TOWARDS THE ENDGAME AND BEYOND: COMPLEXITIES AND CHALLENGES FOR THE ELIMINATION OF INFECTIOUS DISEASES.

Sunday, 9th of March 2014

[source]Philosophical Transactions of the Royal Society B: Biological Sciences[|source]

Vaccination has successfully interrupted circulation of poliomyelitis, measles, rubella and has drastically reduced the incidence of foot-and-mouth disease (FMD) and canine rabies throughout the Americas; mass drug administration has significantly reduced the transmission of lymphatic filariasis and onchocerciasis (river blindness) across their endemic ranges, whereas the number of cases of dracunculiasis (guinea worm) has fallen by more than 99 per cent since 1986 through behavioural interventions without the use of either drugs or vaccines. However, despite these successes, eradication per se of established pathogens has been limited. Only one human (smallpox) and one animal (rinderpest) disease have been eradicated to date.

In this report, the authors list major knowledge gaps across diseases that have been targeted for eradication/elimination, outline some of the current issues in implementation of control methods and finally, conclude by discussing prospects for success. The report re-assures that while the last mile is often the longest, it can also bring the greatest benefits. Details of the lessons learnt over the years in these elimination/eradication drives are accessible at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720036/

 

Abstract

Successful control measures have interrupted the local transmission of human infectious diseases such as measles, malaria and polio, and saved and improved billions of lives. Similarly, control efforts have massively reduced the incidence of many infectious diseases of animals, such as rabies and rinderpest, with positive benefits for human health and livelihoods across the globe. However, disease elimination has proven an elusive goal, with only one human and one animal pathogen globally eradicated. As elimination targets expand to regional and even global levels, hurdles may emerge within the endgame when infections are circulating at very low levels, turning the last mile of these public health marathons into the longest mile. In this theme issue, we bring together recurring challenges that emerge as we move towards elimination, highlighting the unanticipated consequences of particular ecologies and pathologies of infection, and approaches to their management.