Discussion board/Outline Research Paper
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CASE 5 Eliminating Polio in Latin America and the Caribbean*
ABSTRACT
Geographic area: Latin America and the Caribbean
Health condition: In the 1970s, Latin America had an estimated 15,000 paralysis cases and
1,750 deaths each year due to polio. The oral polio vaccine was introduced in the region in
1977.
Global importance of the health condition today: Today, polio is on the verge of being erased
from the globe. As recently as 1988, 125 countries were endemic for polio, with an
estimated 350,000 cases. Through the first half of 2006, just four countries were reported
endemic for polio, and fewer than 700 cases were reported worldwide. This dramatic
reduction is the result of massive oral polio vaccine (OPV) immunizations through a global
eradication campaign.
Intervention or program: In 1985, the Pan American Health Organization began a polio
eradication campaign in Latin America and the Caribbean, to complement the routine
immunization efforts of the newly formed Expanded Programme on Immunization. To
increase immunization coverage in areas with weak routine health services, all endemic
countries in the region implemented national vaccine days twice a year to immunize every
child under 5, regardless of vaccination status. In the final stages of the campaign,
“Operation Mop-Up” was launched to aggressively tackle the disease with house-to-house
vaccinations in communities reporting polio cases and with low coverage. An extensive
surveillance system helped track outbreaks.
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Cost and cost-effectiveness: The first five years of the polio campaign cost $120 million: $74
million from national sources and $46 million from international donors. Taking into
consideration the savings from treatment, these donor contributions would pay for
themselves in just 15 years. The administration of the vaccine is highly cost-effective, at just
$20 for a healthy year of life in a high-mortality environment.
Impact: In 1991, the last case of polio was reported in Latin America and the Caribbean. The
disease reemerged briefly in 2000 when 20 vaccine-associated cases were reported in Haiti
and the Dominican Republic, but no other cases have been reported since 1991. Today, polio
has been eliminated from Latin America and the Caribbean.
As the world struggles to wipe out the last traces of polio, one region has been polio free for
more than a decade. The experience of polio elimination in Latin America and the
Caribbean shines a light on what can be done when regional cooperation and support are
strong, funding is sufficient, and the strategy covers all the bases. As a result of these factors,
polio—which used to cripple thousands in the region each year—is now becoming a distant
memory.
†
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A MIGHTY DISEASE
Polio, short for poliomyelitis, is one of history’s most feared infectious diseases. It is caused
by the intestinal poliovirus, which enters its victim through the mouth or nose and
multiplies in the lymph nodes. Polio’s most distinguishing symptom, paralysis, develops in
less than 1% of all victims and is caused when the virus invades the central nervous system
and irrevocably kills the nerve cells responsible for muscle movement. If enough nerve cells
are destroyed, the victim is left with lifeless limbs (primarily the legs) in what is called acute
flaccid paralysis. In as few as four days, a previously healthy person can become stricken
with paralysis and condemned to a lifetime of crutches and wheelchairs. Quadriplegia
occurs when extensive paralysis develops in the trunk and muscles of the thorax and
abdomen.
The most serious form of the disease, called bulbar polio, occurs when the virus invades the
motor neurons of the brain stem and paralyzes the relevant muscles so that the victim loses
the ability to swallow, breathe, and speak. Respiratory support is needed to keep bulbar
polio victims alive, and fatality runs as high as 40%.
During the virus’s incubation period, ranging from 4 to 35 days, infected individuals are
extremely contagious and can spread the virus to others through their contaminated feces.
The virus can live for as long as two months outside the body and resides in swimming
pools, drinking water, food, and clothing. Transmission is silent; 90% of the carriers show no
sign of the disease at all, thanks to their development of protective antibodies. Of the 9% of
victims who develop nonparalyzing symptoms, their fever, fatigue, headache, vomiting, or
stiff neck rarely point conclusively to polio. As a result, for each case of distinctive polio
paralysis reported in an area, the community is further threatened by another 2,000 to 3,000
contagious carriers, who may show no further sign than a fever—rendering even a single
documented case indicative of an epidemic.
Today, polio is on the verge of being erased from the globe. As recently as 1988, 125
countries around the world were endemic for polio, with an estimated 350,000 polio cases.
