Landmark Developments in Infectious Diseases

A 20-Year Look-Back: Two Steps Forward, One Step Back

Ingrid G. Hein

Disclosures

October 20, 2015

In This Article

Diseases Close to Eradication

Smallpox set the precedent for disease eradication. The first case of smallpox was reported in 1841; the last case, in 1977. As an extraordinarily morbid disease—one with a high mortality rate, and that scarred its millions of survivors for life—smallpox has inspired eradication efforts in infectious diseases for nearly a century.

Other diseases that are close to being wiped out, as a result of tireless work by infectious disease eradication initiatives, are guinea worm and polio.

Guinea Worm

"I would like for the last guinea worm to die before I do," Jimmy Carter said at a press conference on August 22, 2015, the day he went for his first radiation treatment for brain cancer.[21]

Guinea worms enter the body through drinking water that contains larvae. Eliminating guinea worm has largely required community-wide behavioral changes, such as filtering water and preventing persons with guinea worm disease from entering water sources.

Jimmy Carter might very well see the last case eliminated, thanks to his efforts with the Carter Center Guinea Worm Eradication Program. In 1986, at the inception of the program, an estimated 3.5 million cases of Guinea worm in 21 countries occurred annually in Africa and Asia. This year, to date, the Carter Center reports that 14 guinea worm cases remain worldwide.

"A horrible, morbid disease—it's almost eliminated," John Bartlett says. "It's pretty exciting to get rid of an infectious disease."

Polio

According to the Polio Global Eradication Initiative, August 2014 marked the first time that the entire African continent went a full year without a reported case of wild poliovirus. On March 27, 2014, 10 countries in Southeast Asia were certified as polio-free. Polio incidence has dropped more than 99% since the launch of global polio eradication efforts in 1988.

Global polio surveillance data from the CDC reported 37 cases of wild poliovirus in two countries (Pakistan and Afghanistan) as of September 2, 2015. Unfortunately, on September 9, 2015, these figures had to be updated, bringing the numbers back up to four countries affected: A new case in Mali and two new cases in the Ukraine were identified.

These new cases illustrate the importance of adherence to childhood vaccination programs. Tom Frieden, who is chair of the Polio Oversight Board at the CDC (in addition to his role as CDC director), further brought this point home in a recent statement. "The progress is real, but we need active and intensified surveillance to detect any poliovirus, as well as the fortified walls of immunity achieved by high vaccination coverage to prevent polio importation and further global spread," he said.[22]

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