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CSU 59/2010: SIX ON ERADICATION

Friday, 21st of May 2010 Print
CSU 59/2010: SIX ON ERADICATION

Readers of these updates will remember the uneven progress of disease radication initiatives dating back to the 1950s. Here are six ontributions on the subject, old and new.

Good reading.

BD

1) A good backgrounder, though from 1999:
http://www.cdc.gov/mmwr/preview/mmwrhtml/su48tc.htm

2) Fact sheets on candidate diseases for eradication
http://www.cdc.gov/mmwr/preview/mmwrhtml/su48a26.htm

3) Malaria: progress, perils, and prospects for eradication.

J Clin Invest. 2008 Apr;118(4):1266-76.
Greenwood BM, Fidock DA, Kyle DE, Kappe SH, Alonso PL, Collins FH, Duffy PE
.
Department of Infectious and Tropical Diseases, London School of Hygiene
and Tropical Medicine, London, United Kingdom.
Abstract
There are still approximately 500 million cases of malaria and 1 million
deaths from malaria each year. Yet recently, malaria incidence has been
dramatically reduced in some parts of Africa by increasing deployment of
anti-mosquito measures and new artemisinin-containing treatments, prompting
renewed calls for global eradication. However, treatment and mosquito
control currently depend on too few compounds and thus are vulnerable to
the emergence of compound-resistant parasites and mosquitoes. As discussed
in this Review, new drugs, vaccines, and insecticides, as well as improved
surveillance methods, are research priorities. Insights into parasite
biology, human immunity, and vector behavior will guide efforts to
translate parasite and mosquito genome sequences into novel interventions.
Full text at http://www.jci.org/articles/view/33996

4) Update on progress towards eradication of dracunculiasis
http://www.who.int/wer/2010/wer8519/en/index.html

'Editorial note. The 2009 target date for dracunculiasis eradication – set
in 2004 by endemic countries and their partners – having passed, it is time
to take stock and move forward with additional efforts to achieve
eradication.
Eradication is within reach for a disease for which there is no diagnostic
test for preclinical detection, no vaccine to immunize at-risk communities,
and no drug to kill any stage of the parasite. Eradication can be achieved,
as has been demonstrated by 16 of 20 endemic countries that have
successfully eliminated dracunculiasis. And 3 more countries are close to
reaching the elimination goal (interruption of transmission).
As a full-scale programme could be implemented in southern Sudan only since
2006, after the signing of the comprehensive peace agreement, good and
consistent progress has been made, limiting transmission to only 24
counties in southern Sudan; however, with 2733 cases  occurring in 2009,
the elimination goal is still a few years away. It took countries with a
similar number of cases 6–12 years to achieve elimination. However, as the
rate of decline varies among countries, it may not take Sudan 6 more years
to eliminate dracunculiasis given the government’s commitment and the focus
of most global resources on elimination in southern Sudan. The major risk
to elimination is episodes of insecurity.
The keys to eradication in all endemic countries will be surveillance and
case containment. Programmes have reported an increasing proportion of
imported cases, and villages that are reporting only cases imported from
elsewhere.
Most of these villages are located within districts that have reported
cases during the past 3 years; however, a small proportion have been
reported from districts that were free of transmission during the past 3
years.
While a vertical structure for dracunculiasis surveillance is neither
recommended nor feasible, a greater emphasis on passive surveillance
integrated with existing disease surveillance networks should be developed.

Since most surveillance networks are facility-based, their links to the
community need to be established by instituting widely publicized reward
systems for the voluntary reporting of cases. This should be supplemented
with active surveillance in endemic areas and areas where there is a high
risk of importation in order to detect and contain every case within 24
hours of the emergence of a worm. While in 80% of cases only a single worm
emerged, 20% had multiple worms (unpublished data from countries’ reports).
At this crucial juncture programmes need to focus on the emergence of each
worm and ensure complete containment of all cases.

5) When is a disease eradicable?
http://www.ajph.org/cgi/pmidlookup?view=long&pmid=11029980

6) Glimpses into smallpox eradication
It is politically incorrect to call for centralized approaches to public
health. Nonetheless, facts are facts.

Full text,
http://ajph.aphapublications.org/cgi/content/full/94/11/1875?view=long&pmid=15514222

'[W]hen around the middle of 1974 the Indian government accepted the
proposal that the running of the intensified program be fully centralized,
the move was widely celebrated within the WHO offices in Geneva and New
Delhi, not the least because it formally offered their smallpox eradication
units the option of working in an organized manner with the Federal Health
Ministry. The officials attached to these agencies were now going to be
allowed access to a centralized fund, built up with contributions from a
range of donors and held in Geneva. These developments also allowed the
creation of a new, well-organized program bureaucracy that was distinct
from the workforce attached to other disease control programs run by the
federal and state health ministries.'

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