Through the first half of 2006, only four were endemic, and there were fewer than 700
reported cases. This is due to the coordinated efforts of regional and international polio
eradication campaigns that have immunized hundreds of millions of children against the
deadly scourge. The regional polio campaign in Latin America and the Caribbean, in
particular, is an outstanding success and eliminated polio from the region in just six years.
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ROAD TO A VACCINE
In the first half of the 1900s, polio was most prominent in industrialized countries in Europe
and North America. Tens of thousands of children became infected with the disease each
year in the United States, and thousands more died. Each summer the disease would cause
widespread panic when its indiscriminate path left a trail of paralysis and death. Public
pools, movie theaters, and beaches were shut down out of fear of the disease, and crippled
children supported by crutches and breathing through imposing iron lung machines were
common sights.
In the 1930s and 1940s, following a series of prominent outbreaks, the American public
rallied behind the drive for a vaccine. The mobilization effort was led by polio’s most
famous victim, US President Franklin D. Roosevelt, who was left permanently paralyzed
after suffering a bout of polio in 1921. In 1938, President Roosevelt created the National
Foundation for Infantile Paralysis, later renamed the March of Dimes, to support healthcare
for sufferers and to raise funds “a dime at a time” for the urgent quest for a vaccine.
Fourteen years later, in 1952, the millions of nickels and dimes collected through the
grassroots March of Dimes campaigns finally paid off. Dr. Jonas Salk made history that year
with his discovery of an inactivated polio vaccine (IPV), made from a deactivated (“killed”)
version of the poliovirus. Administered through an injection, the IPV is capable of protecting
against the ravages of polio. The successful results from large community trials were printed
in exuberant headlines around the world, and mass immunization led to a rapid and
dramatic reduction in disease incidence over the next few years. Between 1955 and 1961,
more than 300 million doses were administered in the United States, resulting in a 90% drop
in the incidence of polio.
In 1961, a second scientific breakthrough presented the world with a new form of the
vaccine, which would later prove ideally suited for widespread use in developing countries.
Dr. Albert Sabin’s oral polio vaccine (OPV) is made from a live attenuated (weakened) virus
and is administered orally. Just three doses of OPV, properly spaced, can confer lifetime
immunity to both the user and his or her close contacts. The vaccine works like the IPV by
producing antibodies that stop the spread of the poliovirus to the nervous system, thus
preventing paralysis. OPV goes a step further, however, by reducing the multiplication of
the virus in the intestine, thereby helping to halt person-to-person transmission. At
approximately 5 cents per dose, OPV is considerably cheaper than its predecessor. Because
no needles are required, administration of OPV is also easier, and volunteers can do it on a
wide scale.
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The power of the new oral vaccine was first demonstrated during a trial in Chiapas, Mexico,
which suffered a polio outbreak in 1961. In as few as four days, Sabin’s team reached 80% of
children under 11 with the new oral vaccine. After polio was successfully wiped out from
the city a few weeks later, Sabin believed he had discovered not only an improved vaccine
but also a successful strategy for large-scale immunization. It would take another two
decades, however, for Sabin’s model of intensive, widespread vaccine campaigns to be
deployed.
POLIO IN LATIN AMERICA
Polio was not recognized as a major public health threat to developing countries until the
middle of the 1900s, at the same time that the disease was being erased from North America
and Europe. In the 1980s, the incidence of paralysis in developing countries rivaled the level
in developed countries before the introduction of a vaccine. Estimates suggest that there
were more than 250,000 cases of paralytic polio worldwide in 1987.
In Latin America in the 1970s, there were an estimated 15,000 paralysis cases and 1,750
deaths each year due to polio. Countries in the region first added the OPV to regular
immunization in 1977 as part of the new Expanded Programme on Immunization (EPI). At
the program’s outset, immunization in Latin America for the six targeted diseases in the EPI
—diphtheria, tetanus, pertussis (which are collectively known as DTP), plus polio, measles,
and tuberculosis—was quite low at 25%, with OPV coverage among children less than 1 year
of age higher, at 38%. With the support of a broad coalition of both international and
national partners, EPI promoted the delivery of immunization services for polio and the five
other principal diseases through the routine basic health services of Latin American
countries. By 1984, coverage with OPV grew to an impressive 80%, the highest of all EPI
vaccines. Between 1975 and 1981, the incidence of polio in the region was cut almost in half,
and the number of countries reporting cases of polio dropped from 19 to 11.1. See Box 5-1.
