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Smallpox: Eradication Program

Principles & Operations

Handbook for Smallpox Eradication Programmes in Endemic Areas

1967 (1st revision). SEP unit, WHO SE/67/5 Rev 1. 10665/67940

HANDBOOK FOR SMALLPOX ERADICATION PROGRAMMES IN ENDEMIC AREAS

FOREWORD

This Manual has been developed as a guide for WHO staff and senior staff of National Smallpox Eradication Programmes. The principles set forth and the procedures suggested have been based on extensive staff and consultant experiences in field epidemiology and in different types of vaccination campaigns, as well as on recent experiences with smallpox eradication programmes in several parts of the world.

To date, however, no programme of the magnitude and general character of the present project has ever been undertaken and thus there is much which is yet unknown. It is also evident that no manual could provide a satisfactory single blue-print which would be universally applicable, considering the many smallpox endemic countries and the vast differences in present health structures, personnel and policies, population characteristics and attitudes, geography and climate. Further, it is clear that the many countries which have thus far become smallpox-free have achieved this status by a number of different approaches.

This Manual, therefore, has been developed not as a rigid text but as a description of basic principles which, in the informed judgement of the many who participated in its preparation, should facilitate the progress of eradication nationally and globally. Purposefully, every effort has been made to simplify methods and procedures, recognizing, of course, that in a few countries a more complex and sophisticated scheme may be elaborated from these basic principles.

A Manual such as this must continually evolve as the global programme progresses and must constantly be subjected to query and criticism. In cognizance of the fact that the most vigorous testing and scrutiny of the principles set forth will take place during the first years of the programme, the Manual has been distributed initially in "draft" form with the expectation that a more definitive text would be developed after a year's experience.

From all concerned, comments and suggestions with respect to the Manual are welscome.

SE/67.5 Rev 1

TABLE OF CONTENTS

  1. Title, Contents, Foreword and Introduction
  2. Smallpox: Clinical and laboratory diagnosis
  3. Vaccination: Technical considerations
    • Smallpox vaccine: Vaccinia virus strains; vaccine production, standards, and testing
    • Vaccination: Mechanics, clinical response, complications, contraindications, simultaneous multiple vaccines
  4. Operations
    • Principles & background
    • Administrative authority & financing
    • Organization and planning: Collection of information; basic approaches; priorities; inter-country co-ordination; advance publicity; assessment; surveillance
    • Staffing and personnel management: Job descriptions; recruitment, training, retention; local volunteers; supervision
    • Initial contacts; local logistics; design and operation of vaccination posts; accountability for equipment
  5. Education for cooperation
    • Information needs; facts to be conveyed; action required
    • Participation & influence of national and local groups and authorities
    • Staff training
    • Mechanisms for information and education
  6. Assessment
    • Tabulation of numbers of vaccinations performed
    • Field evaluation of vaccination success
    • Extent of coverage
    • Utilization of data obtained
    • Vaccination and smallpox scar surveys; challenge vaccination; serological surveys
  7. Surveillance
    • Principles of execution of a surveillance system
    • Analysis & interpretation of reported data & investigations
    • Corrective action based on reports and analyses
    • Distribution of data & interpretations to all concerned with disease control activities
    • Intensity of surveillance and field investigations
    • Outbreak-control procedures
  8. Smallpox eradication and the general health services
    • General considerations with respect to mass campaigns and the general health services
    • Specific consideration with respect to the smallpox programme
  9. Essentials of health legislation
    • Compulsory vaccination and revaccination
    • Prohibition of variolation and arm-to-arm vaccination
    • Isolation procedures at the time of an outbreak
    • Reporting of cases
    • International Sanitary Regulations
  10. Administrative support
    • Budget
    • Organizational structure
    • Supply services: Warehouse, methods of storage, security, personnel, forms, supervision & control of services; imported supplies and equipment; freeze-fried vaccine shipments
    • Transport: Supervision, control, preventive maintenance
    • Special equipment: Vaccination kits
  11. Areas of particular interest for field research investigation
    • Descriptive epidemiology of smallpox
    • Specific epidemiological indices assessable without laboratory facilities
    • Investigations requiring laboratory assistance
    • Multiple antigen administration
    • Suitable strains of vaccinia virus for vaccine production
    • Chemoprophylaxis and chemotherapeutic agents
    • Operational and sociological studies
  12. Annex: Reports to WHO