Comparison and Contrast of the Elimination Campaigns for Poliomyelitis and Leprosy: Which is More Feasible?

As we approach the third decade since the WHO started addressing the eradication of poliomyelitis and leprosy, a reflection of the previous campaigns efficacy and an evaluation of further elimination feasibility is important to adapt and intensify the next steps. We performed a critical review of the poliomyelitis and leprosy eradication campaigns to evaluate their technical and operational feasibilities. Vaccination and active case search are highly effective tools against poliomyelitis. If political stability and good vaccination coverage is achieved, poliomyelitis will be an easy target for eradication. Leprosy, on the other hand, faces many barriers towards elimination. The lack of a high efficacy vaccine, the long asymptomatic but infective period, the lack of screening tests and a poorly established elimination target, prevents this disease from being eliminated. In a world where resources and funding are limited, it is apparent that poliomyelitis is a more feasible target for elimination than leprosy.

Com o aproximar da terceira década desde o início das campanhas de erradicação da poliomielite e lepra promovidas pela Organização Mundial de Saúde, uma reflexão sobre a eficácia das campanhas anteriores e o estudo da factibilidade da eliminação futura é importante para adaptar e intensificar os próximos passos. Neste trabalho realizamos uma revisão crítica sobre estas campanhas de forma a avaliar as suas exequibilidades técnicas e operacionais. A vacinação e a procura de casos ativos são ferramentas muito eficazes contra a poliomielite. Mediante a existência de estabilidade politica e uma boa taxa de cobertura vacinal, a poliomielite será um bom alvo à erradicação. A lepra, no entanto, padece de várias barreiras à eliminação como a ausência de uma vacina altamente eficaz, a existência de um período infecioso assintomático prolongado, a falta de métodos de rastreio e um objetivo de eliminação primariamente mal definido. Em conjunto, estes aspetos previnem a doença de ser facilmente eliminada. Num mundo onde os recursos e o financiamento são limitados, a eliminação da poliomielite parece mais exequível comparativamente à lepra.

Are we there yet? Assessing achievement of vaccine-preventable disease goals in WHO's Western Pacific Region.

Accelerated disease control goals have long been appreciated for their role in galvanizing commitment and bringing a sense of urgency for disease prevention. WHO's Western Pacific Region has 14 on-going communicable disease reduction goals including 1 targeting eradication, 10 targeting elimination, and 3 control initiatives. These goals cover mother-to-child transmission of HIV, congenital syphilis, tuberculosis, leprosy, five parasitic diseases and four vaccine-preventable diseases (VPD). The initiatives have distinct objectives, approaches, and means in which to measure achievement of the goals. Given the long history and experience with VPD initiatives in the Western Pacific Region, this manuscript focuses on the Region's following initiatives: (1) smallpox eradication, (2) polio eradication, (3) measles elimination, (4) maternal and neonatal tetanus elimination (MNTE), and (5) hepatitis B control. There is good consistency across the Region's VPD initiatives yet a pattern of more robust and representative data requirements, stricter evaluation criteria, and more formal evaluation bodies are linked to the intensity of the goal - with eradication being the peak. On the other end of this spectrum, the Regional hepatitis B control initiative has established efficient and low-cost approaches for measuring impact and evaluating if the goals have been met. Even within the confines of VPD initiatives there are some deviations in use of terminology and comparisons across other disease control initiatives in the Region are provided.

Recent advances in tropical medicine.

There have been significant advances in both the classical and neglected tropical diseases, with Guinea worm looking set to be the next disease after smallpox to be eradicated. Aided by a combination of enhanced understanding of the biology of the pathogens, intensification of immunisation activities or mass drug administration, together with the development of synergies with control programmes for co-endemic tropical diseases, polio, lymphatic filariasis, trachoma and onchocerciasis all appear to be in global decline, with good prospects for eventual successful elimination. While the global incidence of new cases of leprosy continues to decrease, the focus of leprosy control efforts has shifted following more widespread recognition that cure of infection does not necessarily prevent disability. Expansion in funding for HIV/AIDS and malaria provides some grounds for optimism about the control of these diseases. However, ongoing education and access remain essential to increasing the uptake of HIV testing and decreasing transmission. Meanwhile, the rise of drug-resistant tuberculosis and malaria is concerning, and the emergence of the highly pathogenic avian influenza A and re-emergence of viruses such as chikungunya and West Nile virus, without significant recent progress in vaccine development, pose additional ongoing challenges to tropical medicine physicians worldwide.

[Eradication of contagious diseases]. / Eradikace prenosných nemocí.

Based on analysis of eleven-year intense epidemiological intervention against smallpox, a number of findings and demands ensued which should be met by an infectious disease to be included into the programme of eradication or elimination. The author mentions several episodes from the programme of smallpox eradication in which he participated as a member of a WHO team. Part of the paper is a detailed explanation of the terms eradication and elimination. The main part of the article is a characteristic of infections where the global programme of eradication or elimination is underway. At present the eradication of poliomyelitis and dracunculiasis is completed and elimination of tetanus of neonates as well as leprosy, all by the year 2000. By 2010 measles, possibly German measles and mumps should be eradicated and possibly leprosy and Chagas' disease and onchocerciasis should be eliminated. Also for other infections such as lymphatic filariasis, trachoma and non-veneric treponematoses more remote terms are given or are not yet given. Depending on the decision of WHO on the programme of global eradication, under precisely defined conditions seven other infections may be included: cysticercosis (Taenia solium), diseases caused by Haemophilus influenzae b, viral hepatitis A, rotavirus enteritis, diphtheria, whooping cough and tuberculosis. In the case of viral hepatitis B only elimination is foreseen.

Anais do 1§ Congresso Brasileiro de Epidemiologia. Epidemiologia e desigualdade social: os desafios do final do século / Annals of the 1st Brazilian Congress of Epidemiology. Epidemiology and social inequality: the challanges by the end of century

A descentralizaçäo possibilitada pela implantaçäo do SUS aos estados e municípios permitiu a reuniäo de poder, recursos e conhecimentos técnicos. Esta açäo viabilizou a definiçäo de prioridades com a finalidade de atender às demandas näo identificadas pelos indivíduos através de programas de controle de doenças. Uma avaliaçäo dos programas de controle da doença de Chagas, febre amarela, dengue, hanseníase e poliomielite é apresentada (AMSB)