The success of EPI in reducing polio in Latin America during the 1970s and 1980s inspired
Dr. Carlyle Guerra de Macedo, then director of the Pan American Health Organization
(PAHO), to propose the eradication of indigenous wild poliovirus in Latin America and the
Caribbean by 1990 through a coordinated regional effort. A polio eradication campaign was
seen as a stepping stone to strengthening the entire EPI, to improving health infrastructure
throughout the region, and to establishing a greatly needed surveillance system to monitor
the impact of interventions on the reduction of polio and other diseases. Encouraged by the
success of the smallpox eradication campaign 14 years earlier, the PAHO directing council
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passed a resolution in 1985 launching the program to eliminate polio from Latin America
and the Caribbean.
BOX 5-1 The Expanded Programme on Immunization
In May 1974, the World Health Assembly created the Expanded Programme on
Immunization (EPI). The initiative brought together a diverse coalition of both national and
international partners to achieve the goal of immunizing by 1990 all children under 5 years
of age against six vaccine-preventable diseases: diphtheria, tetanus, pertussis (or DTP), plus
measles, tuberculosis, and polio. The second expressed goal of EPI, to “promote the
countries’ self-reliance on the delivery of immunization service within the context of their
comprehensive services,” set in motion the strengthening of the overall health
infrastructure.
Immunization was integrated into regular maternal and child health services and made a
fixture in primary healthcare. Program managers were trained, a comprehensive cold
chain established, and a vaccine procurement fund put in place. To decrease the number of
visits that mothers with small children would have to make, the program synchronized
administration of several vaccines.
The success of EPI has been extraordinary: At the outset of the program in 1974, the average
immunization coverage rate in developing countries was just 5%. By 1991, 83% of children
in developing countries received three doses of DTP vaccines, and 85% received the polio
vaccine.
EPI has succeeded in decreasing the share of the six diseases in the total burden of disease
among children under 5 from about 23% in the mid-1970s to less than 10% in 2000. At a cost
of just $20, fully immunizing a child against the six diseases is one of the most affordable
interventions in existence.
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PUTTING TOGETHER THE PIECES: POLITICAL, FINANCIAL, AND MANAGERIAL
The polio campaign was immediately charged with two crucial objectives: mobilizing the
necessary political, financial, and social commitment for the intense regional effort; and
organizing the managerial oversight to carry out immunization in each country.
To marshal political and financial support, an Interagency Coordinating Committee (ICC) for
Latin America and the Caribbean was established. The committee, comprising
representatives from PAHO, the United Nations Children’s Fund (UNICEF), the US Agency for
International Development (USAID), the Inter-American Development Bank (IDB), Rotary
International, and the Canadian Public Health Association, contributed more than $110
million between 1987 and 1991. The structure was an innovative model with a level of
coordination never before attained in the region. “Prior to the formation of the ICC, many of
these agencies had been working independently and sometimes in competition with each
other, even duplicating efforts at the country level,” explained Dr. Ciro de Quadros, the
leader of the regional eradication initiative. “It was the first time that such a mechanism
was established in the Americas and it proved to be a fundamental means of securing
permanent coordination and continuous support for the program. Its advocacy has been key
for the sustained political and social will generated by the initiative.” The success of the ICC,
according to de Quadros, demonstrated that “diverse organizations can work together to
achieve an important health objective.”
Because national-level leadership, funding, and management were paramount to the
initiative, the ICC model was duplicated at the country level. Each national ICC worked
under the coordination of the country’s ministry of health to develop a 5-year national plan
of action to set immunization program strategies and streamline national resources. The
plans delineated objectives, targets, strategies, activities, expected outputs, and time frames.
