Sunday, June 21, 2009

Words Retrieve From The Carter Center: Force for Disease Eradication

The International Task Force for Disease Eradication at The Carter Center

Carter Center Photo

Force for Disease Eradication

Inspired by the successful eradication of smallpox in 1977, the International Task Force for Disease Eradication formed at The Carter Center in 1988 to evaluate disease control and prevention and the potential for eradicating other infectious diseases. Composed of scientists and notable international health organizations from around the world, the task force has identified seven diseases that could be eradicated.

Between 1988 and 1992 the task force concluded that six diseases — dracunculiasis, poliomyelitis, mumps, rubella, lymphatic filariasis, and cysticercosis — could be eradicated. Measles was added to this list with the current task force in 2002. (See list of eradication and elimination programs currently sanctioned by the World Health Organization.)

The current task force reconvened in June 2001 to work further on international health with support from the Bill & Melinda Gates Foundation. The main goals of the revived task force are to review progress in the field of disease eradication, review the status of selected diseases for control or eradication, and make recommendations regarding opportunities for eradication or better control of certain diseases.

In 2008, The Carter Center supported two task force recommendations to encourage cooperation between the Dominican Republic and Haiti to eliminate lymphatic filariasis and malaria from Hispaniola, and to convene the first program review for Buruli ulcer programs in Benin, Cote d'Ivoire, Ghana, and Togo. (Read the report from the Oct. 29, 2008 meeting of the ITFDE.)

Carter Center health programs address two of the diseases currently identified by the ITFDE for eradication (dracunculiasis and lymphatic filariasis) and three diseases identified for better control (onchocerciasis or river blindness, trachoma, and schistosomiasis).

cEradication of infectious diseases
From Wikipedia, the free encyclopedia

Eradication is the reduction of an infectious disease's prevalence in the global human or animal host population to zero.[1] A number of world organizations together with local governments are working to fully eradicate various diseases. It is sometimes confused with elimination, which describes either the reduction of an infectious disease's prevalence in a regional population to zero, or the reduction of the global prevalence to a negligible amount. Also, the term eradication is sometimes used in the context of HIV and certain other viruses to describe the sought-after total removal of the virus from an individual (i.e. a cure).

Seven attempts have been made to date to eradicate infectious diseases in humans globally - four aborted programs targeting hookworm, malaria, yaws, and yellow fever, one successful program targeting smallpox and two ongoing programs targeting poliomyelitis and dracunculiasis. Five more infectious diseases have been identified as of April 2008 as potentially eradicable with current technology by the Carter Center International Task Force for Disease Eradication - measles, mumps, rubella, lymphatic filariasis and pork tapeworm.[2] Meanwhile, there has been one major attempt to eradicate a disease in animals, namely rinderpest, which is still ongoing.

* 1 Eradicated
o 1.1 Smallpox
* 2 Global eradication underway
o 2.1 Poliomyelitis (polio)
o 2.2 Dracunculiasis
o 2.3 Rinderpest
* 3 Regional or sub-regional elimination established or under way
o 3.1 Malaria
o 3.2 Lymphatic filariasis
o 3.3 Measles and rubella
o 3.4 Onchocerciasis
o 3.5 Yaws
* 4 See also
* 5 References
* 6 External links

[edit] Eradicated

[edit] Smallpox
Main article: Smallpox

Smallpox is the only disease to have been eradicated. It became one of the first diseases for which there was an effective vaccination when Edward Jenner demonstrated in 1798 that inoculation of humans with cowpox could protect against smallpox.[3]

The virus causing smallpox, Variola vera, has two variants: variola major, with a mortality rate around 30 percent, and variola minor, with a mortality rate less than 1 percent. The last naturally occurring case of variola major was diagnosed in October 1975 in Bangladesh, and the last naturally occurring case of variola minor was diagnosed in October 1977 in Somalia. The global eradication of smallpox was certified by a commission of scientists on December 9, 1979 and endorsed by the World Health Assembly on May 8, 1980.[3]

[edit] Global eradication underway

[edit] Poliomyelitis (polio)
Main article: Poliomyelitis eradication

A dramatic reduction of the incidence of poliomyelitis in industrialized countries followed the development of a vaccine in the 1950s. In 1960, Czechoslovakia became the first country certified to have eliminated polio.

In 1988, the World Health Organization (WHO), Rotary International, the United Nations Children's Fund (UNICEF), and the U.S. Centers for Disease Control and Prevention (CDC) passed the Global Polio Eradication Initiative. Its goal was to eradicate polio by the year 2000. The updated strategic plan for 2004–2008 expects to achieve global eradication by interrupting poliovirus transmission, using the strategies of routine immunization, supplementary immunization campaigns, and surveillance of possible outbreaks. The WHO estimates that global savings from eradication, due to forgone treatment and disability costs, could exceed one billion U.S. dollars.[4]

The following world regions have been declared polio-free:

* The Americas (1994)
* Indo-West Pacific region (1997)
* Europe (1998)
* Western Pacific region, including China (2000)

