Control, Elimination, Eradication and Re-emergence of Infectious Diseases: Getting the Message Right

This article, published in the Bulletin of the World Health Organization (WHO), discusses the importance of continued intervention measures to prevent the re-emergence and re-establishment of transmission of infectious diseases. The author states that it is this need for continued intervention after reaching elimination or control targets that has led to confusion among health policy makers, public health workers and politicians, often leading to neglect or complete cessation of intervention activities and thus to a re-emergence of the target disease.

An example of this re-emergence is the case of the spread of poliomyelitis from Nigeria between 2003 and 2005, where wild poliovirus was re-introduced into polio-free countries in Africa, the Middle East and Asia. In this case, many of the routine polio vaccination programmes had been neglected after the countries were declared polio free; thus when wild poliovirus was re-introduced there was no protective barrier to transmission, and polio re-emerged in 18 polio-free countries.

The article then cites the certification of smallpox eradication in 1980 as an example of where continued surveillance and intervention has succeeded in preventing the re-emergence of an infectious disease. In this case, reports of possible smallpox cases are still received and acted on by the WHO.

The author concludes with a call to action for public health professionals, stating that “[s]urveillance and continuation of control interventions are necessary to maintain achievements in infectious disease control unless transmission has been interrupted and the microbe destroyed worldwide. Our job as public health professionals is to ensure that the message is clear, that commitment and political will continue, and that financial resources remain available.”

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