Jpn. J. Infect. Dis., 57, 1-6, 2004

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Review

Eradication of Infectious Diseases: Its Concept, Then and Now

Isao Arita*, John Wickett1 and Miyuki Nakane

Agency for Cooperation in International Health, Kumamoto 862-0901, Japan and 1World Health Organization, Geneva, Switzerland

(Received December 18, 2003. Accepted January 19, 2004)


*Corresponding author: Mailing address: Agency for Cooperation in International Health, 4-11-1 Higashi-machi, Kumamoto 862-0901, Japan. Tel: +81-96-367-8899, Fax: +81-96-367-9001, E-mail: arita@acih.com


CONTENTS:
1. Background
2. Building up the concept of eradication based on the eradication of smallpox
3. Application of smallpox experience to polio eradication
4. Application to measles eradication of experience gained from the smallpox and polio eradication programs
5. Discussion
 5-1. Smallpox
 5-2. Polio
 5-3. Measles
 5-4. Changing world
6. Reconsideration of the concept of eradication
7. Conclusion

SUMMARY: The concept of disease eradication emerged as recently as the mid-20th century. The successful eradication of smallpox resulted in the concept of the extinction of the causative agent in man as well as in the environment, leading to the cessation of all control measures including vaccination. Subsequently, world resources have been invested in global polio eradication and measles eradication in the Western Hemisphere. The former is apparently now at the "end game", the latter, after successful campaign in the Americas, aims at program development worldwide. However, both endeavors are being challenged by delays in schedules, unexpected technical problems, lack of global coordination, and ever-increasing political unrest. It is proposed that disease eradication be redefined as the extinction of the pathogen in man, not in nature, making for a more flexible approach in the post-eradication period. Smallpox eradication was a rare event. That concept is unrealistic in today's world.


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