The lowest annual polio prevalence seen so far was in 2001, with 483 reported cases. However, following interruption of vaccination in Nigeria in 2003-4 and a reduction in immunisation in India in 2001-2, there was a resurgence of polio transmission: in the period of 2002 to 2008, the number of global reported cases has remained between 750 and 2000 per year, with 1,654 cases in 2008. Some of these cases were the result of new importations in 27 countries which had previously interrupted transmission, leading to many subsequent outbreaks; 13 of these countries are believed to have still had active transmission in 2008. Four further countries remain in which poliovirus transmission has never been interrupted - Nigeria, India, Pakistan, and Afghanistan.[5][6][7]

[edit] Dracunculiasis

Dracunculiasis, also called Guinea Worm Disease, is a painful and disabling parasitic disease caused by a worm, Dracunculus medinensis. It is spread through consumption of drinking water infested with copepods hosting Dracunculus larvae. The Carter Center has led the effort to eradicate the disease, along with the CDC, the WHO, UNICEF, and the Bill and Melinda Gates Foundation.

Unlike diseases such as smallpox and polio, there is no vaccine nor drug therapy for dracunculiasis. Eradication efforts have been based on making drinking water supplies safer and through educating people where it is endemic on safe drinking water practices. These strategies have proved successful: two decades of eradication efforts have reduced its global incidence to 4,619 cases in 2008 (provisional figures, March 2, 2009), down from an estimated 3.5 million in 1986, although success has been slower than was hoped - the original goal for eradication was 1995. The WHO has certified 180 countries free of the disease, and only six countries - Sudan, Ghana, Mali, Nigeria, Niger and Ethiopia - are reported to have had domestic transmission of guinea worm in 2008.[8][9]

[edit] Rinderpest

There have been a series of campaigns to eradicate rinderpest, a viral disease of cattle belonging to the same family as measles, primarily through the use of a live attenuated vaccine. The latest of these campaigns was led by the UN Food and Agriculture Organization (FAO). As of 2008, the virus had been last seen in 2001; however, on the basis of earlier setbacks, the FAO were unwilling to declare it eradicated until the end of a period of intensive surveillance due to complete in 2010.[10]

[edit] Regional or sub-regional elimination established or under way

Some diseases have already been eliminated from parts of the world, and/or are currently being targeted for regional elimination. This is sometimes described as "eradication", although technically the term only applies when this is achieved on a global scale. Even after regional elimination is successful, interventions often need to continue to prevent a disease becoming re-established. Several of the diseases here listed - Lymphatic Filariasis, Measles, Mumps, and Rubella - are among the diseases believed to be potentially eradicable by the International Task Force for Disease Eradication, and if successful, regional elimination programs may yet prove a stepping stone to later global eradication programs.

This section does not cover elimination where it is used to mean control programs sufficiently tight to reduce the burden of an infectious disease or other health problem to a level where they may be deemed to have little impact on public health, such as the leprosy, neonatal tetanus, or obstetric fistula campaigns.

[edit] Malaria

Malaria elimination has already been achieved in the USA, Australia and Western Europe. As of early 2009, a further 39 countries were in the process of eliminating malaria from all or part of their territory.[11] The WHO define elimination as having no domestic transmission for the past three years. They also define an "elimination stage" when a country is on the verge of eliminating malaria, as being <1>90% of the burden of lymphatic filariasis is on the island of Hispaniola (comprising Haiti and the Dominican Republic). An elimination effort to address this is currently under way alongside the malaria effort described above; the Dominican Republic expects to eliminate its 7 remaining foci by 2010, but lymphatic filariasis is still endemic to 110/140 communes in Haiti [14].

The efforts of the Global Programme to Eliminate LF are estimated to have already prevented 6.6 million new filariasis cases from developing in children, and to have stopped the progression of the disease in another 9.5 million people who have already contracted it. Overall, of 83 endemic countries, mass treatment has been rolled out in 48, and elimination of transmission reportedly achieved in 21.[22]

[edit] Measles and rubella

In the 1990s, the governments of the Americas, along with the Pan American Health Organization, launched plans to eliminate first measles and then also rubella from the region.[23] As of December 2008, the elimination of endemic transmission of measles from the Americas has been all but achieved, with occasional small outbreaks from imported cases,[24], such as a recent outbreak of measles in Canada.[25]. The WHO regional offices for Europe and for the Western Pacific are aiming to also achieve regional measles elimination by 2010 and 2012 respectively.[26][27] However, the global goal remains control (a 90% reduction in measles deaths by 2010 from the 757,000 deaths in 2000).[28]

Rubella elimination is not yet so advanced, but has also had much success - the number of reported rubella cases in the Americas fell from 135,947 in 1998 to 3,809 in 2008, and domestic rubella transmission in the Americas appeared to be confined to northern Argentina as of March 2009 [29]

[edit] Onchocerciasis

Onchocerciasis (river blindness) is the world's second leading cause of infectious blindness. It is caused by the nematode Onchocerca volvulus, which is transmitted to people via the bite of a black fly. Elimination of this disease is under way in the region of the Americas, where this disease is endemic to Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela. The principal tool being used is mass ivermectin treatment. If successful, the only remaining endemic countries would be in Africa.[30] In most endemic African countries, the focus is currently on control, but a few, such as Uganda,[31] are also attempting elimination.

