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Public health approaches to infectious disease
Public health approaches to infectious disease

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4.1.2 The campaign to eradicate polio

Of the three vaccine-preventable diseases on the WHO target list for eradication – polio, measles and neonatal tetanus – the most progress has been made towards eradicating polio, largely because it has some similar characteristics to those already described for smallpox (see Box 3). One difference is that polio is caused by an RNA virus, but it does not generate the high number of variants typical of influenza viruses or HIV.

The global polio vaccination campaign began in 1988, a year in which an estimated 350 000 people – most of them children – developed acute flaccid paralysis (AFP) – the case-defining symptom of polio – as a result of infection with poliovirus. By 2010, the annual number of cases had dropped to 1352 and, in 2012, just three countries reported new cases: Nigeria, Afghanistan and Pakistan (WHO, 2012i). This progress was achieved through systematic mass polio vaccination campaigns (Figure 9) and an increased focus on case finding and case containment.

Described image
© WHO/P.Virot
Figure 9 Oral polio vaccine (OPV) drops being given to an infant at Malipur Maternity Home, Delhi, India

However, you might wonder why it is taking so long to eradicate polio, given that a 99% reduction in polio cases worldwide had already been achieved by 2001. Since then, the incidence has increased in some locations, particularly in Pakistan where new outbreaks have occurred. Rumours that fuelled opposition to vaccination in some communities have been the main cause of delay in achieving the WHO eradication target, not only for polio but also for measles and neonatal tetanus. But this delay should not overshadow the success of the polio campaign. In the 1980s, before the advent of mass vaccination, polio was paralysing 1000 children every day.

Activity 1 Infectious disease and public health in rural Ethiopia

Timing: Allow 45 minutes

This is the ideal time to study Video 1, a slidecast entitled ‘Infectious disease and public health in rural Ethiopia’. In addition to illustrating the infectious disease epidemiology of a Sub-Saharan African country, and the principal underlying causes of the high burden of infection, this slidecast will give you an insight into how a routine immunisation programme is organised to reach every child even in remote rural locations. It also serves as an introduction to some key points on non-vaccine interventions to prevent and control infectious disease, which form the focus of the next section of this course.

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Video 1 Infectious disease and public health in rural Ethiopia
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If you cannot study the slidecast now, try to do so before you complete this course. Then answer the questions below. There will be other questions on rural Ethiopia later in this course.

  1. Which infectious diseases are covered by the Expanded Programme on Immunization (EPI) in Ethiopia?
  2. What percentage of infants was protected by vaccination in the community served by Almaz? Which of these vaccinations protected newborn babies indirectly?


Question 1

The routine EPI in Ethiopia includes immunisation against diphtheria, pertussis, tetanus, polio, hepatitis B viral diseases, meningitis and pneumonia caused by Haemophilus influenzae and Streptococcus pneumoniae bacteria, and measles; additionally, by 2013, vaccination against diarrhoeal diseases caused by rotaviruses will be added to the EPI.

Question 2

Almaz and her colleague were achieving close to 90% coverage with DTP3 and measles vaccine among the infants in their community. Around 80% protection of newborn babies from neonatal tetanus was achieved indirectly by immunising women with tetanus toxoid in their childbearing years and during pregnancy.