Disease eradication

1. Disease Eradication The Past The Present and The Future By Dr Ehab Omrani M.B.B.Ch M.P.H (Occupational Health) D.T.M&H(Tropical Medicine)

2. CONTENT Definition Eradication Criteria Successful Eradication Programs Ongoing Eradication Programs Former Eradication Programs

3. Definition Eradication It is an absolute process an “ all or none” phenomenon. R estricted to termination of an infection from the whole world.

4. Definition It is sometimes confused with: Elimination : Which used to describe of eradication of disease from a large geographic region or political jurisdiction When a disease stops circulating in a region, it’s considered eliminated in that region. If a particular disease is eliminated worldwide, it’s considered eradicated .

5. Definition Polio , for example, was eliminated in the United States by 1979 after widespread vaccination efforts . Further confusion arises from the use of the term eradication to refer to the total removal of a given pathogen from an individual (also known as clearance of an infection ).

6. Eradication Criteria Selection of infectious diseases for eradication is based on rigorous criteria? B oth biological and technical features determine whether a pathogenic organism can be (at least potentially) eradicated or not.

7. Eradication Criteria The targeted organism must not have a non-human reservoir. This implies that sufficient information on the life cycle and transmission dynamics is available at the time an eradication initiative is programmed. I n the case of animal diseases , the infection reservoir must be an easily identifiable species , as in the case of rinderpest ), and/or amplify in the environment .

8. Eradication Criteria An efficient and practical intervention (e.g., vaccine) must be available to interrupt transmission of the infective agent. The disease to be eradicated should be clearly identifiable, and an accurate diagnostic tool should exist.

9. Eradication Criteria Economic considerations, as well as social and political support and commitment, are other crucial factors that determine eradication feasibility.

10. Eradication Programs T wo successful programs targeting S mallpox R inderpest

11. Eradication Programs Two former programs targeting Hookworm Yellow fever

12. Eradication Programs Four ongoing programs targeting P oliomyelitis Y aws D racunculiasis M alaria

13. Eradication Programs Five more infectious diseases have been identified as of April 2008 as potentially eradicable with current technology: M easles M umps R ubella Lymphatic filariasis C ysticercosis

14. Successful Eradication P rograms

15. Smallpox Smallpox was the first disease, and so far the only infectious disease of humans, to be eradicated by deliberate intervention. It became the first disease for which there was an effective vaccine in 1798 when Edward Jenner showed the protective effect of inoculation (vaccination) of humans with material from cowpox lesions

16. Smallpox Eradication was accomplished with a combination of focused surveillance—quickly identifying new smallpox cases —and ring vaccination.

17. Smallpox “ Ring vaccination ” meant that anyone who could have been exposed to a smallpox patient was tracked down and vaccinated as quickly as possible, effectively corralling the disease and preventing its further spread.

18. Smallpox Last natural smallpox case was of Ali Maow Maalin in, Merca / Somalia on October 26:1977

19. Smallpox It is useful to consider the epidemiological factors which have led to eradication of smallpox; these could form the basis for eradication for other disease: No known animal reservoir. No long-term carrier of the virus. Life-long immunity, after recovery from the disease. S imple detection of cases , the rash was so characteristic and occurred in visible parts of the body.

20. Smallpox Persons with subclinical infection did not transmit the disease Vaccine highly effective, easily administered, heat stable, and confers long term protection International cooperation

21. Rinderpest It is a viral disease which infected cattle and other ruminants and belonged to the same family as measles During the 20th century, there were a series of campaigns to eradicate it, through the use of a live attenuated vaccine

22. The final, successful campaign was led by the Food and Agriculture Organization (FAO) of the United Nations.

23. Rinderpest On 14 October 2010 , with no diagnoses for nine years , the FAO announced that the disease had been completely eradicated. It is the first (and so far the only) disease of livestock to have been eradicated by human undertakings.

24. Ongoing Eradication P rograms

25. 1-Dracunculiasis ; guinea worm disease It is a painful and disabling parasitic disease caused by a worm, Dracunculus medinensi . It is spread through consumption of drinking water infested with copepods hosting the larvae .

26. Dracunculiasis ; guinea worm disease Guinea worm disease is set to become the second human disease in history, after smallpox, to be eradicated. It will be the first parasitic disease to be eradicated and the first disease to be eradicated without the use of a vaccine or medicine.

27. Dracunculiasis Eradication efforts have been based : On making drinking water supplies safer (e.g. through treating the water with larvicide ). C ontainment of infection. E ducation for safe drinking water practices.