Furthermore, because the cost and expected source of funding (either internal or external)
were identified for each activity, the national plans provided a vehicle for systematically
analyzing the financing of immunization activities. National commitment in the region was
extremely strong and was demonstrated in the financial support from Latin American
governments. In the first 5-year plans from 1987 to 1991, 80% of the $544.8 million budget
for EPI was derived from national resources. This figure climbed to 90% in the second 5-
year plan.
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To address managerial needs, PAHO created an EPI technical advisory group of five
international health experts to review the initiative’s progress and set priorities. Thousands
of health workers, managers, and technicians were subsequently trained in tasks ranging
from cold chain management to surveillance. Furthermore, “Resources were decentralized
to strengthen the response capabilities of the local health systems,” added de Quadros.
EXTREME VIGILANCE
Even one confirmed case of polio could threaten an entire community, so the initiative
immediately recognized that a well-developed surveillance system capable of detecting even
low levels of infection was essential to the program’s success and to ensuring immediate
investigation of each case. At the outset of the program in 1985, however, such a system was
lacking.
The campaign set out to establish uniform indicators throughout the region. Suspected cases
were cases of acute paralytic illness that a doctor strongly suspected to be polio.
Epidemiologists were to investigate each suspected case within 48 hours. For probable cases,
or instances of acute flaccid paralysis, two stool specimens would be sent for examination to
one of the diagnostic laboratories established in the network. A probable case would be
dubbed a confirmed case if the laboratories found evidence of the wild poliovirus in the
sample within 10 weeks, if the patient died within 60 days, or if the patient could not be
traced later. To encourage community involvement in case identification at the end of the
campaign, PAHO offered a reward of $100 for the reporting of suspected cases.
A Field Guide for Surveillance and Polio Eradication was widely disseminated, and
hundreds of health workers were trained in surveillance. Surveillance indicators to track
program performance were established, and the overall system was computerized by 1989.
A reporting network of 22,000 health institutions was established, through which local
clinics were required to report weekly on either the presence or absence of suspected cases.
Furthermore, eight diagnostic laboratories were equipped to detect wild poliovirus in stool
specimens.
IMMUNIZATION STRATEGIES
The immunization strategy of the polio campaign centered around three primary
components: achieving and maintaining high immunization coverage, prompt identification
of new cases, and aggressive control of outbreaks. Each country in the Latin American and
Caribbean region was grouped into one of two categories: (1) “polio-free” countries where
no case of polio was reported in the previous three years, and (2) “polio-endemic” countries
that had at least one identified case. Countries in the former category were encouraged to
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maintain their polio-free status through routine immunization—a central pillar of the
eradication campaign—and through effective surveillance.
The approach implemented to increase polio immunization coverage in polio-endemic
countries was based on Brazil’s OPV experience. Beginning in 1980, after disappointing
coverage rates in the previous decade exposed that routine health services alone would not
accomplish the EPI goals, Brazil embarked on a new strategy of national vaccine days. Held
twice a year, one to two months apart, each national vaccine day administered OPV to 20
million children, accounting for nearly all of those in the under-5 age group. The national
vaccine days were designed to vaccinate as many children as possible, regardless of their
vaccination status, to instantly deprive the virus of its lifeline and halt its transmission.
Brazil’s strategy was not new; in fact, it was the very approach that Sabin tested in Chiapas
and subsequently recommended. In the 1960s, Cuba used the strategy to interrupt the
disease with the help of more than 80,000 local committees that were mobilized to conduct a
series of week-long house-to-house campaigns. In fact, every country that had halted polio
transmission employed some sort of mass vaccination campaign. Brazil’s experience,
however, was a powerful example of how poor countries in the region with less developed
health infrastructures could bolster coverage and interrupt polio transmission.
By 1987, all 14 countries in the polio-endemic category had incorporated national vaccine
days to complement, but not replace, regular immunization, and immunization coverage
quickly rose. DTP and measles vaccines were likewise incorporated into the national vaccine
days to help boost the overall EPI goals.
“OPERATION MOP-UP” AND THE FINAL CASE
Although the national vaccine days helped slow polio’s transmission in most of Latin
America by 1989, the disease still lingered in 1,000 of the 14,000 districts. “Operation Mop-
Up” was launched that year to aggressively tackle the virus in its final bastions. The
initiative targeted the communities where polio cases had been reported; where coverage
was low; or where overcrowding, poor sanitation, weak health care infrastructure, and/or
heavy migration prevailed. In these communities, two house-to-house vaccination
campaigns were conducted to finally wipe out the disease.
