Tuberculosis remains the leading cause of death in the world from a single infectious disease, although there is little knowledge of the mechanisms of its pathogenesis and protection from it. After a century of decline in the United States, tuberculosis is increasing, and strains resistant to multiple antibiotics have emerged. This excess of cases is attributable to changes in the social structure in cities, the human immunodeficiency virus epidemic, and a failure in certain major cities to improve public treatment programs. The economic costs of not adequately addressing the problem of tuberculosis in this country are estimated from an epidemiological model.

https://science.sciencemag.org/content/sci/257/5073/1055.full.pdf

Tuberculosis: commentary on a reemergent killer.

Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD) Study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY). This article describes key features of the Global Burden of Disease analytic approach, the evolution of the GBD starting from the first study for the year 1990, and summarizes the methodological improvements incorporated into GBD revisions carried out by the World Health Organization. It also reviews controversies and criticisms, and examines priorities and issues for future GBD updates.

Global Burden of Disease

Herd immunity has to do with the protection of populations from infection which is brought about by the presence of immune individuals. The concept has a special aura, in its implication of an extension of the protection imparted by an immunization program beyond vaccinated to unvaccinated individuals and in its apparent provision of a means to eliminate totally some infectious diseases. It is a recurrent theme in the medical literature and has been discussed frequently during the past decade. This new popularity comes as a consequence of several recent major achievements of vaccination programs, i.e.: the historic success of the global smallpox eradication program; dramatic increases in vaccination coverage stimulated by national programs and by the Expanded Programme on Immunization; the commitment of several countries to eradicate measles; and international dedication to eliminate neonatal tetanus and to eradicate poliomyelitis from the world by the year 2000.'

Herd Immunity: History, Theory, Practice

Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care. Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in neonatal health.

/pdf/community-based-interventions-for-improving-perinatal-and-17rlant020.pdf

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

The Vaccine Adverse Event Reporting System (VAERS).

The Expanded Programme on Immunization (EPI) was established in 1974 to develop and expand immunization programmes throughout the world. In 1977, the goal was set to make immunization against diphtheria, pertussis, tetanus, poliomyelitis, measles and tuberculosis available to every child in the world by 1990. Problems encountered by the Programme have included: lack of public and governmental awareness of the scope and seriousness of the target diseases; ineffective programme management; inadequate equipment and skills for vaccine storage and handling; and insufficient means for monitoring programme impact as reflected by increasing immunization coverage levels and decreasing incidence of the target diseases. When the EPI was initiated in 1974, fewer than 5% of children in developing countries were receiving a third dose of DPT and poliomyelitis vaccines in their first year of life. These coverage levels have now surpassed 50% in developing countries, and millions of cases of the target disease have been prevented. Over 700,000 measles deaths were prevented by immunization in developing countries in 1987, and an increasing number of neonatal tetanus deaths is now being prevented by maternal immunization and improved childbirth conditions. Poliomyelitis immunization efforts have been so successful that the Pan American Health Organization is leading a drive to eradicate poliomyelitis from the Americas by 1990. The successes of the Programme represent a major public health achievement, but much remains to be done.(ABSTRACT TRUNCATED AT 250 WORDS)

Expanded programme on immunization.

The Expanded Program on Immunization (EPI) aims at the reduction of morbidity and mortality from vaccine-preventable diseases through the provision of immunization to women and children. Program effectiveness is measured by immunization coverage and by incidence of the target diseases. Information on these 2 indicators is provided by national programs to WHO Regional Offices and forwarded to EPI Geneva. Although considerable progress has been made in delivering vaccines to the children of the world the potential impact of immunization remains unfulfilled. In the developing world (excluding China) less than 40% of infants receive a 3rd dose of DPT or polio vaccines and coverage with measles vaccine remains at only 1/2 of that level. Over 3 million children still die each year from measles neonatal tetanus and pertussis while over a 1/4 of a million children are crippled by poliomyelitis. In the European Region the coverage goal of the EPI has been largely achieved. In the American Region dramatic progress has been made since the beginning of EPI. The South-East Asia Region has made steady progress since the start of the EPI. The Western Pacific Region is the most heterogenous within WHO with countries ranging in size from the smallest to the largest in the world. Levels of socioeconomic development and immunization coverage also differ widely. Nevertheless satisfactory progress is observed in the majority of countries. In the African Region the problems of drought famine and civil unrest are extensive. Despite these problems progress has been satisfactory and exemplary in a few countries. In the Eastern Mediterranean Region progress in increasing immunization coverage has been remarkably good. It will be difficult however to improve immunization services for the remainder of the decade in a number of countries currently ravaged by drought famine and civil unrest.

C. Chan

Papers

Expanded programme on immunization.

Effectiveness of the expanded programme on immunization