Smallpox: the death of a disease, DA Henderson

Tags: Endemic countries, Operational plan, health units, Surveillance, smallpox, Indira Ghandi, Vaccine supply, eradication program, Disease, Jonns Hopl, Epidemiological research, India, Netherlands, Canada, alternative methods, bifurcated needle, vaccines, resourceful ideas, er, smallpox eradication, Wyeth, Labs, Ben Rubin
Content: Smallpox: Death of a Disease ...miracle and legacy D.A.Henderson, MD, MPH Jonns HoplMce Pro:essor Pro.tenorOfMed.IClnOat..oPU*Kt·11.h, tJ. Ofstiuh 7"' Unither Baruch Blumberg Lecture OXlord University 14 Novembc1 2012 Center fo Biosecwity
Observations There hasbeen nogreater medical - orhumanitarian - miracle in modem times than the eradication orsmallpox. .it offers a winning blueprint torthegreatmedical challenges tocome. Ptde=xDawd°""lQ< 2ooePulitztll'--..f9strxy (It)is atestamenttothe cJdf9r&/'IC{ thogloblllpublichealth community can make whenti trutyoomes Jogetherforacommon purpose Sect.iaty ThomPSM. o.pa,tmMtolHtolth and HumanSe.Mc$s
J>.fo,\ rҐ.·· _,,.;: ·.. . ··.:
. .
Center for Biosecurity . .. . : ,. E ::: :: :; ::;::. :; ;
The Presentation -- in brief
1 9,\ , · Clinical features of smallpox, a disease last seen in
campaign _ · L;;;:rks of the eradication
"\
The legacy of the program
critical factors intrinsic to its success
Center for Bioseurity . " .....: ::;;.;;;;;..;:: :;·;:
Smallpox - a unique disease
Severe febrile disease with rash- death rate of 30% Virus transmitted by face-to-face contact Man was the only host · Chain of infection going back more than 3500 years · Only disease with deities -Asia and Africa Patient has permanent immunity on recovery but will be disfigured and may possibly be blind A very heat-stable vaccine protects with one dose
Cent.er fur Bioseuiity
...
;,,.,.::.:::::::;:;:;,.;;:;::;:
Day 3
Day 9 1
Day 13
Confluent smallpox
Confluent smallpox (recovered)
Global efforts to eradicate a disease
· Hookworm
1909-23
· Yellow fever
1915-32
Yaws
1948-66
· Malaria
1955-73
· Smallpox
1967-80
G. worm infection 1986-?
· Poliomyelitis
1988- ?
14 years 17 years 18 years 18 years 14 years 26 years+ 24 years+
CeofЈ.J:.f.u;r..B:.i::o;s;;e;;L;u:r;it;;y:;;:;·;
Landmarks in smallpox eradication · World Health Assembly adopted 1959 USSR proposal for a global eradication program · 1959 -1966 · Strategy: mass vaccination (few countries complied) · WHO budget of <$100,000 per year · Six WHO staff members · Negligible progress in most infected areas Ca. n.er.f..o.r;:B::: ;io:!s:;e:c;;u;r:;i:t:y;:::
A new, intensified eradication program · Assembly requires DG to submit a plan -1966 · Strategy Large-scale vaccination Surveillance and containment 10 year goal - WHO budget of$ 2.4 million/year · Objections by delegates · Not feasible · Demand for no further increases in WHO budget · 58 votes for acceptance; 60 voted for approval Cente.r..f.,o..r: .B;,;i:o::s:e:c;:u;r:;i;L:y;: ;::;
2
Program leadership · Director General believed program would fa il · Malaria eradication effortwas collapsing · Demanded an American serve as Director The candidate declines: Justbeg111ng as d.-ector of a new CDC program limited resources - }· \ The challenge · Status of sma llpox - 1967 · >10,000,000 cases 2,000,000 deaths 43 countries reporting cases · program staff Headquarters - 5 medical, 2 admi n, 3 secretaries · Regions - one staff for each of 4 WHO Regions · International staff- never more than 150 ; : Center forBiosecurity . ..; . :d : ::::;:: ; ; : : :...:
· = Endemic countries · = Others with cases
Smallpox 1967
Vaccine supply · Heat-stable, potent vaccine was essential Need for >250 million doses/year U.S./USSR commftted to 75 miltiontyear 42 labs other labs were producing vaccine International quality control (Netherlands, Canada Development of national capacity Production manual and research On-site consuttant assistance By 1973, all vacnci e met potency, stability standards Cent.er fur Biosecurity . ... . : - ·:::. ::; ; ;;; ::, ;,.; ;::;
Vaccination · Research to find faster, better methods · Jet Injector gun · Bifurcated needle-multiple puncture method One-fourth as much vacane required Training time -15 minutes Easily sterilized anc:I reuseSurveillance-containment strategy · Operational plan · Surveillance - weekly case report from all health units · Teams - to investigate and contain outbreaks epidemiological research on smallpox Strategy evolved to meet Ille challengs The textbooks prove wrong ·smallpox spreads like a pra1ne fire" "Revaccination required every 3 10 5 years· Cc11re1· forBiosecW'ity
· = Endemic countries · = Others with cases
Smallpox 1967

