Considerations for Viral Disease Eradication Lessons Learned and Future Strategies: Workshop Summary (2002) / Chapter Skim
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4 Operational and Instutional Challenges to Post-Eradication
4 Operational and Instutional Challenges to Post-Eradication
Pages 98-120
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From page 98... ...
provides a functional and effective template for national surveillance in countries that do not already have an effective system in place. One of the greatest challenges in the IHR revision process is ensuring that reporting of public health risk expands to all urgent international public health events, instead of focusing only on specific diseases.
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From page 99... ...
REVISION OF THE ~ERNATIONAL HEALTH REGULATIONS: PROGRESS REPORT Mario Libel, M.D., M.P.H. Epidemiologist, Communicable Diseases Program Division of Disease Prevention and Control Pan American Health Organization, Washington, D.C.
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From page 100... ...
Revised Core Concepts Although there are some new core concepts proposed for the revised IHR, most of the changes involve developing and fine-tuning already extant rules: Surveiliance The new IHR will neither contain a list of notifiable diseases nor depend solely on the use of syndromes for notification. Instead, they will require the reporting of all "events of urgent international importance related to public health." The reason for this is two-fold.
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From page 101... ...
This requires a reliable electronic communication and back-up system within each member state. Reporting Capaciry a: In order to ensure the quick dissemination of information regarding urgent national events of potential international importance, each country must have the capacity to quickly report, analyze, and determine the potential effect of national disease events on other member states.
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From page 102... ...
To prevent threatened countries from responding to unverified news by restricting cross-border traffic and trade, WHO will need to inform member states and issue recommendations on appropriate measures. Economic Considerations In order for a global surveillance system to function well, the economic consequences of reporting disease events must be considered.
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From page 103... ...
However, the revised IHR will contain a list of all key measures that could potentially be used in a WHO recommendation to prevent international disease spread at embarkation, during travel, and at point of entry. Some examples of measures potentially applicable at point of entry into non-affected member states from an affected member state are shown in Table 4-1.
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From page 104... ...
Many countries need assistance from multilateral institutions for their national surveillance systems. Plus, even localized national events can quickly affect international traffic.
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From page 105... ...
SOURCE: PAHO/WHO. ..~ potential international health events will need to be developed in countries where they are not already available.
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From page 106... ...
Surveillance is also an important control issue for other viral diseases, such as yellow fever, that are not currently slated for eradication but for which vaccines are available and in various stages of implementation worldwide. Following is a review of several disease control programs and lessons to be learned from their historical examples.
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From page 107... ...
differentiation between the wild type and polio vaccine virus strains. Differentiating the oral polio vaccine strains is a major challenge to laboratory surveillance because it requires a relatively cumbersome cell culture technique.
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From page 108... ...
It was not until 1935 that Dr. Fred Soper, Regional Director of the Rockefeller Foundation's International Health Division in Rio de Taneiro, acknowledged Franco's contribution and finally agreed that jungle yellow fever existed.
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From page 109... ...
Hi: Adenoviruses Adenoviruses are the best example of an evolving or re-emerging virus that is filling art ecological niche left vacant after vaccination. Acleno-viruses, particularly types 4 and 7, are a major problem in military populations.
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From page 110... ...
Of particular concern are live attenuated vaccines with segmented genomes, such as influenza and rotavirus, for which we can almost certainly expect recombinant variants of wilct type and vaccine type to emerge. Hopefully, none will be more virulent or more transmissible than the wild type parent.
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From page 111... ...
Conclusion . Several lessons can be learned from our past efforts to control or eradicate viral diseases: Yellow fever: The presence of a non-human reservoir (i.e., jungle yellow fever)
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From page 112... ...
Professor Emeritus, Department of International Health Johns Hopkins School of Hygiene and Public Health, Baltimore, MD During global eradication initiatives, global priorities tend to override local priorities. Evidence suggests, however, that there are cost-effective, synergistic ways to meet both objectives simultaneously.
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From page 113... ...
Stronger local health systems are also needed to increase child immunization rates. UNICEF is now using independent surveys for the State of the World's Children Report and is changing some of its earlier claims about child immunization patterns of the past decade.
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From page 114... ...
PE depends on both NIDs and surveillance, both of which in turn depend on technological mobilization and research on the changing nature of health services. They also depend on flexible methods of social mobilization to bring vaccines and children together and ways to identify and diagnose acute flaccid paralysis (AFP)
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From page 115... ...
How long will poor countries continue to let global priorities completely override local priorities? And, most importantly, what can we do so that the remarkable public enthusiasm for PE social mobilization enhances other immunization programs and promotes interventions for the main infections that cause death in each locality, thereby truly balancing global and local priorities?
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From page 116... ...
BRCs relieve storage and distribution burdens for investigators and institutions, and they provide controlled on-site biosecurity and access to their holdings. Types of BRCs included 1Key to abbreviations: ATCC, American Type Culture Collection; BDSC, Bloomington Drosophila Stock Center, Indiana University; CBS, Centraalbureau voor Schimmelcultures; CDC, Centers for Disease Control and Prevention; CGC, Caenorhabditis Genetics Center; Coriell Institute for Medical Research, New Jersey; DSMZ, Deutsche Sammlung van Mikroorganismen und Zellkulturen GmbH; IFO, Institute for Fermentation, Osaka; JCM, Japan Collection of Microorganisms; NRCC, National Resource Center for Cephalopods, University of Texas; RPRC, Regional Primate Research Center; RSMAS, Rosenstiel School of Marine and Atmospheric Science; USDA, U.S.
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From page 117... ...
Agents that present a grave cianger to a post-immunization community TABLE 4-3 The Role of Biological Resource Centers · Provide central source and controlled access to standard biomaterials, reagents, and data Provide controlled conditions for on-site biosecurity Provide central source of technical support Minimize redundancy of biomaterials Relieve storage and distribution burdens for investigators Coordinate regulatory compliance Provide safety deposit for essential germplasm Support equitable sharing of biomaterials Provide intellectual property management and services Provide knowledge management and distribution Promote translation of research discoveries into practical applications Facilitate industrialization of technologies in medicine, public health, pharmacy, agriculture, food, and environment
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From page 118... ...
Admittance to material can be restricted by providing secure, controlled access to the viral agents. Levels of access should be established so that the most dangerous strains have the greatest restrictions for access and use.
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From page 119... ...
Distribution of disease-causing viral agents requires strict adherence to the permit and licensing requirements of local, state, federal, and international agencies. End-users should process requests for their material through an institutionally controlled system that identifies materials needing special permits and licenses.
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From page 120... ...
It is critical, however, that access to potentially dangerous microbial agents be controlled uncler strict guidelines and regulations mandated outside the BRCs, and that BRCs function solely as a means of ensuring compliance with these requirements.
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