[edit] Yaws

Yaws is a rarely fatal but highly disfiguring disease caused by the spiral-shaped bacterium (spirochete) Treponema pertenue, a relative of the syphilis bacteria Treponema pallidum, spread through skin to skin contact with infectious lesions. The global prevalence of this disease and the other endemic trematoses, Bejel and Pinta, was reduced by the Global Control of Treponematoses (TCP) programme between 1952 and 1964 from about 50 million cases to about 2.5 million (a 95% reduction). However, following the cessation of this program these diseases remained at a low prevalence in parts of Asia, Africa and the Americas with sporadic outbreaks. Yaws is currently targeted by the South-East Asian Regional Office of the WHO for elimination from the remaining endemic countries in this region (India, Indonesia and East Timor) by 2010, and so far, this appears to have met with some success, since no cases have been seen in India since 2004.[32][33]

[edit] See also

* Globalization and disease
* Public health

[edit] References

1. ^ Bulletin of the World Health Organization 76 (S2): 14–31. 1998.
2. ^
3. ^ a b "Smallpox". WHO. 2000. Retrieved on 2007-11-30.
4. ^ World Health Organization (2003). Global polio eradication initiative : strategic plan 2004-2008. Geneva: WHO. ISBN 924159117X. Retrieved on 2007-11-30.
5. ^ "Progress towards interruption of wild poliovirus transmission - Worldwide, January 2007 to April 2008". MMWR Morb Mortal Wkly Rep 57 (18): 489–494. 2008. PMID 18472451. Retrieved on 2009-01-16.
6. ^ Cochi and Kew (2008). "Polio today: are we on the verge of polio eradication?". JAMA 300 (7): 839–41. doi:10.1001/jama.300.7.839. PMID 18714066. Retrieved on 2009-01-16.
7. ^ Global polio eradication initiative website, access date 20 February 2009
8. ^ Dracunculiasis (Guinea Worm) Wrap-up #187: English | Carter Center
9. ^ Berry, Michele (June 21 2007). "The Tail End of Guinea Worm — Global Eradication without a Drug or a Vaccine". The New England Journal of Medicine 356 (25): 2561–64. doi:10.1056/NEJMp078089.
10. ^ Normile (2008). "Driven to Extinction". Science_(journal) 319: 1606–1609. doi:10.1126/science.319.5870.1606. PMID 18356500. Retrieved on 2009-03-28.
11. ^ Malaria Elimination Group description and list of elimination countries, access date 05 May 2009
12. ^ "WHO World Malaria Report 2008". 2004-11-08. Retrieved on 2009-02-27.
13. ^ "WHO Weekly Epidemiology Record 82 (4), 2007". Retrieved on 2009-03-12.
14. ^ a b "WHO Weekly Epidemiology Record 84 (11 & 12), 2009". Retrieved on 2009-03-12.
15. ^ "UCSF School of Medicine - Global Health Sciences". Retrieved on 2009-02-27.
16. ^ Roberts and Enserink (7 December 2007). "MALARIA: Did They Really Say ... Eradication?". Science 318: 1544–1545. doi:10.1126/science.318.5856.1544.
17. ^ Announcements - Bill & Melinda Gates Foundation
18. ^ "Global Malaria Action Plan". Retrieved on 2009-02-27.
19. ^ a b c d The Carter Center, "How is Lymphatic Filariasis Treated?",, retrieved on 2008-07-17
20. ^ "Lymphatic Filariasis Disease - Carter Center Lymphatic Filariasis Program". Retrieved on 2009-02-27.
21. ^ U.S. Centers for Disease Control and Prevention, "Preventing Two Diseases with One Net",, retrieved on 2008-07-17
22. ^ BBC World Service, "'End in sight' for elephantiasis",, retrieved on 2008-10-08
23. ^ PAHO measles & rubella control main page
24. ^ CDC MMWR, progress towards measles elimination, 2004
25. ^ NORTH YORK: Measles outbreak may bring new strategy
26. ^ WHO resolution EUR/RC55/R7
27. ^ WHO resolution WPR/RC56.R8
28. ^ Measles Initiative website, accessed 07 January 2009
29. ^ PAHO Measles/Rubella Weekly Bulletin volume 15, issue 10.
30. ^
31. ^ The Carter Center (2008-01-22). "Uganda Attempts Nationwide Elimination of River Blindness". Retrieved on 2009-02-27.
32. ^ Asiedu et al. (2008). "Yaws eradication: past efforts and future perspectives". Bulletin of the World Health Organisation 86 (7): 499–500. doi:10.2471/BLT.08.055608. PMID 18670655. Retrieved on 2009-04-02.
33. ^ WHO South-East Asia report of an intercountry workshop on Yaws eradication, 2006

External links

* Carter Center International Task Force for Disease Eradication
* Polio eradication page
* WHO home page

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