Update: International Task Force for Disease Eradication, 1990 and 1991

In 1988, a decade after the successful eradication * of smallpox, the International Task Force for Disease Eradication (ITFDE) was formed to systematically evaluate the potential for global eradicability of candidate diseases, identify specific barriers to their eradication that might be surmountable, and promote eradication efforts. In its first two meetings in April and October 1989, the ITFDE determined that two of eight diseases examined were eradicable and three others were candidates for elimination of transmission or clinical symptoms (1). In its third and fourth meetings in August 1990 and June 1991, the ITFDE evaluated the potential eradicability of seven other diseases. This report summarizes the results of the third and fourth meetings.

The working criteria used by the ITFDE in evaluating the diseases evolved from formulations used in the first two meetings (see box). Based on these criteria, the ITFDE concluded that, of the seven diseases considered, mumps and rubella are potentially good candidates for eradication (Table 1). Diseases Evaluated

Mumps. Mumps is probably eradicable through the use of measles-mumps-rubella (MMR) vaccine, but more data are needed documenting the impact of mumps and the use of the vaccine in developing countries. The necessary studies of mumps and rubella could be conducted simultaneously at the same sites.

Rubella. Rubella is probably eradicable, but more data on this disease's impact in developing countries are needed to support development of the necessary political commitment to do so. Eradication appears economically feasible because of the combined MMR vaccine.

Hepatitis B. Although global eradication of hepatitis B is not now feasible, transmission can be eliminated over an extended period (i.e., decades) by universal vaccination.

Neonatal tetanus. Neonatal tetanus, a major cause of death in developing countries, is completely preventable and can be eliminated if effective interventions (e.g., aseptic deliveries and vaccination of mothers and children) are universally applied indefinitely; however, the disease cannot be eradicated.

Diphtheria. Diphtheria might eventually be eradicable; however, information regarding its effects in developing countries and the epidemiologic effects of widespread diphtheria vaccination in these areas is limited.

Pertussis. Pertussis is not now eradicable, but better control could be attained by improving the vaccine and diagnostic methods and by more thorough study of the disease's epidemiology in developing countries. If an appropriate antigen were available that could be administered safely to adults, studies should be conducted regarding the possibility of protecting infants better by booster vaccination of their mothers to enhance maternal antibody.

Yellow fever. Yellow fever is not eradicable because of the sylvatic cycle of infection. Nonetheless, better use of vaccine could eliminate yellow fever in urban areas and reduce epidemics in rural areas. Other Diseases Discussed

In addition to evaluating the potential eradicability of these seven diseases, the ITFDE determined that an opportunity exists to greatly reduce the burden of disease caused by several major helminthic infections (e.g., schistosomiasis, ascariasis, hookworm disease, and trichuriasis) by using mass chemotherapy with appropriate combinations of broad-spectrum anthelminthics that are now available for oral administration in a single dose. The ITFDE endorsed an effort to undertake such a program in a developing country. Reported by: DR Hopkins, MD, Global 2000, Inc, Carter Center of Emory Univ, Atlanta. K Warren, MD, Maxwell Communication Corporation, New York City. Div of Immunization, National Center for Prevention Svcs; Technical Support Div, International Health Program Office; Div of Viral and Rickettsial Diseases, Div of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note:

At its first meeting, the ITFDE agreed on the eradicability of dracunculiasis and poliomyelitis, two diseases whose eradicability had been acknowledged previously by the World Health Organization. With its finding that rubella and mumps are also good potential candidates for global eradication, the ITFDE added a new element to the future international agenda for eradication. Appropriate agencies and other institutions should act promptly on the recommendation to seek more information about the impact of those two diseases (and of the respective vaccines) in developing countries.

In addition to adopting a resolution officially establishing the goal of eradicating dracunculiasis by the end of 1995, the 1991 World Health Assembly also set a goal of global leprosy elimination (defined as incidence less than 1 case per 10,000 population) by the year 2000.

Criteria for Assessing Eradicability of Diseases Scientific Feasibility

• Epidemiologic vulnerability (e.g., existence of nonhuman reservoir, ease of spread, natural cyclical decline in prevalence, naturally induced immunity, ease of diagnosis, duration of any relapse potential).

• Effective, practical intervention available (e.g., vaccine or other primary preventive, curative treatment, ``vectoricide.'' Ideally, intervention should be effective, safe, inexpensive, long-lasting, and easily deployed).

• Demonstrated feasibility of elimination (e.g., documented elimination from island or other geographic unit). Political Will/Popular Support

• Perceived burden of the disease (e.g., extent, deaths, other effects; true burden may not be perceived; the reverse of benefits expected to accrue from eradication; relevance to rich and poor countries).

• Expected cost of eradication (especially in relation to perceived burden from the disease).

• Synergy of attack with other interventions (potential for added benefits or savings, spin-off effects (e.g., polio eradication/Expanded Program on Immunization, guinea worm/Water and Sanitation Decade, yaws/Primary Health Care)).

• Necessity for eradication rather than control.

Reference

1. CDC. International Task Force for Disease Eradication. MMWR 1990;39:209-12,217.

• Eradication is defined as achievement of a status whereby no further cases of a disease occur anywhere, and continued control measures are unnecessary.

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