THE GLOBAL ERADICATION OF SMALLPOX
THE GLOBAL ERADICATIONOF SMALLPOXFinal Report of the Global Commission forthe Certification of Smallpox Eradication,Geneva, December 1979WORLD HEALTH ORGANIZATIONGENEVA1980
HISTORY OF INTERNATIONAL PUBLIC HEALTH, No. 4ISBN 92 4 156065 7 World Health Organization 1980Publications of theWorld Health Organization enjoy copyright protection in accordance withthe provisions ofProtocol2 of the Universal Copyright Convention. Forrights of reproduction ortranslation of WHO publications in part or in toto, application should be made to the Office ofPublications, World Health Organization, Geneva, Switzerland. The World Health Organizationwelcomes such applications.The designations employed and the presentation of the material in this publication do notimply the expression of any opinion whatsoever on the part of theDirector-General of theWorldHealth Organization concerning the legal status of any country, territory, city or area or of itsauthorities, or concerning the delimitation of its frontiers or boundaries.PRIN1ED IN SWITZERLAND80/4790- Alar- 5500
ForewordOn 8 May 1980, the 155 Member States of the World HealthOrganization, represented by their delegates to the Thirty-third WorldHealth Assembly, unanimously accepted the conclusions of theGlobal Commission for the Certification of Smallpox Eradica tion-namely, that:"1. Smallpox eradication has been achieved throughout theworld."2. There is no evidence that smallpox will return as an endemicdisease."Because of the uniqueness of the achievement and the effect it hasalready had, and will continue to have, on the lives of peoplethroughout the world, it is important that public health officials,historians and future generations should have access to the evidenceupon which these conclusions are based. This book, The GlobalEradication of Smallpox, which is the report of the Global Commis sion, carefully presents and discusses that evidence. It also includesrecommendations on policy for the post-eradication era to ensure thatthis achievement is permanent.The eradication of smallpox has shown that resounding victoriescan be attained by international cooperation when the objectives arewell focused, plans are realistically constructed, and the necessaryresources are made available in time. Let this final report of theGlobal Commission stimulate us all to reflect not only on theeradication of one disease but on how this experience can help us toattack more effectively other health problems with the same enthu siasm, optimism, and sheer hard work that characterized the success ful crusade against smallpox.H. MAHLER, M.D.Director-General
MEMBERS OF THE GLOBAL COMMISSION FOR THE CERTIFICATION OF SHALLPOX ERADICATIONLeft to right.Front row:Dr Koinange Karuga;Dr Dumbell;Dr Marennikova;Dr Zhang.Dr Netter;Back row:Dr Tagaya;Dr J. AashiAssistant Director-GeneralPreventive MedicineMinistry of HealthRiyadSaudi ArabiaDr J. AzurinUnder-Secretary of HealthDepartment of HealthManilaDr Azurin;Dr \i'ehrle;Dr Hoeti;Dr Burgasov;Dr Basu;Dr Kalisa;Dr Fenner;Dr Aashi;Dr Shrestha;Dr Kostrzewski;Dr Henderson;Dr Rodrigues;Dr Lundbeck;Dr Deria.Dr D.A. HendersonDr I. TagayaDean,Director-,School of Hygiene and Public HealthDepartment of EnterovirusesThe Johns Hopkins UniversityNational Institute of Health615Murayama AnnexNorth Wolfe StreetBaltimoreGakuenMaryland 21205Musashi-MurayamaUSATokyo 190-12JapanDr Kalisa RutiDirector,Expanded Programme onI:mmunizationDr P .F.Wehrle (Rapporteur)Hastings Professor of PediatricsPhilippinesP.O. Box 1899Pediatric PavilionKinshasaZaireLos Angeles County - University ofDr R.N. BasuAssistant Director-General ofHealth Services (Smallpox)Directorate General ofHealth ServicesNew DelhiDr W. Koinange KarugaDirectOr of Medical Servic sMinistry of HealthP.O.USADr Zhang Yi-haoKenyaDr P.N.BurgasovDeputy Minister of Healthof the USSRMinistry of Health of the USSRR.:-,hmanovskij per. 3MoscowDeputy DirectorNational Serum and Vaccine InstituteDr J. KostrzewskiSecretary,(Vice-Chairman)Medical SectionPolish Academy of SciencesBeijingChinaPalac Kultury i NaukiDr R. Netter00-901 WarsawDirector-G eneralPolandUSSRLos AngelesCalifornia 90033Box 30016NairobiIndiaLaboratoire25Dr A. DeriaNational Programme ManagerSmallpox Eradication Programme/c o WHO Programme CoordinatorP.O. Box 374MogadishuSomaliaDr K.R.Head,Southern California Medical Center1129 North State StreetDumbellDepartment of VirologyThe Wright-Fleming Instituteof MicrobiologySt Mary's Hospital MedicalSchoolLondonW2 lPGUnited KingdomDr F. Fenner (Chairman)Director,Centre for Resource andEnvironmental StudiesThe Australian National UniversityP.O. Box 4Canberra,AustraliaA.C.T. 2600national de la SanteBoulevard Saint-JacquesDr H. LundbeckParis 75014DirectorFranceNational Bacteriological LaboratorylOS 21 StockholmDr Bichat A. RodriguesSwedenExecutive Secretary of NationalDr S.S. MarennikovaMinistry of HealthChief, Smallpox Prophylaxis DepartmentBrasilia 70.000Research Institute of Virus PreparationBrazilCouncil of Health1st Dubrovskaya ul. 15Dr P.N.USSRChief,ShresthaPlanning DivisionInstitute of MedicineDr J.S. i:1oetiHaharajgunjaChief Medical Officer of HealthKathmandu inistry of HealthNepalGaboroneBotswana1Dr C. McfidiApartment o. 249,Block 1Behjatabad BuildingTeheran l5Iran1unable to attend
page 5C 0 N T E N T SPREFACE91.S l)M}"JARY102.CONCLUSIONS AND RECOMMENDATIONS122. 12.21212ConclusionsRecommendations : Pol i cy for the po st-eradication eraVaccination policyRes erve stocks of vaccineInvestigation of suspected smallpox cas e sLaboratori es retaining vario la virus stocksHuman monkeypoxLaboratory inve stigationsDocumentation of the smallpox eradication progr ammeWHO headquarters staff3.HIS TORY OF SMALLPOX , VARIOLATION Ju D VACCINATION163.13.21617Pos sib l e origin of smallpox and h i story of its g lob al spreadE arly efforts at control3.2.13 . 2.24.CLINICAL FEATURES AND DIAGNO S I S OF SMALLPOX194.119C l inical cours e4.1 . 14.24.35.6.Variol ation as a method of controlVaccination as a method of controlCase fatality rate2020C linical differentiation from other diseasesLaboratory diagnosisEPIDEHIOLOGY OF nitySpreadAge incidenceS easonal incidenceINTERNATIONAL INVOLVEYffiN T IN CONTROL AND ERADICAT ION6.16.26.31924-1 9 4 71948- 1 9 5 7195 8- 1 9 6 71924- 1 9 6 623232424
page 67.THE ESTABLISHMENT OF THE INTENSIFIED SMALLPOX ERADICATION PROGRAMME7.17.27.38.HeadquartersRegional officesNat ional programmesS TRATEGIES IN THE INTENSIFIED ERADICATION PROGRAMHE8.1Provi s ion of a sufficient amount of potent and heat- stab l e 8.2.48.38.3.28.48.4.18.4.38.4.4.28.5.23133S p ecial s earchesConcealment of outbreaksVariolationResearch8.5.130Conta inmentS pe c ial prob lems8.4.4.18.527Routine report ing sys temsAct ive surveil lance8.4.2.18.4.427Les sons from the fieldCharacteristics of smallpox fac i l i tating eradicationThe survei l lance and containment strategy8.4.226Rat ionaleVaccinat ion coverageAs s e s smentSuc c e s s e s and failuresChanging s t rategies8.3.12526Freeze-dried vaccineProduct ionQua l i ty controlProvision of consul tant services , f el l owship training andvacc ine t e s t ing by WHOTechniques of vacc inat ionCompl i cations of vaccinationThe mas s vaccination s t rategy8.2.125Epidemiology and pub l i c healthVirology36