28. Dracunculiasis The original goal for eradication was 1995 . T wo decades of eradication efforts have reduced guinea worm's global incidence to: m ore than 99.99%   to  126 cases in 2014 , down from an estimated 3.5 million in 1986

29. Dracunculiasis South Sudan , the world's youngest nation, reported 70 cases or 56 percent of the worldwide case total in 2014. The remaining indigenous cases in 2014 were reported in isolated areas of Chad (13), Mali (40), and Ethiopia (3).

30. 2-Measles It is an airborne disease Spreads easily through the coughs and sneezes of those infected , and contact with saliva or nasal secretions. Nine out of ten people who are not immune who share living space with an infected person will catch it.

31. Measles The measles vaccine is effective at preventing the disease? Vaccination has resulted in a 75% decrease in deaths from measles between 2000 and 2013 with about 85% of children globally being currently vaccinated.

32. Measles In 2009 the regional committee for Africa agreed a goal of measles elimination by 2020 Europe had set a goal to eliminate measles transmission by 2010, but were hindered by : The MMR vaccine controversy ? They have set a new target of 2015

33. Measles The Americas set a goal in 1994 to eliminate measles transmission by 2000, and successfully achieved regional measles elimination in 2002 . As of February 2015 , measles is no longer eliminated in the US . From January 1 to April 10, 2015 , 159 people were reported to have measles. most of these cases [117 cases (74%)] are part of a large, multi-state outbreak linked to an amusement park in California

34. O utbreak Response in Sudan 5 April 2015 – The Ministry of Health of Sudan, in collaboration with the World Health Organization (WHO), UNICEF and other partners, respond to the measles outbreak More than 1600 suspected measles cases (with 710 confirmed) have been reported from 23 localities in 12 states of Sudan.

35. Outbreak Response in Sudan One of the most affected states is West Darfur , with most cases being reported among goldmine workers A WHO proposal to allocate US$ 3.9 million for response activities Ongoing actions are being undertaken for the implementation of initial response and containment measures including: Case management A lert investigation Response vaccination campaigns and community health awareness .

36. Geographic distribution of measles cases in the EMR countries by district and final diagnosis between July 2010 and June 2011 Source : Official countries’reports

37. Measles At the 63rd World Health Assembly in May 2010 , delegates agreed to move towards eradication, although no specific global target date has yet been agreed

38. Challenges Funding: specially for the follow-up campaigns National managerial Capacity: Inadequate number and qualification of staff Competing priorities: Polio eradication Pockets of susceptible populations/groups Hard to reach populations in low income countries Pockets in countries with big expatriate population Security situation: rapidly deteriorating in the EMR Delayed implementation of planned activities Financial support from international partners Interest of the countries Polio infrastructures Opportunities Measles

39. History of polio… The disease of poliomyelitis has a long history. The first example may even have been more than 3000 years ago. An Egyptian stele dating from the 18th Egyptian dynasty shows a priest with a deformity of his leg characteristic of the flaccid paralysis typical of poliomyelitis. 3-Poliomyelitis (polio)

40. Poliomyelitis(polio) The World Health Assembly launched the Global Polio Eradication Initiative (GPEI) in 1988 Since the GPEI was launched, the number of cases has fallen by over 99%. In 2013 , only three countries in the world remain polio-endemic: Nigeria, Pakistan and Afghanistan

41. Poliomyelitis(polio) Middle East: The most recent case reported from Syria had onset of paralysis on 21 January 2014, while in Baghdad- Resafa province, on 7 April 2014. Horn of Africa The most recent case, which had onset of paralysis on 11 August 2014 , was from central Somalia

42. The Global Polio Eradication Initiative ( GPEI) Objectives T o interrupt transmission of wild poliovirus as soon as possible T o achieve certification of global polio eradication T o contribute to health systems development and strengthen routine immunization and surveillance for communicable diseases

43. The Global Polio Eradication Initiative Four Pillars of the Global Polio Eradication Initiative Strategy: Routine Immunization. Supplemental Immunization Activities. Acute Flaccid Paralysis (AFP) Surveillance. Targeted Mop-Up Campaigns.

