Smallpox and its Eradication
F. Fenner, D. A. Henderson, I. Arita, 2. JeZek, I. D. Ladnyi
World Health Organization Geneva HISTORY OF INTERNATIONAL PUBLIC HEALTH, No. 6
THE AUTHORS
Frank Fenner, M.D., has been a professor at the Donald Ainslie Hendemon, M.D., while at the Australian National University since 1949. Since Communicable Disease Center in the USA, was 1969 he has been a member of the WHO Informal responsible in 1965-1 966 for the planning of the Group on Monkeypox and Related Viruses and of western and central African smallpox eradication- various WHO committees on orthopoxviruses, measles control programme, conducted with the and in 1978-1979 was Chairman of the Global support of the United States Agency for Interna- Commission for the Certification of Smallpox tional Development. From 1966 to 1977 he was Eradication. He is currently a Visiting Fellow in Chief of the Smallpox Eradication unit in the the John Curtin School of Medical Research, World Health Organization, In 1977 he became Australian National University, Canberra. Dean of the Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland, USA, and Professor of Epidemiology and International Isao Arita, M.D., worked for the smallpox eradi- Health. He was a member of the Global Commis- cation programme in western Africa in 1962- sion for the Certification of Smallpox Eradication. 1963 as a member of the staff of the WHO Regional Office for Africa. In 1964 he was ZdenEk JeZek, M.D., joined the field staff of the transferred to WHO Headquarters in Geneva, and Intensified Smallpox Eradication Programme in in 1966 he joined the Smallpox Eradication unit, 1972, working first with the WHO Smallpox of which he was Chief from 1977 until 1984. He is Eradication and Epidemiological Advisory Team now Director of the Kumamoto National Hospi- in the WHO South-East Asia Region and later in tal in Japan and a member of the advisory group Somalia. He joined the Smallpox Eradication unit on international health of the Ministry of Health at WHO Headquarters in 1980 and became Chief and Welfare of Japan. of the unit in 1985.
Ivan Danilovich Ladnyi, M.D., served as a WHO Intercountry Adviser on smallpox eradication in Africa from 1965 to 1971. From 1976 to 1983 he was Assistant Director-General of the World Health Organization, responsible for communica- ble and parasitic diseases. He was then Deputy Director of the All-Union Institute of Medical Information of the Ministry of Health of the USSR from 1983 until his death in 1987.
The authors alone are responsible for the views expressed in this publication.
ISBN 92 4 156110 6
@World Health Organization 1988 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation of WHO publications, in part or in toto, application should be made to the Officeof Publications, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. The designationsemployed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
PRINTED IN SWITZERLAND Smallpox and its eradication was published by WHO in 1988. It contains illustrative material both from WHO and from other published sources, as indicated. In the case of the latter, the copyright holders granted WHO permission to reproduce their material in this book.
Stocks of Smallpox and its eradication were exhausted some years ago and the book is now out of print. In view of current concern about the threat of smallpox, WHO has decided with some urgency to make the book available on the World Wide Web. WHO requests the understanding of the copyright holders of the illustrations from other published sources and invites those who object to their material being made available in this way to contact us at [email protected].
The book is a WHO copyright publication and therefore the terms of the WHO copyright notice apply (see www.who.int/m/topics/copyright_notice/en/index.html).
Contents Page Foreword, by Dr Halfdan Mahler vii Preface ix Acknowledgements xiii
Chapter 1. The clinical features of smallpox 1 Page 1-7 Page 8-11 Page 12-15 Page 16-18 Page 19-26 Page 27-36 Page 37-68
Chapter 2. Variola virus and other orthopoxviruses 69
Chapter 3. The pathogenesis, pathology and immunology of smallpox and vaccines 121
Chapter 4. The epidemiology of smallpox 169
Chapter 5. The history of smallpox and its spread around the world 209
Chapter 6. Early efforts at control: variolation, vaccination, and isolation and quarantine 245
Chapter 7. Developments in vaccination and control between 1900 and 1966 277
Chapter 8. The incidence and control of smallpox between 1900 and 1958 315
Chapter 9. Development of the global smallpox eradication programme, 1958-1966 365
Chapter 10. The Intensified Smallpox Eradication Programme, 1967-1980 421 Page 421-442 Page 443-458 Page 459-498 Page 499-516 Page 517-538 Chapter 11. Smallpox vaccine and vaccination in the Intensified Smallpox Eradication Programme 539
Chapter 12. South America 593
Chapter 13. Indonesia 627
Chapter 14. Afghanistan and Pakistan 659
Chapter 15. India and the Himalayan area 711 Page 711-756 Page 757-805
Chapter 16. Bangladesh 807
Chapter 17. Western and central Africa 849
Chapter 18. Zaire and Sudan 911
Chapter 19. Eastern Africa: Kenya, Uganda, United Republic of Tanzania, Rwanda and Burundi 945
Chapter 20. Southern Africa 969
Chapter 21. Ethiopia, Yemen and Democratic Yemen 997
Chapter 22. Somalia and Djibouti 1037
Chapter 23. Smallpox in non-endemic countries 1069
Chapter 24. The certification of eradication: concepts, strategy and tactics 1103
Chapter 25. Certification by international commissions: 1973-1977 1149
Chapter 26. Certification of 29 countries of Africa and Asia: 1978-1979 1195
Chapter 27. The completion of global certification: the Horn of Africa and China 1227
Chapter 28. Post-eradication operations: implementation of the recommendations of the Global Commission 1263
Chapter 29. Human monkeypox and other poxvirus infections of man 1287
Chapter 30. Potential sources for a return of smallpox 1321
Chapter 31. Lessons and benefits 1345
References 1371 Index of names 1411 Subject index 1421