page 79.IMPLEMENTATION OF THE INTENSIFIED ERADICATION PROGRAMME9.1The p eriod from 1 967 to 19729.1.19.1.2Other central Afr i c an countriesSouth-eastern Afr i c a9.1.5Sudan and Uganda10 .Indone s ia42BurmaAfghanistanPak i s t anNepalIndiaBhutanBang l adeshThe countries o f the Arabi an peninsulaCountries in the Horn of Africa9.4. 19 .4. 29.4.39.4.49.5UgandaSudanSouthern Asi a9.2.19.2.29.2.39.2.49.2.59.2.69.2.79.39.4Braz i lOther countries9.1.39.1.49.1.5 . 19.1.5.29.237West and central AfricaSouth America9.1.2.19.1.2.29.1.6364646Djibout iEthiopi aKenyaSomaliaMi s s ed outb reaks49OUTBREAKS OF SMALLPOX IN NON-ENDEMIC AF.EAS5010 . 1 Importations of sma l lpox501 0 . 1 . 1 International quarantine10 . 1 . 2 Impo rtations into Europe , 19 50-1 9 7 711 .10 . 2 Lab oratory-asso ciated outbr eaks51THE CERTIFICATION OF ERADICATI ON511 1 . 1 Internati onal Commi s s i ons1 1 . 2 Preparati ons for certi f icati on5152
page 811.2.1 In recently endemic and adj acent countries11.2.1.1 Effectivenes s o f the routine r eporting system11.2.1.2 Active s earches11.2.1.3 Pockmark surveys11.2.1.4 Chickenpox survei l l ance11.2.1.5 Rumour reg i s t er11.2.1.6 Specimens f o r laboratory diagno s i s11.2.1.7 Pub l i c i ty , knowledge about sma l lpox, and rewards11.2.2 In countries free from smal lpox for s everal years11.3 Cert i f i cation by international commi s s i ons5711.4 Certi f ication by the Global Commi s s ion5911.4.1 Rationale11.4.2 Action by the Global Commi ss ion11.4.2.1 Countrie s al ready cer t i fied by international commis sion s11.4.2.2 Countries designated f o r special reports and / o r vi sits11.4.2.3 Formal s tatements by countrie s and areas12.11.5 Internat ional smal lpox rumour register59HUMAN MONKEYPOX6012.1 Discovery and prop erties of monkeypox virus13.6012.2 Human infections with monkeypox virus61POSS IBLE SOURCE S FOR A RETURN OF SMALLPOX6213.1 Laboratory s t o cks of variola virus6213.2 De liberate releas e6213.3 Natural reservoi r s o f variola virus6213.3.1 Virus in crus t s13.4 An animal reservo ir6213.4.1 Whitepox virus13.4.2 Whi te pock variants of monkeypox virus14.INTEID ATIONAL RESOURCES FOR THE INTENSIFIED ERADICATION PROGRAMME6314.1 Financial6314.1.1 1958- 196614.1.2 1967 - 198014.2 National and l o cally recruited p ersonnel6414.3 International p er s onnel6414.4 Vaccine6514.5 Trans p o rt65ANNEXES 1-1966
n the Worlduntildisease1958Health Organizationcontrolofdecade,inbutsmallpox.1 9 67timeofsmallpoxoraffectedanother.of lfofand Oceania,thebutitAsia and South America.whichthat there was an expliciteradication1200thecenturyonemost countriesremained endemic in most of Africa,importantatcall28Another1 9 48was set up inshouldbefromsoughtbythe Worldcountriesbecamethe disease was still endemic inmillion and in that year it "caused an estimatedit singled out smallpox as anallcountries,He althfreebutitwasnotAssembly for the worldwideofsmallpox33 countries10-15 millionduringthenextwith a total population ofcases,2with dHealtheradicationprogramme received substantialsupportafter country achieved theglobalworlderadicationcould beofcallingtheappearedassuredforaneradication.As a resul , countrytoo,·from the regular budget of WHO.andsoForof thetimminent.Somereality ofthisunprecedented achievement.In1 9 77O ctobertheDirector-GeneralofWHOconvenedcountries throughout the world to advise the Organization onshouldbetakentobeen achieved.assurethe OrganizationandSuch an assurance was )toreporthad been achieved,. andThirty-firstsmallpoxshouldauthoritiesittothe(4 )pos t-eradicationHealthAssemblyGlobalCommission met inthatfromeradicationwere totake Generalbeinitexpertsfor the(2 onsatisfiedthatto recommend such additional measures as it consideredera.Worldexpertsmeasures