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Voir page 355 le resume en francais. En la pagina 355 figura un resumen en espanol. Introduction In 1988, the World Health Assembly adopted a resolution to eradicate poliomyelitis globally [...], Since 1988 reported polio cases worldwide have declined by about 85% and the number of known or suspected polioendemic countries has decreased from over 120 to less than 50. With eradication of poliomyelitis approaching, issues potentially affecting when and how vaccination against poliovirus can be stopped become extremely important. Because of the potential risks and benefits inherent in such a decision, the best available science, a risk-benefit analysis, contingency plans, a stock pile of poliovirus vaccines, and the endorsement by the global policy-making committees will all be needed before vaccination can be discontinued. The scientific basis for stopping polio immunization has been reviewed by WHO. This Round Table article summarizes the current state of knowledge, provides an update on the processes and timelines for certification, containment, and stopping vaccination, and highlights some of the unanswered scientific questions that will be addressed by further research. These include whether transmission of vaccine-derived poliovirus strains could be sustained so that poliomyelitis could re-emerge in future unvaccinated population and whether prolonged excretion of vaccine-derived poliovirus from individuals with immune deficiencies could be a mechanism through which this could occur. Keywords: certification, standards; immunization, trends; poliomyelitis, prevention and control; polioviruses, human 1-3, pathogenicity.

Voir page 293 le resume en francais. En la pagina 294 figura un resumen en espanol. Introduction 'Elimination and eradication are the ultimate goals of public health, evolving naturally from [...], Disease eradication as a public health strategy was discussed at international meetings in 1997 and 1998. In this article, the ongoing poliomyelitis eradication initiative is examined using the criteria for evaluating candidate diseases for eradication proposed at these meetings, which covered costs and benefits, biological determinants of eradicability (technical feasibility) and societal and political considerations (operational feasibility). The benefits of poliomyelitis eradication are shown to include a substantial investment in health services delivery, the elimination of a major cause of disability, and far-reaching intangible effects, such as establishment of a 'culture of prevention'. The costs are found to be financial and finite, despite some disturbances to the delivery of other health services. The 'technical' feasibility of poliomyelitis eradication is seen in the absence of a non-human reservoir and the presence of both an effective intervention and delivery strategy (oral poliovirus vaccine and national immunization days) and a sensitive and specific diagnostic tool (viral culture of specimens from acute flaccid paralysis cases). The certification of poliomyelitis eradication in the Americas in 1994 and interruption of endemic transmission in the Western Pacific since March 1997 confirm the operational feasibility of this goal. When the humanitarian, economic and consequent benefits of this initiative are measured against the costs, a strong argument is made for eradication as a valuable disease control strategy. Keywords: cost--benefit analysis; immunization programmes, case studies, and organization and administration; poliomyelitis, prevention and control; programme evaluation.

Looks at the magnitude of hospitalizations for pertussis and pertussis mortality and estimates the total burden of clinically significant pertussis in the United States. Study results which suggest that there is a substantial under reporting of pertussis, and that severe complications of pertussis are reported preferentially to the Centers for Disease Control (CDC). More.