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WORLD HEALTH ORGANIZATION А31/20 ORGANISATION MONDIALE DE LA SANTÉ 5 May 1978 THIRTY-FIRST WORLD HEALTH ASSEMBLY Ф � INDEXED 8 agenda item 2.6.9 � «f+; '2ј Provisional fli F tio�,y A SMALLPDX ERADICATION PROGRAMME CURRENT STATUS AND CERTIFICATION Report by the Director -General No cases of smallpox have been reported anywhere in the world for the last six months, i.e., since a patient in Somalia had onset of rash on 26 October 1977. Interruption of smallpox transmission may now have been achieved. This can only be proved during a further 18 months of intensive surveillance. At its sixty -first session (January 1978) the Executive Board endorsed the recommendations made by the Consultation on Worldwide Certification of Smallpox Eradication, held in October 1977. The Director -General has now established a Global Commission for the Certification of Smallpox Eradication. This group will collaborate with WHO and Member States to verify the eradication of the disease throughout the world. The present report contains, in paragraph 10, a draft resolution for consideration by the Health Assembly. In this draft, a reward is proposed for the first person reporting an active case of smallpox in the period preceding final certification of global eradication. 1. A summary of current smallpox eradication activities is shown in the Weekly Epidemiological Record, published on 5 May 19781 and annexed hereto. Worldwide nil incidence of smallpox during the past six months 2. The Organization has recorded the incidence of smallpox throughout the world as nil during the past six months; the last case was reported from Somalia, with onset of rash on •26 October 1977. From that date until now in Somalia, nationwide searches for hidden foci have been conducted; 5915 rumours of smallpox were investigated; 601 specimens were collected from cases of rash with fever and were tested by WHO reference laboratories. None of these numerous investigations revealed any evidence of additional cases since 26 October 1977. Assessment made during the same period showed that at least 60% of the population, both nomadic and settled, knew of the smallpox reward and how and where to report smallpox to the health authorities should they encounter possible cases. 3. Adjacent to Somalia, southern Ethiopia constitutes a high -risk area where smallpox transmission might have continued undetected. In this zone, however, the last reported case - in Bale Region - had onset of rash on 9 August 1976. Intensive surveillance continued without detection of foci until July 1977. From that time until recently, activities have been severely affected by the conflict in the area. Surveillance, however, has been continuously maintained although at a low level. During this period, 106 specimens were collected and 1 Weekly Epidemiological Record, 53: 125 (1978). A31/20 page 2 forwarded for testing through teams working in the border areas of Ethiopia, Kenya and Somalia. Variola virus was not isolated in any of the specimens. In the areas surrounding the Ogaden, teams from Djibouti, Ethiopia, Kenya and Somalia have been investigating rumours of smallpox among the nomads and refugees crossing the borders. There has been no evidence of the disease. 4. Elsewhere in the world surveillance continues, but no smallpox cases have been reported. Certification of global smallpox eradication 5. Considering that global eradication of smallpox is imminent, a Consultation on World- wide Certification of Smallpox Eradication was convened in Geneva in October 1977. The Consultation recommended: (1) establishment of an International Commission for the Global Certification of Smallpox Eradication (Global Commission); (2) verification of the elimination of the last known focus; (3) certification of smallpox eradication throughout the world; and (4) other activities related to the termination of the smallpox eradication programme, including control of variola virus stocks in laboratories, animal orthopoxvirus studies, vaccination policy changes and the building -up of a vaccine reserve. These activities are expected to be completed during the next two years if the current epidemio- logical situation continues. The Consultation recommended that "when global eradication has been certified, vaccination should be terminated ". The full text of the recommendations is to be found in Annex 4 to Official Records No. 244. • 6. In January 1978, the Executive Board, at its sixty -first session, endorsed the recommendations of the October Consultation. The current status of the recommended activities is as follows: (1) The Global Commission has already been set up by the Director- General. The members include epidemiologists and virologists experienced in smallpox eradication, laboratory