thatcertificates.establishreviewdeemedofthethat travellers should no longervaccinationformallytoasgroupif health authoritiesdecision that smallpox vaccination should be terminated andbeanature ofinThe1978MayExecutiveBoardendorsedthein1 .Thesubsequent activities.DecemberIt met again in December1978 to review the programme and1979 to assess progress, and atmade the final recommendations that are presented in this ethehistorydisease,intensifiedthe certification tachieved.tribute to the internationalhundreds ofthousandsmade it eradication arefindings provide the evidence al,it1 9 6 7-197 9 .asthat m etingThe report also contains aeradicatewellto advise ceduresfindingsinvirological1 9 6 6,differentcountries.Theseconclusion that the global eradication ofachievement,theGlobalCommissionpayscooperation received in the programme and to the devoted work dthat
10page1.SUMMARYSmallpox,describedministers of death",have· sweptJennertherehopedemonstratedthatwidespread iewedtheshouldbeenthemade.decided that an intensified programme ngspecialBrazil1 94 8 ,inoferadication,programmessmallpox-free during the followingsouthhadtimeitemphasizingcountries becameareasthe1958Insmallpox-endemicnumber ofendemicprogress"theancientinoculation with cowpox would protect against smallpox was·.could be c ontrolled.Jenner himself foresaw the eradication ofabout smallpox.worldthatAasdecimating populations and altering the course of history.later,HealthconcernfromMacaulaymankind sincesmallpox persisted in many parts of the world.The Worldincreasinghistorianscourge ofthatthe disease170yet,theaacross the world,untilsmallpox,byhas beenyears,South-EastNineteenth inanced from the regular budget of nciestoprovide additional assistance.Theoveralldevelopmentandout by a smallpox unit iedofficesEarliercampaigncoordinationat ers 80%theleastofpopulation within a period of two or three years, during which time reporting systems andsurveillance activities would be developed that would permit detection and elimination of tainedfrommanydifferentgovernments and agencies.Progress was slow in somecentralAfricacountriesinbecameeasternIndian subcontinent,1975.1977.Finally,Twocountries but rapid in nwith increased WHO support,in ftheafter,andotherwere visited ctedassessed.totheand thesmallpoxtheirCo messpecialriskandthecountries of tofrom lpoxreportingTheofbyeach country in which smallpox had been endemiccontinuingthecampaignsachieved eradication therecommission.laboratoryThe countries of west andIndonesiabecame smallpox-freesurveillancedetecteffectivenessdetect facial pockmarks,wherecountriesinternational1971 ,inMajornationalfollowing a period of intensive surveillance,inBrazilsmallpoxcasesman ywerepartsofand,alsoeachcountry before certifying that the country was Commissionreviewedadditional programmes for obtainingberecognizedassmallpox-free.Arecent past were visited by WHOallfortheCertificationprevioussufficient xactivitiesfrom eachknowntoEradicationandwasrecommendedcountry to permit it tohavebeeninfectedintheconsultants or staff 'and special programmes were developed toassess the quality of the evidence that no smallpox had occurred since the last reported case.TheGlobalCommissionalsoof smallpox infection from nvirustheconditionsfromnumberrequiredconsidered the questionheld in fvirusescapesreservoirs.B ecauseandisnowtheofthestrictconsidered
