effects of the injectables on users. Norethisterone enanthate, although not possessing the same degree of effectiveness as DMPA, when adminstered every 3 months, remains an attractive injectable because of its lower incidence of amenorrhea.
In: Zatuchni GI, Labbok MH, Sciarra JJ, eds. Research frontiers in fertility regulation. Hagerstown, Maryland, Harper and Row, 1980. 213-29. (PARFR Series on Fertility Regulation)The systems-engineering approach to delivery of long-term contraception can involve the use of matrix devices for contraceptive steroids from which the steroid is released at a controlled rate over a prolonged period of time after a single administration. The concept of system design principles in contraceptive delivery is explained. In 1973, WHO organized a task force on long-acting systemic agents for fertility regulation. This is the report on a WHO-sponsored project to incorporate the basic design principles of a long-acting system into the design of an injectable particulate contraceptive system. The initial requirements included: 1) provision by a single administration of continuous controlled release of NET (norethisterone) for at least 6 months; 2) injection-administered carrier; 3) biodegradable carrier; 4) no carrier-induced side effects at the site of the injections; 5) complete disappearance of all components from the injection site; 6) a flexible system as to dose and duration to accommodate individual needs; and 7) reversibility of treatment. Experimental data so far satisfy the 1st 6 requirements. The injectable particulate system cannot be made reversible. Aspects for future research in this area are mentioned.
Lancet. 1980 May 17; 1(8177):1082.This letter reports rehydration of 7 infants by an oral solution similar to the UNICEF formulation. This solution contained: sodium chloride (3.5 gm), sodium bicarbonate (2.5 gm), potassium chloride (1.5 gm), and glucose (20 gm) dissolved in 1 liter of potable water. When admitted, 2 patients were hypernatremic and 5 had normal sodium levels. All children were well-nourished. They were given the oral glucose-electrolyte solution at admission, and in all cases treatment had to be interrupted after a mean period of 41+ or -9 hours due to high levels of potassium in 6 cases and aggravation of preexisting hypernatremia in the other. Average oral volume was 140 ml/kg. It is recommended that well-nourished children be given the UNICEF oral therapy formulation for no more than 24 hours, since potassium loading seems probable.
Oral rehydration therapy for treatment of rotavirus diarrhoea in a rural treatment centre in Bangladesh.
Archives of Disease in Childhood. 1980 May; 55(5):376-9.The outcome of a rehydration treatment used during a 40-day period at a WHO Center in Bangladesh on 216 children under age 5 is reported. In addition, an enzyme-linked immunosorbentassay (ELISA) designed to detect rotavirus in stool specimens is described and its application explained. The ELISA assay was adaptable to use in a rural treatment center. In a 40-day period, using the new virus-detecting assay, rotavirus without other pathogens was found in stools of 216 (45%) of 480 children who attended the center with gastrointestinal illness. Of these 216 children with only rotavirus pathogen, 188 were treated with oral rehydration alone (oral glucose solution prepared according to WHO procedures); 28 required additional intravenous rehydration therapy. No deaths occurred. 95% of the cases were judged successful on oral rehydration alone for gastrointestinal effects of rotavirus infection. No serious side effects were reported. This oral glucose solution is now indcated in E. coli (enter otoxin)-mediated diarrhea as well as in rotavirus-induced diarrhea.