In 1991, just seven cases of polio were confirmed: six in Colombia and one in Peru. An
aggressive mop-up campaign was launched in Colombia to vanquish the disease. House-to-
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house vaccination campaigns reached almost a million households, and nearly a million
children under 5 were immunized.
In August 1991, 2-year-old Luis Fermin Tenorio of Pichinaki, Peru, made history as the last
polio victim in Latin America. By the end of 1993, two years later, 9,000 stool specimens had
been examined, and no poliovirus was found. In 1994, vaccine coverage rates through
routine immunization services peaked at 86% in the region, meeting the high surveillance
standards set by the International Commission for Certification of the Eradication of
Poliomyelitis in the Americas. Polio was then declared eliminated from Latin America and
the Caribbean (see Figure 5-1).
IMPACT OF ELIMINATION
In addition to the tangible benefits to the health and welfare of residents in Latin America
following the eradication of polio, the program’s success has left an indelible mark on the
region’s health infrastructure and its capacity to control other infectious diseases.
Thousands of trained epidemiologists and health workers with experience in surveillance,
disease control, cold chain management, and operational research currently are addressing
new health challenges. The program’s surveillance system is considered to be the “most
comprehensive surveillance system for human health that has ever existed in the Western
Hemisphere,” and the network of diagnostic laboratories now detects and controls
additional public health threats, such as measles, cholera, and tetanus.
The health planning capacity of national governments also has improved considerably. The
annual national plans of action continue to serve as an important program management
tool and have expanded to cover broader mother and child health services. Finally, the polio
campaign succeeded in advancing the overall goals of the EPI. By the end of 1990, coverage
for the six EPI vaccines reached a historic high: Coverage for every vaccine was above 70%
and in many regions exceeded 80%.
ECONOMICALLY JUSTIFIED?
Administration of an oral polio vaccine is both an inexpensive and an extremely cost-
effective intervention. It is estimated that the cost of immunizing a child with three doses of
the polio vaccine (along with the DTP vaccine) is about $14. The cost of a healthy year of life
from polio immunization ranges from $7 to $16 in high-mortality environments, placing it
among the most cost-effective health interventions for children.
Even without considering the additional benefits of productivity, strengthened capacity to
fight other diseases, and reduced pain and suffering, the polio eradication campaign
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was economically justified based on the savings of medical costs for treatment and
rehabilitation alone. The cost of the first five years of the program was reported at $120
million: $74 million from national sources and $46 million from international donors—and
$10 million annually from donor sources thereafter. Comparing the savings from treatment
costs with the cost of the 5-year program, the net benefit of the eradication campaign (after
discounting even at the high rate of 12% per year) in its first five years was $217.2 million.
In the 10 years after eradication, the discounted net savings climbed to $264.2 million. Over
a 15-year period, donor contributions would pay for themselves. In short, economist Philip
Musgrove concluded, “The eradication of polio would actually put money in the coffers of
the Ministry of Health, or whoever now pays to treat polio victims.”
FIGURE 5-1 Eradication of wild poliovirus from Latin America and the Caribbean: acute flaccid paralysis, 1969–1995.
Note: OPV = oral polio vaccine. Bars represent percent of coverage. Source: de Quadros (1997).
MAINTAINING AND EXPANDING SUCCESS
The success of the polio eradication campaign was due in large part to exemplary political
commitment and inter-agency and regional coordination. Complacency and polio
importation from endemic regions, however, pose a risk to the program’s achievements. In
2000, these dangers were realized when incomplete immunization allowed polio to briefly
return to Latin America and the Caribbean. A total of 20 cases and two deaths were reported
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in Haiti and the Dominican Republic after a child developed a rare strain of the disease
when the circulating vaccine virus reverted to a more virulent form. Polio was then able to
spread quickly because the immunization coverage on the island was inadequate. The
outbreak was eventually contained, but not without first illustrating the need for sustained
financial support for immunization, sustained political will, and effective surveillance to
keep the region polio free.
