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tion. In 1978, three countries out of 17 reported that no gressing well and appears to have resulted in extended supervision could be provided for the tuberculosis pro- coverage, increased bacteriologic diagnosis, and reduced gram in the general health services. Of the rest, nine hospital treatment. The introduction of new and more po- countries provided supervision under a program drawn tent drugs has decreased the duration of treatment. Super- up at the beginning of the year, and in the other five, vised administration of drugs has been recognized as feasi- supervision was provided without prior programming in ble and useful in controlling the completion of treatment response to the needs of the moment. Supervisory per- and in lessening costs in short course chemotherapy sonnel was specialized in tuberculosis in six countries, through intermittent treatments schedules. multipurpose health services in one, and both types in Abandonment of treatment by the patient, loss of con- the other seven. tact by the health services, inadequate training of periph- Health laboratories in most countries provide supervi- eral general services personnel, and lack of supervision ap- sion for smear examinations either directly, where the pear to be the current major deficiencies of the programs. A supervisor observes the work in visits to local laborator- more active management is needed to supervise and ies, or indirectly, where the local laboratory periodically evaluate the programs, as well as to train and support the sends slides to the regional or central laboratory. general health services personnel in order to achieve more In general, program evaluations are done in national effective tuberculosis control programs in the near future. or regional seminars comprised of several political units in a country, and in some countries a yearly report of data and conclusions is published. However the quality and the operational or epidemiological emphasis of the evalu- (Source: Tuberculosis Control Program, ations vary from country to country and there is no stand- Communicable Diseases Unit, Division of ard evaluation method generally accepted in the Americas. Disease Prevention and Control, PAHO.) Summary Integration of tuberculosis control activities in the general health services of the Region of the Americas is pro- . Human Plague in 1980 In 1980 a total of 505 cases of human plague were re- same as in previous years, except for 1979 when 471 cases ported to the World Health Organization, resulting in 56 and 12 deaths were reported. deaths. The corresponding figures for 1979 were 881 In the Americas. an increase in the number of notified cases and 30 deaths (Figure 1). cases was observed, particularly in South America, Cases of human plague in Africa were reported in four where 142 cases and seven deaths were reported, com- countries: Angola (for the first time since 1975), Kenya, pared with the 23 cases and two deaths recorded in 1979 Madagascar, and the United Republic of Tanzania. The (Table 1). This increase was due mainly to change in diag- 1980 totals (80 cases and 20 deaths) were roughly the nostic criteria in Brazil where 98 cases (and no deaths) e 4 Table 1. Number of cases and deaths of human plague reported in the Americas, 1971-1980. 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 Country C D C D C D C D C D C D C D C D C D C D Bolivia 19 3 0 0 0 0 14 5 2 0 24 5 29 9 68 2 10 0 26 2 Brazil 146 2 169 13 152 ... 291 ... 496 5 97 ... 1 ... 11 ... 0 0 98 0 Ecuador 27 0 9 0 1 1 0 0 0 0 8 1 0 0 0 0 0 0 0 0 Peru 22 5 118 15 30 2 8 2 3 0 1 0 0 0 6 1 0 0 0 0 United States of Americaa 2 0 1 0 2 0 8 1 20 4 16 3 18 2 12 2 13 2 18 5 Total 216 10 297 28 185 3 321 8 521 9 146 9 48 11 97 5 23 2 142 7 C = Cases. D = Deaths. aRodent plague present. ... Data not available. Figure 1. Number of cases and deaths of human plague in the were reported in the northeastern States of Bahía, Ceará, world, 1971-1980. and Pernambuco. In Bolivia, the La Paz Department reported 26 cases and two deaths between September and 4.422, November in the localities of Mohima (20 cases) and Culata (six cases) in Franz Tamayo Province; a high den- sity of Pulex irritans was found in these areas. In the United States, 18 cases and five deaths were reported in California, Nevada, and New Mexico. Thirteen of these cases occurred between May and September in six coun- ties in New Mexico. Asia recorded a reduction in morbidity in 1980, with 283 cases and 29 deaths, (compared with 387 cases and 16 deaths in 1979). Vietnam notified 180 cases and five deaths (as against 306 and eight deaths the year before). Health administrations should be aware of the Techni- cal Guide for a System of Plague Surveillance and The Manual on Plague and Plague Surveillance and Control (a report of an informal consultation of experts held in June 1979). These documents are available from the Bac- terial and Venereal Diseases Unit, WHO. (Source: WHO, Weekly Epidemiological Record, 35:273-275, 1981.) 1 5.

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