Since the 1915 launch of the first international eradication initiative targeting a human pathoge... more Since the 1915 launch of the first international eradication initiative targeting a human pathogen, much has been learned about the determinants of eradicability of an organism. The authors outline the first 4 eradication efforts, summarizing the lessons learned in terms of the 3 types of criteria for disease eradication programs: (1) biological and technical feasibility, (2) costs and benefits, and (3) societal and political considerations.
A major factor influencing the success of poliomyelitis eradication in the Americas was the relia... more A major factor influencing the success of poliomyelitis eradication in the Americas was the reliance on mass immunization campaigns with oral poliovirus vaccine (OPV). As global poliomyelitis eradication activities accelerate and campaign vaccine delivery strategies are applied elsewhere, it is critical to determine whether the risk of vaccine-associated paralytic poliomyelitis (VAPP) is altered when routine delivery strategies are supplemented with mass immunization campaigns. We analysed all 6043 cases of acute flaccid paralysis (AFP) reported in Latin America over the period 1989-91 in order to estimate the risk of VAPP. The overall risk was estimated to be one case per 1.5-2.2 million doses of OPV administered, compared with one case per 1.4 million doses administered in England and Wales (1985-91) and with one case per 2.5 million net doses distributed in the USA (1980-89). These data suggest that to eradicate poliomyelitis globally, strategies that rely on mass immunization ca...
The Pan American Health Organization in 1985 adopted an initiative to eradicate poliomyelitis fro... more The Pan American Health Organization in 1985 adopted an initiative to eradicate poliomyelitis from the Western Hemisphere. In 1990, over 2000 cases of acute flaccid paralysis (AFP) were reported in this region, of which < 1% were determined to be caused by wild poliovirus. At present, the eradication programme uses AFP as the criterion for surveillance of children aged < 15 years; this is 100% sensitive, but not specific. To minimize unnecessary diagnostic investigations, we studied all 4333 cases of AFP reported to the programme during 1989 and 1990 in order to develop more efficient operational screening criteria for cases of AFP. Among children with AFP, the use of criteria such as age < 6 years and either presence of fever at the onset of paralysis or a < 4-day period for complete development of paralysis resulted in a sensitivity of 96% (95% C.I. 90-103%) and specificity of 49% (C.I. 47-52%). With criteria of age < 6 years and fever present at the onset of paraly...
Prior to the 2004 Philippines Measles Follow up Elimination Campaign, measles caused an estimated... more Prior to the 2004 Philippines Measles Follow up Elimination Campaign, measles caused an estimated 6000 deaths among Filipino children. After the campaign, cases and deaths decreased by 96.4% and 99.2%, respectively. The Nationwide Rapid Coverage Assessments, with an extensive system of feedback, was the prime factor in reaching the under-immunized areas.
Page 1. MINI REVIEW Expanded Program on Immunization in the Americas: Update by Jean-Marc Olivé, ... more Page 1. MINI REVIEW Expanded Program on Immunization in the Americas: Update by Jean-Marc Olivé, Claudio M. da Silveira, Peter Carrasco, and Ciro A. de Quadros IN SEPTEMBER 1977, following a resolution of the World ...
References 1. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National H... more References 1. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Interview Survey, 1985-94. Vital Health Stat 2 1989:1 10. 2. Peak RR, Cadell D. Overview of the National Immunization Provider Record Check Study. In: 1996 Proceedings of the ...
This article provides a framework for the design of future eradication programmes so that the gre... more This article provides a framework for the design of future eradication programmes so that the greatest benefit accrues to health systems development from the implementation of such programmes. The framework focuses on weak and fragile health systems and assumes that eradication leads to the cessation of the intervention required to eradicate the disease. Five major components of health systems are identified and key elements which are of particular relevance to eradication initiatives are defined. The dearth of documentation which can provide "lessons learned" in this area is illustrated with a brief review of the literature. Opportunities and threats, which can be addressed during the design of eradication programmes, are described and a number of recommendations are outlined. It is emphasized that this framework pertains to eradication programmes but may be useful in attempts to coordinate vertical and horizontal disease control activities for maximum mutual benefits.