t
· = Endemic countries
· = Others with cases
,, Smallpox 1970
4
India -- the pivotal challenge
1973-75
· India - the "home of smallpox"?
· Population -550,000,000
Surveillance-containment strategy-not working
June 1973- search every village>every house
130.000 health stall for 10 days Resutts of first sean::h - Oc;tober
Spring 1974 - the darkest days Gas crisis + strikes by alnlnes, railway, health stafHfloods India explodes a nuelear devloe
Emphasis on cases-notnumber of vaccinations
l0Ґ1i!Y:.-· z.,: ..:····" .. . . ·
Center for Biosccurity
Indian Independence Day August 15, 1975 Prime Minister Indira Ghandi Saluted India on its 28'"Anniversary of Freedom Announced India's freedom from smallpox for the first time in the nation's written history
:·; .- ·.
.. . .. .. . .
Ce
nef rfur , . . .. .
.Riosecurity : : ;; ;;;;; ; ....... .
;;;
J = Endemic countries = Others with cases
Smallpox 1976
The last strongholds Et11iop1a and Somalia · Ethiopia · Country - twice the size of Texas Largely highland --011er 5000 feet health facilities serve 5% of 30 million people Travel largely by donkey end on loot Emperor is assassinated: Marxist take-over No foreign staff outside of Addis exoept smallpox teams · Civil War, floods, famine, kidnapping, hostages · Somalia - the final chapter Cent.er for Biosi=uity : ..... .·;.::;:;..;:::;;;::: 5
World Health Assembly --1980 · Declares solemnly that the world and all its peoples have won freedom from smallpox Smallpox vaccination should be discontinued in every country 0 TIMrtyt!dH.. khAtsombly, 8""1Y 1980 Center for Biosccw·ity
A new era for vaccination
· The genesis was smallpox eradication African teams averaged 500 vaccinations/day One year: 40,0 000 vaccinations by a 4 person team Surveillance strategy proved invaluable Nation-wide smallpox eradication programs were workable even in the least developed African countries and even in densely populated Madras State, India WHO agreed to an intemational meeting on possible global targets for vaccine preventable diseases · 1970
. . · ·. ' .'
Cente.;r. f.o;. .r. B:: ;io: -;s;e;c;:u:r: ;il:.y.:::::
WHO Expanded Program on Immunization the legacy of smallpox eradication - 1974 · A global program to reach all children - smallpox, measles, DPT, polio, BCG Surveillance of vaccine-preventable diseases UNICEF and Rotary made this a high priority Target: 1990 - 80% coverage To some - *the beginning ofthe Vaccine Eran ; Center for 13io$e"Urity ' : :: . ·· . ; : : ; ; = ; , ;,; ;;;; ;
Vaccine coverage (%) - the Americas
-·wu YAW'
; woo
zoos
0'1'1" 50 Meas!.. 51
74 BO
91 92
92 ::i 93
Pollo· 57
75
90
92
Hep8'
70
88
lfib·
?5
90
·30oses
Transmission inleCenter fur
: .; . . .
.
:B; :io; s;;e;c;u;:r;i; ;l;y; ;
;;
:
;
Poliomyelitis 1Job·l aan"al tcportcd cuu and Poll covcuac. 1910.2008
'tm::::
_.,.- .. ::
.
,. . . I l ·--·r·:.:. I, ... . 1 ..::.::=-: .:r:- t·
. .. ,..,.
i jI
. .
_,,
. :!t1110? l. u . . JJ 141,,,).J
. -
fl ,
.60 .. : J.O 20 ...oJ.L: ----- ........:·
lliff!!!!l!!l!f!fl!llllllllll
Cenli!r for Biosecurity . .; ::: : : ;...;;;:;: =:::::
Meulu glob.a aaau·I rt-ported cues and M CV r-ovetatf' I 9t0.2009 Center for Biosecurity . .. · . .:!: :;::;:;;;;:.;::;:;;
6
Factors responsible for the rapidity of eradication
A continually evolving strategy with an active interplay of Laboratory research Epidemiology -- surveillance-containment Dedicated, enthusiastic field staff Most important: an inexpensive, easily applied, heat stable, single-dose vaccine providing durable protection Vaccine in use into the 1960's -- liquid, calf lymph, inactivated within days, inadequate quality control
. ·. ·: . .. ::.. :
Cenrex for BiosecDevelopment of the vaccine and a better vaccination instrument 1950s -· Leslie Collier(Lister Institute) developed commercial-scale freeze drying technique for the vaccine Five vaccine producers joined to write a standard manual and subsequently trained lab directors Production in developing countries rose from Oto >250 million doses within 5 years Labs in Canada and Netherlands regularly tested all vaccines used in the program Ben Rubin(Wyeth) invented the bifurcated needle.
Cent·er ....:.
for . .· · ·
·B:;i:o:s:::e:c:;w:i;;;t;y;;;:;;
Are there opportunities for dramatically better control of other diseases with new technologies for better vaccines and alternative methods for delivery? Polio, pertussis, measles, hepatitis B, dengue, malaria . ..?
Center for.Biose'1.uity
.':· · ·'-'.:..· !:·-·· ;· ·· '.:·:, :'..' ..
;, :....:::;;;; ::;;;;::;;;;;
Coda From Smallpox: Death of a Disease: 'We are only beginning to realize the potential of public health...It is a field begging for fresh. resourceful ideas and a new generation of professionals who are not constrained by 'knowing' what can't be done. So it was with so many who contributed so much to making smallpox eradication a possibility.·
7

DA Henderson

File: smallpox-the-death-of-a-disease.pdf
Author: DA Henderson
Pages: 7
File size: 0.85 Mb


, pages, 0 Mb

The ugly duckling, 6 pages, 0.29 Mb

, pages, 0 Mb

, pages, 0 Mb

Strategic management, 34 pages, 1.28 Mb
Copyright © 2018 doc.uments.com