44. 1. Routine Immunization A major cornerstone of the polio eradication strategy According to WHO/UNICEF immunization coverage estimates, 86% of infants received three doses of oral polio vaccine in 2010 , compared with 75% in 1990 . . The Global Polio Eradication Initiative

45. Good routine OPV coverage: I ncreases population immunity Reduces the incidence of polio Makes eradication feasible plan of routine immunization for out reach areas. The Global Polio Eradication Initiative

46. The Global Polio Eradication Initiative 2. Supplemental Immunization Activities Mass polio immunization campaigns that complement routine immunization programs are intended to: Interrupt transmission by immunizing every child under the age of 5 with oral polio vaccine annually, regardless of the number of times they have been immunized previously.

47. The Global Polio Eradication Initiative 3. Acute Flaccid Paralysis (AFP) Surveillance As many as 90% of people infected with the poliovirus experience very mild or no symptoms. A single symptomatic case can therefore represent a significant community-wide outbreak. Robust surveillance to detect and investigate every case of polio-like AFP is essential to polio eradication.

48. The Global Polio Eradication Initiative 4. Targeted Mop-Up Campaigns Last stage in polio eradication Low routine immunization coverage: very dense or mobile populations, inadequate sanitation, and poor access to health services exacerbate communities’ vulnerability to polio.

49. The Global Polio Eradication Initiative In focal areas where polio cases have been confirmed within the previous 3 years and circulating virus is confirmed or suspected. In mop-up campaigns vaccinators go house-to-house to immunize every child under 5 and help to stop transmission.

50. The Global Polio Eradication Initiative Before a WHO region can be certified polio-free , the following conditions must be satisfied: (A) AT LEAST THREE YEARS OF ZERO POLIO CASES DUE TO WILD POLIOVIRUS (B)  EXCELLENT CERTIFICATION STANDARD SURVEILLANCE EACH COUNTRY MUST ILLUSTRATE THE CAPACITY TO DETECT, REPORT AND RESPOND TO “ IMPORTED ” POLIO CASES .

51. The goal of the 2013-2018 Polio Eradication and Endgame Strategic Plan is to complete the eradication and containment of all wild, vaccine-related and Sabin polioviruses , such that no child ever again suffers paralytic poliomyelitis

52. Poliomyelitis(polio ) in Libya Libya reported the last confirmed polio case in 1991.  Routine immunization Routine immunization against polio has been mandatory since 1970. National immunization days National immunization days and supplementary immunization days in high-risk areas are conducted yearly.

53. Poliomyelitis(polio) in Libya Acute flaccid paralysis surveillance National reporting started in Libya in 1997.  Acute flaccid paralysis surveillance indicators have met certification standards since 2002. Laboratory There is no poliovirus laboratory in Libya; it is served by the Tunisian poliovirus regional reference laboratory in Tunisia.  laboratory containment of polioviruses has been completed and a report documenting the quality of containment activities has been submitted to WHO. 

54. Conclusion At present , polio is endemic in three countries Until poliovirus transmission is interrupted in these strongholds, all countries remain at risk, as shown not only by the outbreak in Syria , but also in recurrent outbreaks across sub-Saharan Africa , including an ongoing outbreak in Somalia. But the outbreak also serves as a reminder that high vaccination coverage is essential in countries where the disease is not currently circulating. .

55. F ormer Eradication Programs Hookworm Hookworm infection is caused by the transmission of the hookworm parasite common to warmer climates. Hookworm larvae live in soil and typically enter humans through the soles of their feet Hookworm eradication campaign start at US in 1909

56. Hookworm 700 million people worldwide, including 44 million pregnant women. Tropical or sub-tropical environments in poverty-stricken areas of Africa, Latin America, Southeast Asia and China. In North American countries , such as the United States, elimination of hookworm had been attained .

57. Hookworm While regions such as Mexico still deal with these infections from parasitic worms, WHY ? Hookworm campaign start in the 1920s was supposed to focus on the eradication for those living in Mexico and other rural areas. However, the campaign was politically influenced, causing it to be less successful.

58. Hookworm In 2001 , the World Health Organization adopted a resolution aimed at the deworming of 75 percent of all at-risk school -age children by 2010 . The largest public health program ever attempted to date.

59. Hookworm A hookworm vaccine is also in development and is currently in a Phase I clinical trial by the Sabin PDP. The 2012 WHO Road Map added 75% coverage of all at-risk pre -school-age children .

60. Conclusion It is useful to consider the successful eradication p rograms, these programs could form the basis for eradication for other disease . Both biological and technical features of the disease should be considered before starting it is eradication programme. We have to put in our knowledge the economic , social and political issues before setting a specific global target date for any eradication programme.

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