Disease eradication as a public health strategy was discussed at international meetings in 1997 a... more Disease eradication as a public health strategy was discussed at international meetings in 1997 and 1998. In this article, the ongoing poliomyelitis eradication initiative is examined using the criteria for evaluating candidate diseases for eradication proposed at these meetings, which covered costs and benefits, biological determinants of eradicability (technical feasibility) and societal and political considerations (operational feasibility). The benefits of poliomyelitis eradication are shown to include a substantial investment in health services delivery, the elimination of a major cause of disability, and far-reaching intangible effects, such as establishment of a "culture of prevention". The costs are found to be financial and finite, despite some disturbances to the delivery of other health services. The "technical" feasibility of poliomyelitis eradication is seen in the absence of a non-human reservoir and the presence of both an effective intervention an...
Highly sensitive case definitions were first introduced by national poliomyelitis eradication pro... more Highly sensitive case definitions were first introduced by national poliomyelitis eradication programmes to avoid missing true cases of the disease, though false-positive diagnostic errors could still occur owing to low specificity. Extensive data from all 1620 cases of acute, flaccid paralysis reported in Brazil during 1987-88 provided an opportunity to study the characteristics of confirmed poliomyelitis cases and epidemiologically to evaluate potential case definitions that maximized both sensitivity and specificity. Cases that had been confirmed by wild poliomyelitis virus isolation were compared with those that had been rejected (non-polio cases). To guarantee the consistency of clinical, epidemiological and laboratory investigations, only cases less than 10 years of age that had been investigated within 15 days of the onset and with complete laboratory specimens were included. No single practical case definition combining both high sensitivity and high specificity emerged from...
Since the 1915 launch of the first international eradication initiative targeting a human pathoge... more Since the 1915 launch of the first international eradication initiative targeting a human pathogen, much has been learned about the determinants of eradicability of an organism. The authors outline the first 4 eradication efforts, summarizing the lessons learned in terms of the 3 types of criteria for disease eradication programs: (1) biological and technical feasibility, (2) costs and benefits, and (3) societal and political considerations.
A major factor influencing the success of poliomyelitis eradication in the Americas was the relia... more A major factor influencing the success of poliomyelitis eradication in the Americas was the reliance on mass immunization campaigns with oral poliovirus vaccine (OPV). As global poliomyelitis eradication activities accelerate and campaign vaccine delivery strategies are applied elsewhere, it is critical to determine whether the risk of vaccine-associated paralytic poliomyelitis (VAPP) is altered when routine delivery strategies are supplemented with mass immunization campaigns. We analysed all 6043 cases of acute flaccid paralysis (AFP) reported in Latin America over the period 1989-91 in order to estimate the risk of VAPP. The overall risk was estimated to be one case per 1.5-2.2 million doses of OPV administered, compared with one case per 1.4 million doses administered in England and Wales (1985-91) and with one case per 2.5 million net doses distributed in the USA (1980-89). These data suggest that to eradicate poliomyelitis globally, strategies that rely on mass immunization ca...
The Pan American Health Organization in 1985 adopted an initiative to eradicate poliomyelitis fro... more The Pan American Health Organization in 1985 adopted an initiative to eradicate poliomyelitis from the Western Hemisphere. In 1990, over 2000 cases of acute flaccid paralysis (AFP) were reported in this region, of which < 1% were determined to be caused by wild poliovirus. At present, the eradication programme uses AFP as the criterion for surveillance of children aged < 15 years; this is 100% sensitive, but not specific. To minimize unnecessary diagnostic investigations, we studied all 4333 cases of AFP reported to the programme during 1989 and 1990 in order to develop more efficient operational screening criteria for cases of AFP. Among children with AFP, the use of criteria such as age < 6 years and either presence of fever at the onset of paralysis or a < 4-day period for complete development of paralysis resulted in a sensitivity of 96% (95% C.I. 90-103%) and specificity of 49% (C.I. 47-52%). With criteria of age < 6 years and fever present at the onset of paraly...
