The place of leprosy in the control-elimination-eradication spectrum.
نویسنده
چکیده
The place of leprosy in the control–elimination–eradica-tion spectrum Editor – I would like to expand on Lockwood & Suneetha's reflections on the leprosy elimination campaign (1), and in particular their statement that " leprosy is perhaps more appropriately classed as a chronic stable disease rather than as an acute infectious disease responsive to elimination strategies " , by using the control–elimination– eradication (CEE) paradigm that has served public health workers and surveillance experts so well in the fight against communicable diseases since the late 19th century (2). Infectious disease " elimination " commonly refers to reducing the number of cases of disease to a small and routinely manageable number. Thus, prevalence trend is a key yardstick in the CEE paradigm. When leprosy elimination campaigns were put in place in the 1990s, their primary goals were to implement enhanced surveillance activities in order to detect leprosy cases promptly and to treat them immediately with multidrug therapy (3). Between 1985 and 2002, global leprosy prevalence fell by about 95% (1). In May 2001, the World Health Assembly affirmed that " the overall target, set ten years ago, for the global elimination of leprosy as a public health problem has been attained " (4). " Control " is usually the first approach to cope with the deleterious effects of intractable infectious diseases such as tuberculosis and syphilis. When the prevalence and adverse effects are curtailed, the focus normally shifts from control to elimination. For example, as the prevalence of Chagas disease continues to fall in Central America, the focus has shifted from disease control to disease elimination, through vector control activities and the screening of blood banks (5). Smallpox is probably the only human disease so far that has reached the " eradication " end of the spectrum (no cases reported since 1979), though dracunculiasis (guinea-worm disease) — which, like leprosy, is a chronic stable disease — and poliomyelitis are also inching very close to being eradicated. For instance, there are currently less than 800 incident cases of polio worldwide , and the formidable infrastructure for polio eradication makes it more likely than ever that the disease will be eradicated during this decade (6). Interestingly, erstwhile polio researchers expressed serious doubts concerning the feasibility of poliomyelitis elimination or eradication about a century ago, when poliovirus microbiology and vaccination were less well understood (7). It is noteworthy that diseases that have progressed steadily from …
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ورودعنوان ژورنال:
- Bulletin of the World Health Organization
دوره 83 7 شماره
صفحات -
تاریخ انتشار 2005