recognition of smallpox and related poxviruses, aid certification procedures. They come from countries in all six WHO regions. The Commission will meet in Geneva in December 1978 to review the progress made in certification as well as to plan activities for 1979. (2) In addition to the countries already certified as smallpox -free prior to this consultation (10 countries in South America, 15 countries in West Africa, 9 countries in Central Africa and 6 countries in Asia - in total 40 countries), an international commission visited Burma and Bangladesh in November and December in 1977 and another international commission visited Malawi, Mozambique, United Republic of Tanzania, and Zambia in March 1978. Smallpox eradication has been certified for these countries. • (3) Between now and the end of 1979, certification activities will take place in 31 countries in Africa and Asia. Preparations are already under way in most of these countries. Global reward 7. During the eradication programme, rewards to persons reporting smallpox have proved extremely useful in the detection of hidden foci. The countries where the reward system has been in practice include Afghanistan, Bangladesh, Djibouti, India, Indonesia, Kenya, Nepal, Pakistan and Somalia. In Nairobi, in April 1978, the eradication programme staff from Democratic Yemen, Djibouti, Ethiopia, and Kenya met for the preparation of future certification activities. The meeting requested that WHO initiate a global reward, payable to the first person reporting an active case of smallpox. А31/20 page 3 Contributions to eradication activities 8. Since January 1978, cash donations of US$ 1 694 748 to the Special Account for Smallpox Eradication have been received from three countries; US$ 90 900 has been pledged by one country. Vaccine having a cash value of US$ 455 704 has been donated or pledged by three countries. 9. These donations, and those already pledged or anticipated, will permit continuation of the required activities in 1978. However, in order to continue smallpox surveillance leading to global certification by the end of 1979, it is estimated that additional funds of US$ 2000 000 will be required. Owing to intensified vaccination activities in East Africa, the WHO vaccine reserve in Geneva has been reduced to a quantity sufficient to vaccinate 66 million people. Donations of an additional 3 750 000 ampoules /vials will be needed by the end of 1979 in order to establish a satisfactory reserve, i.e., sufficient to vaccinate 200 -300 million people. Draft resolution 10. The Health Assembly may wish to consider a resolution along the following lines: The World Health Assembly, Having considered the Director -General's report on smallpox eradication; Endorsing Executive Board resolution EB61.R10 on smallpox eradication; Recognizing that for six months smallpox incidence throughout the world has been nil, that achievement of smallpox eradication is now imminent, and that it will constitute an unprecedented event in the history of medicine; 1. CONGRATULATES Somalia on the successful eradication campaign and adjacent countries on their intensive surveillance and maintenance of their smallpox -free status; 2. COMMENDS Bangladesh, Burma, the nine countries of Central Africa (Burundi, Central African Empire, Chad, Congo, Equatorial Guinea, Gabon, Rwanda, United Republic of Cameroon, and Zaire), and the four countries of south -east Africa (Malawi, Mozambique, United Republic of Tanzania, and Zambia), where international commissions have visited and certified eradication of smallpox in 1977 and in 1978 to date; 3. REQUESTS the 31 countries where certification activities will take place in 1978 and 1979 to proceed with their planned activities, in collaboration with WHO and the Global Commission for the Certification of Smallpox Eradication; can be completed by the end of 1979; 4. REQUESTS the Director -General to establish a reward of US$ 1000 for the first person who, in the period preceding final certification of global eradication, reports an active case of smallpox resulting from person -to- person transmission and confirmed by laboratory tests, in the belief that such a reward will strengthen worldwide vigilance for smallpox as well as national surveillance in priority countries; 5. REITERATES the final paragraph of Executive Board resolution EB61.R10, which urged all governments to continue full support and cooperation for this final phase of the programme. Wkly Epidem. Rec. - Relevé épidém. hebd.: 1978, 53, 125-1Э2 No. 18 WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANT$ GENEVA GEN$VE WEEKLY EPIDEMIOLOGICAL RECORD RELEVÉ ÉPIDÉMIOLOGIQUE HEBDOMADAIRE Epidemiological Surveillance of Communicable Diseases Service de la Surveillance épidémrologique des Maladies transmissibles Telegraphic