Vaccine
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Review Historical Article
The Emergency campaign for smallpox eradication from Somalia (1977-1979)--revisited.
The historical significance of smallpox eradication from Somalia lies in the fact that the country was the last to record the last endemic smallpox case in the world. Before 1977 the programme was mismanaged. In the mid-1970s, the programme was plagued with concealment. ⋯ The strategy to stop the smallpox transmission was based on surveillance and containment. The WHO took the leading role of the campaign which, in spite of the Somalia/Ethiopia war of 1977/78, culminated in the eradication of smallpox from the country. Somalia was certified smallpox-free on 19 October 1979.
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Interest and support for malaria control, eradication, and research has increased greatly over the past decade. This has resulted from appreciation of the huge medical, social, and economic burden that malaria exacts from endemic populations. Recent breakthroughs in drug development (artemisinin-based combination treatments), preventive interventions (long-lasting, insecticide-treated bed nets), improved diagnosis (rapid diagnostic tests), and community mobilization have resulted in deployment of new antimalarial tools. ⋯ President's Malaria Initiative, and other donors have resulted in substantial reductions in malaria morbidity and mortality. Bill and Melinda Gates have given great impetus to eradication with support for the development of key research strategies and direct funding of innovative research projects, including malaria vaccine and drug discovery, that could decrease disease and transmission. Linking research to field operations is a strategy that succeeded for smallpox eradication and will be required for the demise of malaria.
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Rigorous, independent, confirmation of disease eradication is necessary to assure credibility of the claimed accomplishment. The criteria and procedures for formal certification of global disease freedom are based on the biological and epidemiological features of the pathogen and its manifestations. Certification activities by previously endemic and at-risk countries include comprehensive documentation focusing on surveillance, reports of national independent review groups, and special field surveys. ⋯ Dracunculiasis (guinea worm) freedom has been certified in 187 countries. Regional commissions have certified the Americas, Asia, and Europe polio-free; however, re-establishment of endemic foci in countries previously declared disease-free has created special challenges for completing this program. Post-eradication activities require attention to surveillance, maximum security of the microbial agent, and essential research to assure maintenance of disease freedom.
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Accumulating evidence for the substantial burden of influenza in children has increased interest in the vaccination of young children against influenza. So far, however, few European countries have issued official recommendations to vaccinate healthy children, which is largely due to the popular belief that inactivated influenza vaccines are ineffective in young children. ⋯ The live attenuated influenza vaccine provides even greater effectiveness in children, but the overall potential of this vaccine is limited by its licensure for only children older than 2 years of age. The safety record of seasonal inactivated influenza vaccines is excellent even in the youngest children.
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During the 2009 influenza A (H1N1) pandemic several pandemic H1N1 vaccines were licensed using fast track procedures, with relatively limited data on the safety in children and adolescents. Different extensive safety monitoring efforts were put in place to ensure timely detection of adverse events following immunization. These combined efforts have generated large amounts of data on the safety of the different pandemic H1N1 vaccines, also in children and adolescents. ⋯ As a result, relatively little has been learned on the comparative safety of these pandemic H1N1 vaccines - particularly in children. It should be a collective effort to give added value to the enormous work going into the individual studies by adhering to available guidelines for the collection, analysis, and presentation of vaccine safety data in clinical studies and to guidance for the clinical investigation of medicinal products in the pediatric population. Importantly the pandemic has brought us the beginning of an infrastructure for collaborative vaccine safety studies in the EU, USA and globally.