Excerpt

In an effort to better understand the dynamics of disease eradication and post-immunization policies, the Institute of Medicine (IOM)'s Forum on Emerging Infections hosted a two-day workshop (February 1–2, 2001) on The Consequences of Viral Disease Eradication. Through invited presentations, panel discussion, and open dialogue with workshop participants, we explored the principles underlying the biological challenges, medical interventions, and operational considerations for post-immunization strategies for vaccine-preventable viral diseases, and highlighted important efforts that may facilitate wise decision making.

Contents

• THE NATIONAL ACADEMIES
• FORUM ON EMERGING INFECTIONS
• BOARD ON GLOBAL HEALTH
• Reviewers
• Preface
• Summary and Assessment
  Joshua Lederberg, Ph.D.
  • POLIO
  • MEASLES
  • CONGENITAL RUBELLA SYNDROME
  • POST-ERADICATION CHALLENGES
  • REINTRODUCTION OF DISEASE IN THE POST-ERADICATION ERA
  • DETECTION AND SURVEILLANCE
  • CONTINUED VIRAL RESEARCH IN THE POST-ERADICATION ERA
  • VACCINES AND ANTIVIRAL THERAPIES FOR USE IN THE POST-ERADICATION ERA
  • INSTITUTIONAL AND SYSTEMS PREPAREDNESS FOR DISEASE OUTBREAK
  • CONCLUSION
  • REFERENCES
• 1. Introduction
  Ciro A. de Quadros, M.D., M.P.H.
  • HISTORY AND PROSPECTS FOR DISEASE ERADICATION
  • PRECONDITIONS FOR DISEASE ERADICATION
  • HISTORY: SUCCESSES AND FAILURES
  • LESSONS FROM RECENT EXPERIENCES: POLIO AND MEASLES ERADICATION IN THE AMERICAS
  • PROSPECTS FOR ERADICATION OF OTHER VIRAL DISEASES
  • CONCLUSION
  • REFERENCES
• 2. Major Efforts for Disease Eradication
  • OVERVIEW
  • SMALLPOX
  • THE NEXT TARGET AFTER POLIO: GLOBAL ERADICATION OF MEASLES
  • ERADICATION OF CONGENITAL RUBELLA SYNDROME
  • POST-POLIO ERADICATION: ISSUES AND CHALLENGES
  • REFERENCES
• 3. Biological Challenges to Post-Eradication
  • OVERVIEW
  • HERD IMMUNITY AND THE DESIGN OF VACCINATION PROGRAMS
  • ERROR, HUBRIS, AND MALICE
  • NATURAL SIV RESERVOIRS AND HUMAN ZOONOTIC RISK: CHALLENGES TO DISEASE ERADICATION
  • VACCINE-ASSOCIATED CASES DUE TO IMMUNIZATION WITH LIVE VIRUS VACCINES
  • REFERENCES
• 4. Operational and Institutional Challenges to Post-Eradication
  • OVERVIEW
  • REVISION OF THE INTERNATIONAL HEALTH REGULATIONS: PROGRESS REPORT
  • DISEASE SURVEILLANCE, PROGRAM MANAGEMENT, AND SUSTAINMENT OF IMMUNIZATION PROGRAMS
  • THE CAPACITY OF PUBLIC HEALTH SERVICES TO RESPOND TO AN OUTBREAK IN THE POST-ERADICATION ERA
  • LABORATORY SECURITY AND REGULATIONS GOVERNING VIRAL PATHOGENS IN A POST-IMMUNIZATION ERA
• 5. Medical Intervention and Technological Solutions
  • OVERVIEW
  • THE POLIO ERADICATION EFFORT: SHOULD VACCINE ERADICATION BE NEXT?
  • ANTIVIRAL THERAPY IN THE MANAGEMENT OF POST-ERADICATION INFECTIOUS DISEASE OUTBREAKS
  • POTENTIAL USE OF CYTOKINES AND ANTIBODY FOR POST-EXPOSURE PROPHYLAXIS IN THE POST-ERADICATION ERA
  • THE POTENTIAL ROLE OF PROBIOTICS AND MICROBIAL ECOLOGY IN HOST DEFENSE
  • REFERENCES
• 6. The Challenges to Post-Eradication Outbreaks
  • OVERVIEW
  • READY OR NOT: THE U.S. HEALTH CARE SYSTEM AND EMERGING INFECTIONS
  • VACCINES FOR POST-ELIMINATION CONTINGENCIES
  • STRATEGIC PRIORITIES FOR ADDRESSING POST-ERADICATION OUTBREAKS
  • UNDERSTANDING THE PUBLIC AND MEDIA RESPONSE TO AN OUTBREAK
  • POST-ERADICATION CHALLENGES IN THE DEVELOPING WORLD
  • REFERENCES
• APPENDIXES
  • Appendix A Glossary and Acronyms
  • Appendix B Workshop Agenda
  • Appendix C Forum Member and Speaker Biographies

This report is based on the proceedings of a workshop that was sponsored by the Forum on Emerging Infections. It is prepared in the form of a workshop summary by and in the name of the editors, with the assistance of staff and consultants, as an individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Emerging Infections. The content of those sections is based on the presentations and the discussions that took place during the workshop.

Support for this project was provided by the U.S. Department of Health and Human Services' National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Agency for International Development; Abbott Laboratories; American Society for Microbiology; Bristol-Myers Squibb Company; Burroughs Wellcome Fund, Eli Lilly & Company; The Ellison Medical Foundation; Glaxo Wellcome; F. Hoffmann-La Roche AG; Pfizer, Inc.; SmithKline Beecham Corporation; and Wyeth-Ayerst Laboratories.

The views presented in this report are those of the Institute of Medicine Forum on Emerging Infections and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.