William H. Foege

Guide to Community Preventive Services: harnessing the science.

This article presents reactions in the development of the Guide to Community Preventive Services, which brings public health to the same level of scientific scrutiny with evidence-based recommendations for community prevention services. The first reaction found this development a good change that should be supported, encouraged, and continued. It would help health providers know which practices are based on some level of evidence and which practices warrant more study. The second reaction welcomed the development as a step in the institutionalization of public health, subsequently developing public health systems, standardizing the training of public health workers, and incorporating epidemiology in public health practice. In addition, it is noted that the Guide aggregates the experiences of those who have tried and documented preventive practices. In the third reaction, it is viewed that the Guide would point the way to those activities for which additional attention and study is needed. The fourth reaction indicated that the guidelines would further improve collective knowledge. Finally, the fifth reaction stated that this publication would provide local health departments with an abundance of clear and factual information to plan activities, and educate the community.

The President’s National Security Agenda: Curtailing Ebola, Safeguarding the Future

A clear lesson of the Ebola epidemic in West Africa is the need for strong public health systems globally, including in the United States. Ebola has highlighted the dangers of weak public health systems, from the immense shortage of health workers in West Africa to the budget cuts at the U.S. Centers for Disease Control and Prevention. In response to Ebola and the broader threat of infectious disease, President Obama has proposed a

Lessons and innovations from the West and Central African Smallpox Eradication Program.

6.2 billion supplemental funding request to Congress. The supplemental would surge resources for containing and treating Ebola in West Africa -- including a reserve of funds to enable a robust, flexible response going forward -- enhance prevention and detection of, and response to, Ebola in the United States, and buttress U.S. and partner country health systems to respond rapidly and flexibly to all infectious disease hazards in the future. The additional resources the supplemental would devote to the ongoing Ebola crisis is critically important. So is the supplemental requests funding to prepare for the future, including developing treatment centers in the United States that would provide advanced care and isolation facilities, and funding for research and development for vaccines and medicines for Ebola and other novel infections. The request would also provide the first significant batch of funding to the Global Health Security Agenda, which President Obama unveiled in February 2014. The Global Health Security Agenda takes an all-hazards approach to building greater global capacity to prevent, detect, and respond to infectious diseases, from zoonotic diseases and antibiotic resistant bacteria to biosecurity and bioterror threats. From environmental degradation to increased human-animal interchange, the threats are only increasing. Strong public health systems at home and globally are our best defense. Congress should support the Presidents supplemental funding request, furthering a bipartisan U.S. tradition of support for global health, continuing U.S. global leadership in the Ebola response, and preparing our country and our world for disease threats of the future.

Discontinuance of Routine Smallpox Vaccination

In 1966, the Centers for Disease Control began training medical officers and public health advisors for a program that would encompass 20 countries of West and Central Africa with the objective of eradicating smallpox and controlling measles. The program was funded by the US Agency for International Development with a target of smallpox eradication within 5 years and the immunization of children from 6 months to 6 years of age against measles in all areas of every country. The 40 plus field staff were directed by a Regional Office in Lagos, Nigeria and a headquarters group in Atlanta, Georgia. The teams greatly expanded the knowledge of smallpox epidemiology, helped to expand the capabilities of Ministries of Health, pioneered the use of jet injectors to provide millions of immunizations, and expanded the use of surveillance/containment to become a primary strategy for interrupting smallpox transmission. Smallpox transmission was interrupted in three and one half years, a year and a half before the time targeted and under budget. Measles transmission was interrupted in one country, The Gambia, and significantly reduced in the other 19 countries.

Actual causes of death in the United States.

To the Editor.— The immunity status of the US population by age and geographic area is well known from previous immunization surveys. However, a study of European importations and control efforts in west Africa have shown that population immunity is not the single most important factor in determining whether an importation spreads widely. Instead, the important factors appear to be the specific population immunity in the hospital admitting the patient, the speed with which smallpox is recognized, and appropriate control procedures. The administration of attenuated smallpox vaccine or killed vaccine prior to smallpox vaccination cannot be recommended at this time. While it is known that attenuated vaccines can reduce fever and local reactions at the time of vaccination, information is not available regarding life-threatening complication rates with attenuated vaccine. Also, there is no information concerning the protective effect of attenuated vaccine alone or followed by calf lymph vaccine against smallpox