GOING GLOBAL
Prompted by the success in Latin America and the Caribbean, an effort in 1998 was
launched to eradicate polio from the rest of the world. The global campaign, considered the
largest public health campaign in history, has been led by the World Health Organization,
Rotary International, UNICEF, and the US Centers for Disease Control and Prevention (CDC).
More than $3 billion has been rallied from the international community, including private
foundations, donor governments, development banks,
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nongovernmental organizations, and corporate partners. Rotary International has played a
particularly instrumental role, raising more than $500 million for the effort and providing
volunteers to assist with national immunization days.
The global initiative has employed many of the same effective immunization strategies that
proved successful in Latin America and the Caribbean, including national immunization
days and “mop-up” campaigns. Since 1988, an estimated two billion children have been
immunized against polio, and 5 million children who would have been paralyzed from polio
without the vaccine are now walking. Today less than 700 cases have been reported,
compared to 350,000 when the initiative began.
The global eradication effort faced a serious setback during 2003 and 2004 when the
discontinuation of immunization activities in northern Nigeria due to public fears over
vaccine safety led to a regional spread of the virus to 21 previously polio-free countries.
Weak routine immunization systems, low vaccine coverage rates, and discontinuation of
periodic national immunization days in many of these countries fueled the outbreaks. A
series of large-scale supplementary immunization activities was able to dramatically curtail
transmission in the countries experiencing importation, except in Somalia. Today, polio
transmission has been eliminated from all but four endemic countries: India, Pakistan,
Afghanistan, and Nigeria, where just five states contain more than two thirds of all cases.
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REFERENCES
1. de Quadros CA. Polio. In: Lederberg J, Alexander M, Bloom BR, et al, eds. Encyclopedia of Microbiology. Vol. 3. 2nd. ed. Burlington, VT: Academic Press, Inc.;2000:762–772.
2. Guwande A. The mop-up: eradicating polio from the planet, one child at a time. New Yorker. January 2004:34– 40.
3. Global Polio Eradication Initiative. Progress report. Available at: http://www.polioeradication.org/content/publications/2003-progress.pdf. Accessed January 12, 2007.
4. Henderson DA, de Quadros CA, Andrus JK, Olivé J-M, Guerra de Macedo C. Polio eradication from the Western Hemisphere. Annu Rev Public Health. 1992;13:239–252.
5. Olivé J-M, de Quadros CA. The Polio Eradication Initiative: An Opportunity for Costing EPI. Geneva, Switzerland: Expanded Programme on Immunization; 1989.
6. Hinman AR, Foege WH, de Quadros CA, Patriarca PA, Orenstein WA, Brink EW. The case for global eradication of poliomyelitis. Bull WHO. 1987;65:835–840.
7. Pan American Health Organization. Final Report of the Taylor Commission: The Impact of the Expanded Programme on Immunization and the Polio Eradication Initiative on Health Systems in the Americas. Washington, DC: Pan American Health Organization; 1995.
8. Musgrove P. Is the eradication of polio in the Western Hemisphere economically justified? Bull Pan Am Sanitary Bureau. 1988;22(1).
9. de Quadros CA. Global eradication of poliomyelitis. Int J Infect Dis. 1997;1(January):125–129.
10. de Quadros CA, Henderson DA. Disease eradication and control in the Americas. Biologicals. 1993;21:335–343.
11. de Quadros CA, Andrus JK, Olivé J-M, et al. Eradication of poliomyelitis: progress in the Americas. Pediatr Infect Dis J. 1991;10(3):222–229.
12. Brenzel L, Wolfson LJ, Fox-Roshby J, Miller M, Halsey NA. Vaccine-Preventable Diseases. In: Jamison D, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Mosgrove P, eds. Diseases Control Priorities in Developing Countries. 2nd Ed. New York: Oxford University Press; 2006.
13. World Health Organization. Weekly Epidemiological Record. 2006;81(7):61–68.
* Case drafted by Molly Kinder
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Whereas eradication refers to the reduction of worldwide incidence of a disease to zero, elimination refers to zero transmission in a specific geographic area or region.
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