Mumps and mumps vaccine: a global review.
Mumps is an acute infectious disease caused by a paramyxovirus. Although the disease is usually mild, up to 10% of patients can develop aseptic meningitis; a less common but more serious complication is encephalitis, which can result in death or disability. Permanent deafness, orchitis, and pancreatitis are other untoward effects of mumps. Based on data reported to WHO up to April 1998, mumps vaccine is routinely used by national immunization programmes in 82 countries/areas: 23 (92%) of 25 developed countries, 19 (86%) of 22 countries with economies in transition (mainly the Newly Independent States of the former Soviet Union), and 40 (24%) of 168 developing countries. Countries that have achieved high coverage have shown a rapid decline in mumps morbidity. Furthermore, in many of these countries, mumps-associated encephalitis and deafness have nearly vanished. This review considers the disease burden due to mumps; summarizes studies on the immunogenicity, efficacy, and safety of different strains of mumps vaccine; and highlights lessons learned about implementing mumps immunization in different countries. Countries already using mumps vaccine should monitor immunization coverage and establish routine mumps surveillance with investigation of outbreaks. Where mumps is targeted for elimination, countries need to add a second dose of mumps vaccine for children, keeping in mind that the disease may still occur in susceptible adults. (+info)
Eradication: lessons from the past.
The declaration in 1980 that smallpox had been eradicated reawakened interest in disease eradication as a public health strategy. The smallpox programme's success derived, in part, from lessons learned from the preceding costly failure of the malaria eradication campaign. In turn, the smallpox programme offered important lessons with respect to other prospective disease control programmes, and these have been effectively applied in the two current global eradication initiatives, those against poliomyelitis and dracunculiasis. Taking this theme a step further, there are those who would now focus on the development of an inventory of diseases which might, one by one, be targeted either for eradication or elimination. This approach, while interesting, fails to recognize many of the important lessons learned and their broad implications for contemporary disease control programmes worldwide. (+info)
The principles of disease elimination and eradication.
The Dahlem Workshop discussed the hierarchy of possible public health interventions in dealing with infectious diseases, which were defined as control, elimination of disease, elimination of infections, eradication, and extinction. The indicators of eradicability were the availability of effective interventions and practical diagnostic tools and the essential need for humans in the life-cycle of the agent. Since health resources are limited, decisions have to be made as to whether their use for an elimination or eradication programme is preferable to their use elsewhere. The costs and benefits of global eradication programmes concern direct effects on morbidity and mortality and consequent effects on the health care system. The success of any disease eradication initiative depends strongly on the level of societal and political commitment, with a key role for the World Health Assembly. Eradication and ongoing programmes constitute potentially complementary approaches to public health. Elimination and eradication are the ultimate goals of public health, evolving naturally from disease control. The basic question is whether these goals are to be achieved in the present or some future generation. (+info)
Disease eradication and health systems development.
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. (+info)
Perspectives from micronutrient malnutrition elimination/eradication programmes.
Micronutrient malnutrition cannot be eradicated, but the elimination and control of iron, vitamin A and iodine deficiencies and their health-related consequences as public health problems are currently the targets of global programmes. Remarkable progress is occurring in the control of goitre and xerophthalmia, but iron-deficiency anaemia (IDA) has been less responsive to prevention and control efforts. Subclinical consequences of micronutrient deficiencies, i.e. "hidden hunger", include compromised immune functions that increase the risk of morbidity and mortality, impaired cognitive development and growth, and reduced reproductive and work capacity and performance. The implications are obvious for human health and national and global economic and social development. Mixes of affordable interventions are available which, when appropriately adapted to resource availability and context, are proven to be effective. These include both food-based interventions, particularly fortification programmes, such as salt iodization, and use of concentrated micronutrient supplements. A mix of accompanying programmes for infection control, community participation, including education, communication and information exchange, and private sector involvement are lessons learned for overcoming deterrents and sustaining progress towards elimination. (+info)
Perspectives from the dracunculiasis eradication programme.
After a slow beginning in association with the International Drinking Water Supply and Sanitation Decade (1981-1990), the global Dracunculiasis Eradication Programme has reduced the incidence of dracunculiasis by nearly 97%, from an estimated 3.2 million cases in 1986 to less than 100,000 cases in 1997. Over half of the remaining cases are in Sudan. In addition, the programme has already produced many indirect benefits such as improved agricultural production and school attendance, extensive provision of clean drinking-water, mobilization of endemic communities, and improved care of infants. Most workers in the campaign have other responsibilities in their communities or ministries of health besides dracunculiasis eradication. (+info)
Perspectives from the global poliomyelitis eradication initiative.
Ten years after the year 2000 target was set by the World Health Assembly, the global poliomyelitis eradication effort has made significant progress towards that goal. The success of the initiative is built on political commitment within the endemic countries. A partnership of international organizations and donor countries works to support the work of the countries. Interagency coordinating committees are used to ensure that all country needs are met and to avoid duplication of donor effort. Private sector support has greatly expanded the resources available at both the national and international level. At the programmatic level, rapid implementation of surveillance is the key to success, but the difficulty of building effective surveillance programmes is often underestimated. Mass immunization campaigns must be carefully planned with resources mobilized well in advance. Programme strategies should be simple, clear and concise. While improvements in strategy and technology should be continuously sought, changes should be introduced only after careful consideration. Careful consideration should be given in the planning phases of a disease control initiative on how the initiative can be used to support other health initiatives. (+info)
Important micronutrient deficiencies in at-risk populations can be addressed simultaneously with programmatically cost-effective results. Because of the interaction between many micronutrients, this would also be biologically effective. With adequate investment and political support, the chances of eliminating iodine deficiency as a problem in women of reproductive age and young children and of eliminating vitamin A deficiency as a problem in young children in the future are high. To eliminate iron deficiency and folic-acid-dependent neural tube defects (FADNTDs) in low-income populations, a new set of approaches will have to be developed. These same approaches, if successful, could be used to tackle other important micronutrient deficiencies. (+info)