Disease Elimination

Mohith MathewRoll No.111

What is meant by elimination of diseases?

In 1998, Dowdle proposed a definition of control as a reduction in the incidence, prevalence, morbidity or mortality of an infectious disease to a locally acceptable level; elimination as reduction to zero of the incidence of disease or infection in a defined geographical area; and eradication as permanent reduction to zero of the worldwide incidence of infection.

Berlin (Dahlem) Conference 1997, Atlanta Conference 1998

Extinction: The specific infectious agent no longer exists in nature or the laboratory.

Eradication: Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; intervention measures are no longer needed.

Elimination of Infection: Reduction to zero of the incidence of infection caused by a specific agent in a defined geographic area as a result of deliberate efforts; continued measures to prevent reestablishment of transmission are required.

Elimination of Disease: Reduction to zero of the incidence of a specified disease in a defined geographic area as a result of deliberate efforts; continued intervention measures are required.

Control: Reduction of disease incidence, prevalence, morbidity, or mortality to a locally acceptable level as a result of deliberate efforts; continued intervention measures are required to maintain the reduction.

Some diseases that are eliminated:

Leprosy (2005, India)

Measles (2002, USA)

Neonatal Tetanus (in 29 countries including Bangladesh during 1999 to 2013)

Strategies include:

mass drug administration,control of illness levels, vector control, andsocial mobilization and education, depending on the disease.

Some diseases that can be eliminated:

The elimination of hunger and malnutrition, included as one of the objectives in the United Nations Declaration on Social Progress and Development, and the elimination of the causes that determine this situation are the common objectives of all nations

Some diseases that can be eliminated:

Elimination of rabies is set as goal in Latin American regions by 2015 and in the South-east Asia and West- Pacific regions by 2020 according to WHO

Some diseases that can be eliminated:

Criteria for disease elimination:

Biological and technical feasibility

Natural history of biological agentNon-human reservoirEffective intervention toolEffective delivery strategySimple and practical diagnosticSensitive surveillanceField-proven strategies

Criteria for disease elimination:

Costs and benefits

Cases averted per yearCoincident benefitsIntangible benefitsEstimated annual direct savingsEstimated total external financing

Criteria for disease elimination:

Societal and political consideration

Political commitment Social support Disease burden in politically unstable areasCore partnerships and advocatesTechnical consensusDonor base

In summary, elimination and eradication programs are laudable goals, but they carry with them an awesome responsibility. There is no room for failure. Careful and deliberate evaluation is a prerequisite before embarking on any program. Elimination and eradication are the ultimate goals of public health. The only question is whether these goals are to be achieved in the present or some future generation.

Thank you