Prior to the 2004 Philippines Measles Follow up Elimination Campaign, measles caused an estimated... more Prior to the 2004 Philippines Measles Follow up Elimination Campaign, measles caused an estimated 6000 deaths among Filipino children. After the campaign, cases and deaths decreased by 96.4% and 99.2%, respectively. The Nationwide Rapid Coverage Assessments, with an extensive system of feedback, was the prime factor in reaching the under-immunized areas.
Page 1. MINI REVIEW Expanded Program on Immunization in the Americas: Update by Jean-Marc Olivé, ... more Page 1. MINI REVIEW Expanded Program on Immunization in the Americas: Update by Jean-Marc Olivé, Claudio M. da Silveira, Peter Carrasco, and Ciro A. de Quadros IN SEPTEMBER 1977, following a resolution of the World ...
References 1. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National H... more References 1. Massey JT, Moore TF, Parsons VL, Tadros W. Design and estimation for the National Health Interview Survey, 1985-94. Vital Health Stat 2 1989:1 10. 2. Peak RR, Cadell D. Overview of the National Immunization Provider Record Check Study. In: 1996 Proceedings of the ...
This article provides a framework for the design of future eradication programmes so that the gre... more This article provides a framework for the design of future eradication programmes so that the greatest benefit accrues to health systems development from the implementation of such programmes. The framework focuses on weak and fragile health systems and assumes that eradication leads to the cessation of the intervention required to eradicate the disease. Five major components of health systems are identified and key elements which are of particular relevance to eradication initiatives are defined. The dearth of documentation which can provide "lessons learned" in this area is illustrated with a brief review of the literature. Opportunities and threats, which can be addressed during the design of eradication programmes, are described and a number of recommendations are outlined. It is emphasized that this framework pertains to eradication programmes but may be useful in attempts to coordinate vertical and horizontal disease control activities for maximum mutual benefits.
Disease eradication as a public health strategy was discussed at international meetings in 1997 a... more Disease eradication as a public health strategy was discussed at international meetings in 1997 and 1998. In this article, the ongoing poliomyelitis eradication initiative is examined using the criteria for evaluating candidate diseases for eradication proposed at these meetings, which covered costs and benefits, biological determinants of eradicability (technical feasibility) and societal and political considerations (operational feasibility). The benefits of poliomyelitis eradication are shown to include a substantial investment in health services delivery, the elimination of a major cause of disability, and far-reaching intangible effects, such as establishment of a "culture of prevention". The costs are found to be financial and finite, despite some disturbances to the delivery of other health services. The "technical" feasibility of poliomyelitis eradication is seen in the absence of a non-human reservoir and the presence of both an effective intervention an...
Highly sensitive case definitions were first introduced by national poliomyelitis eradication pro... more Highly sensitive case definitions were first introduced by national poliomyelitis eradication programmes to avoid missing true cases of the disease, though false-positive diagnostic errors could still occur owing to low specificity. Extensive data from all 1620 cases of acute, flaccid paralysis reported in Brazil during 1987-88 provided an opportunity to study the characteristics of confirmed poliomyelitis cases and epidemiologically to evaluate potential case definitions that maximized both sensitivity and specificity. Cases that had been confirmed by wild poliomyelitis virus isolation were compared with those that had been rejected (non-polio cases). To guarantee the consistency of clinical, epidemiological and laboratory investigations, only cases less than 10 years of age that had been investigated within 15 days of the onset and with complete laboratory specimens were included. No single practical case definition combining both high sensitivity and high specificity emerged from...
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