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In 1988, the eradication of poliomyelitis (polio) was adopted by the World Health Organization as a goal to be achieved by the year 2000. The successful eradication of smallpox serves as an important reminder that concerted efforts can completely eliminate a disease. However, there are serious obstacles that make eradicating polio more challenging than eliminating smallpox. The authors review the current state of polio around the world and the impediments to its eradication. One serious problem is that many cases of polio are asymptomatic, which makes it difficult to quarantine known cases. The difficulty in identifying all cases of polio also make it difficult to monitor the progress of any immunization program. More sophisticated health facilities will be necessary for evaluating the status of polio in developing countries than were needed for evaluating smallpox. Other problems involve the vaccine itself. The trivalent oral poliovirus vaccine (TOPV), a current version of the live virus Sabin vaccine, is much less stable than the smallpox vaccine. TOPV can lose much of its potency after only one day at 37 degrees centigrade. Furthermore, unlike the smallpox vaccine for which one dose can confer years of immunity, TOPV requires booster doses. While two doses are adequate in the US, at least four doses may be necessary in some developing countries to confer protective immunity. Obviously, this requires many small villages be visited more often, creating problems in both logistics and record-keeping. The eradication of smallpox cost about $300 million, but the elimination of this disease is estimated to save about $1 billion each year worldwide. Considering the greater difficulties, the eradication of polio is likely to be more costly. However, the eradication of polio would save $114 million each year in the US alone. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Background: The monitoring and evaluation of lymphatic filariasis (LF) has largely relied on the detection of antigenemia and antibodies in human populations. Molecular xenomonitoring (MX), the detection of parasite DNA/RNA in mosquitoes, may be an effective complementary method, particularly for detecting signals in low-level prevalence areas where Culex is the primary mosquito vector. This paper investigated the application of a household-based sampling method for MX in Tamil Nadu, India. Methods: MX surveys were conducted in 2010 in two evaluation units (EUs): 1) a hotspot area, defined as sites with community microfilaria prevalence ≥1%, and 2) a larger area that also encompassed the hotspots. Households were systematically selected using a sampling interval proportional to the number of households in the EU. Mosquito pools were collected and analyzed by real-time polymerase chain reaction (qPCR). Two independent samples were taken in each EU to assess reproducibility of results. Follow-up surveys were conducted in 2012. Results: In 2010, the proportion of positive pools in the hotspot EU was 49.3% compared to 23.4% in the overall EU. In 2012, pool positivity was significantly reduced to 24.3% and 6.5%, respectively (p<0.0001). Pool positivity based on independent samples taken from each EU in 2010 and 2012 were not significantly different except for the hotspot EU in 2012 (p = 0.009). The estimated prevalence of infection in mosquitoes, measured by PoolScreen, declined from 2.2–2.7% in 2010 to 0.6–1.2% in 2012 in the hotspot area and from 0.9–1.1% to 0.2–0.3% in the larger area. Conclusions: The household-based sampling strategy for MX led to mostly reproducible results and supported the observed LF infection trends found in humans. MX has the potential to be a cost-effective, non-invasive monitoring and evaluation tool with sensitive detection of infection signals in low prevalence settings. Further investigation and application of this sampling strategy for MX are recommended to support its adoption as a standardized method for global LF elimination programs. [ABSTRACT FROM AUTHOR]

The article presents the text of a speech by Ralph H. Henderson, assistant director-general of the World Health Organization (WHO), delivered at the "Conference on Global Disease Elimination and Eradication as Public Health Strategies," February 23 to 25, 1998, in which he discussed the nature of leadership, choosing a specific elimination or eradication goal, and resource mobilization.