25 January 2009

Pearls f= rom the online WHO “Smallpox and its Eradication” (I): Development = and Use of the WHO Smallpox Recognition Card in Indonesia 1970-71.

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Smallpox is the o= nly human infectious disease that has been eradicated from the world. The defin= itive description of this immense accomplishment appears in the 1,460-page, 31-chapter pdf book posted on the World Health Organization (WHO) website a= t: http://whqlibdoc.= who.int/smallpox/9241561106.pdf

The original book= was published in 1988 by the WHO (Geneva) and was titled “Smallpox and its Eradication”. The five authors are: Frank Fenner (Australia), Donald Ainslie (DA) Henderson (USA), Isao Arita (Japan), Zdenek Jezek (former Czechoslovakia), and Ivan Danilovi= ch Ladnyi (former USSR). Smallpo= x was officially declared eradicated in 1980 by the WHO.

While reading this book one is struck by multiple lessons learned, as well as by many poignant public health and clinical stories (“pearls”). As such, renewed recognition may benefit current and future human disease eradication, elimination, and control efforts. Thus, succinct excerpts of such examples = will be cited periodically in this forum as w= ww.BePast.org “newsletters”. Some of these examples can also stand alone as literature regarding = the human condition itself, beyond the specific context of smallpox and its eradication.

Chapter 13 Indone= sia

“The Development and Use of the WHO Smallpox Recognition Card”<= /span>

&= nbsp; “Events which led to the development of the WHO smallpox recognition card and the u= se of schools in the search for cases in Indonesia occurred in Bandung. Among = the many vaccinators engaged in search activities, there was one who recorded e= xceptional success in detecting outbreaks. Supervisors noted that, paradoxically, this vaccinator was considered to be one of the laziest workers---the last to le= ave for the field and the first to return home. When asked how he was so successful, he admitted that instead of visiting all the houses in a villag= e, as instructed, he was only visiting the schools. There he showed children a= nd teachers pictures of smallpox cases which appeared in a WHO teaching folder= on smallpox diagnosis that had been prepared for Africa. Numerous case notifications were obtained with the minimum of effort.

&= nbsp; The teaching folder contained many different pictures of smallpox in African children. The photographs were small and the smallpox rash on a black skin appeared to differ somewhat from the rash on the skin of Indonesians, which= was lighter in colour. Nevertheless, most children had recognized the disease. Programme staff suggested the preparation of a single large picture of an A= sian child with smallpox for use as a recognition card. Thus, the WHO smallpox recognition card was first prepared, encased in plastic for durability, and widely distributed around the world.” (page 651).

Comment: One of the observations that could be made on this exam= ple is the importance of disease surveillance. The WHO smallpox recognition card = and the use of schools in the search for cases contributed significantly to the “Surveillance-Containment Strategy” of the WHO “Intensifi= ed Smallpox Eradication Programme, 1967-1980” that culminated in the glo= bal eradication of smallpox.

Daniel R. Lucey, = MD, MPH

EROne Institutes, Washington Hospital Center

Adjunct Professor= of Microbiology and Immunology

Georgetown Univer= sity Medical Center

Washington, D.C.<= o:p>

Website for this posting: www.BePast.org

DRL23@Georgetown.= edu