page 11minimal. Dried c rusts and variolators' stocks provided a natural reservoi r 1n which variolavirus c ould survive for some months, but the passage of several years since the last case ofsmallpox also renders th is ri sk ne gligible .From the outset of the intens i f i ed c ampaign special attention was paid to thepossib i l ity that there was an animal reservoir of variola virus.No evidenc e of such areservoi r has b e en found.However, 45 c ases of a new human d isease resembling smallpoxc linically have been d i scovered since 1970 in west and c entral Africa.It i s c aused by ad istinct spe c i es of orthopoxvirus called monkeypox v irus.Al though c ases of presumedhuman-to-human transmission of monkeypox virus have been recorded, this virus is genetic allyd i f ferent from variola virus and i s not believed to have the potential for epi demic spread.As a result of its deliberations in December 1979, the Global Commission concludedthat global eradication of smallpox had b een achieved and made a number of rec ommendationsfor WHO p olicy in the post-eradication era.They inc lude the d i sc ontinuation of smallpoxvaccination, c ontinuing surveillance of monkeypox in West and Ce ntral Afric a , supervision ofthe stocks and use of variola virus in laboratorie s , a policy of insuranc e against the returnof the d isease that includes thorough investigation of reports of suspected smallpox, themaintenanc e of an international reserve of freez e-dried vacc ine under WHO c ontrol , andmeasures designed to e nsure that laboratory and epidemiological expertise in human p oxvirusi nfecti ons should not be d issipated.
page 122.CONC LUSIONS AND RECOMMENDATIONS2. 1ConclusionsThe Global Co mmission c oncludes that:2.21.Smallpox eradication has been achieved throughout the world;2.The re is no evidence that smallpox will return as an ende mic disease.Rec ommendations : policy for the po st-eradication eraVac c ination policySmallpox va ccination of the general public.As smallpox has been e radic ated,smallpox vac c i nation is no longer justified.Because vac cination may result in seriouscomplications, wh ich are occasionally fatal, no one except investi gators at spec ial riskshould be vac c inated in any country including those where monkeypo x cases have occurred.Rec ommendation ( 1 ). Smallpox vac c i nation should b ediscontinued in e ve ry country exc ep t for investigators a tspe c ial risk.vacc inationc ertificatesforinternationalWithSmallp oxtravellers.thecertification of global eradication of smallpox, no country should now require vac c inationc ertificates from international travellers.Recommendation (2 ).International certificates of vac c i nationagainst smallpox should n o longer b e required of any travellers.Reserve stocks of vacc neAl though human-to-human transmission of smallpox has been int
Eradication of Smallpox, which is the report of the Global Commis sion, carefully presents and discusses that evidence. It also includes recommendations on policy for the post-eradication era to ensure that this achievement is permanent. The eradication of smallpox has shown that resounding victories
Somali smallpox eradication programme. Since that date, 26 October 1977, no further case of smallpox infection has been detected in the Horn of Africa, or anywhere in the world . This date, therefore, appears to mark the turning point in the global smallpox eradication campaign. Until then, the major objective had been to eliminate all smallpox .
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .
against smallpox. Since the eradication of smallpox in 1980, many countries (including DR Congo) have eliminated childhood vaccination against smallpox, and, as a result population-level vaccine-derived immunity has been diminished. A newer and safer third-generation smallpox vaccine is a good candidate for use in an endemic are for monkeypox .
On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
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