WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ

W O R L D H E A L T H O R G A N I Z A T I O N

ORGANISATION MONDIALE DE LA SANTÉ

EXECUTIVE BOARD SB21/WP/21

24 January 1958 Twenty-first Session

ORIGINAL: ENGLISH Agenda item 3*2

CiÜ№AIGNS AGAINST SMALLPOX

Outline of Previous Decisions of the World Health Assembly and the Executive Board

The Third World Health Assembly recommended (ША3.18) that greater weight should be given to smallpox in the regular programme of the World Health

Organization. The Executive Board at its eleventh session noted a report (EBll/63) submitted by the Director-General regarding general world health problems and

considered that a campaign against smallpox was a suitable subject for a world-wide pr3gramme (EB11.R5S). The Sixth World Health Assembly after considering the

resolution of the Executive Board requested the Board to proceed with a detailed study of the means of implementing such a campaign (ШАб,18)# At the request of the Executive Board (EB12.R13) the Director-General carried out consultations with Member States, WHO regional committees, and members of Expert Advisory Panels and reported to the thirteenth session of the Board (EB13/50) which requested the Director—General to urge health administrations to conduct campaigns against

smallpox as an integral part of public-health programmes and to include additional studies on smallpox in his future programmes (SB13.H3). The Seventh World Health Assembly considered the results of the study carried out by the Executive Board and requested the Directo寥‘General to continue studies on effective methods of smallpox control in those countries where the disease is endemic, to urge health

administrations to continue their efforts to control smallpox, and to provide within budgetary limitations such assistance as might be requested for this

purpose (WHA7.5)• The Director-General called the attention of all Member States to these resolutions as a result of which new requests for assistance were received from 12 countries, many of which have been or are in the process of being implemented After considering the report of the Director-General on the progress made in this field the Eighth World Health Assembly (A8/P&B/7) again urged health administratione to conduct where necessary campaigns against smallpox as an integral part of their public health programmes (WHA8#38)• Some information regarding progress in this direction up to the present was given to the Executive Board by Regional Directors

ih the course of discussions of the repôi^ts of regional committees. More detailed information is contained in this document.

Reported Smallpox

In connexion with prior recommendations of the Executive Board and the World Health Assembly, it is of interest to survey briefly the extent of the smallpox

situation• The annexed chart provides information from records of the Organization on cases of smallpox reported from 1948-1957• Figures for 1956 and 1957 are

provisional.

In 1948 about 157 000 cases were notified in the world (outside China and the Union of Soviet Socialist Republics) including 26 000 in Africa， 30 000 in America and 101 000 in Asia; about 73 000 of these were reported in India and 13 000 in

Pakistan, In Europe 373 cases were recorded in 7 countries (Germany, Belgium, Spain, France, Ireland (one imported), Italy and Portugal) •

In 1957> some 136 000 cases were notified to the Organization, as compared with 85 000 in 1956 and an annual average of 178 000 during the period 1951-55. The marked increase in 1957 as compared with 1956 was due primarily to a more than 50 per cent, increase in Asia and West Africa (French West Africa, Sierra Leone, Nigeria)•

Of the 1957 notifications some 32 000 were in Africa, including about 12 500 in French West Africa, 9000 in Nigeria and 5000 in Sierra Leone • In South America the majority of the 3500 cases were in Colombia, Bolivia， Ecuador and Brazil. Of the 97 000 cases in Asia, 67 000 were reported from India and 23 000 from Pakistan.

(In 1956: 63 000 in Asia with 45 000 in India and 5500 in Pakistan)t

In recent years, a declining incidence has been reported in South America (especially in Peru, Venezuela, Colombia and Argentina), in the southern part of Africa (Federation of Rhodesia and Nyasaland, Mozambique, Union of South Africa), and in Korea, Viet Nam, Cambodia and Afghanistan - in Asia.

S m a l l p o x due to Imported Cases

In 1956 and 1957， smallpox cases were b r o u g h t i n and secondary f o c i started in several countries of Europe and the E a s t e r n Mediterranean areas w h i c h h a d b e e n free of smallpox for two o r more consecutive years: United Kingdom (4 c a s e s ) , Italy (8)， Turkey (128), L e b a n o n (209), B a h r e i n (68), Qatar (6), Kuwait (31), M u s c a t and Oman (26)， Trucial O m a n (3)， Aden Colony and Protectorate (65) a n d , in S o u t h East A s i a , in Ceylon (21)•

C o o r d i n a t i o n of Research

In the course of the studies carried out by the Dirèctor-General since the resolution of the Third W o r l d Health A s s e m b l y , it became clear t h a t the precise nature of the problems r e q u i r i n g solution before smallpox could b e eradicated, as w e l l as their relative importance, varied greatly f r o m country to country and from r e g i o n to r e g i o n . It w o u l d only be possible to define the problems i n a given country or r e g i o n b y studies in that country and region• S u c h studies have b e e n undertaken i n some countries and further studies are being planned as requests for assistance are received.

There w a s , h o w e v e r , one difficulty common to almost all countries w h e r e smallpox persisted on any considerable scale, that of ensuring the potency of the vaccine at the time of vaccination under the difficult conditions of climate and communications prevailing in these countries. The availability o f a stable dried vaccine w h i c h could w i t h s t a n d prolonged exposure under these conditions w o u l d clearly solve this specific problem， thou^i it w a s of course recognized that in many countries l a c k of such a vaccine w a s only one of the reasons for the failure to control s m a l l p o x . Provision of such a vaccine alone w o u l d n o t solve the problems arising f r o m

insufficient development of h e a l t h services or public indifference o r resistance to vaccination•

In 1952， therefore^ W H O initiated a programme of research designed to determine the stability of existing dried vaccines a n d , if these w e r e found to be inadequate

or inconsistent in their behaviour, to find a method of production which could be relied upon to produce consistently a stable products

The progress of these studies was discussed at the Ninth W o r l d Health Assembly and, as requested by the Assembly (WHA9.60), a report (A10/P&B/5) giving details of their successful conclusion w a s submitted to the Tenth W o r l d Health Assembly w h i c h recommended that countries should take advantage of the availability of an improved method of production of stable dried smallpox vaccine wherever the use of such a vaccine would be advantageous (WHA10^#37)• The results of these studies have been published (Bull. W l d Hlth O r g . (1957)， 1 6 , 63-77)•

W H O has made the production method available to all countries (WHO/Smallpo^/7) and is giving assistance to a number of countries planning to Initiate production of this vaccine. It is anticipated that this w i l l materially inqprove the prospects for eradicating smallpox wherever environmental conditions are difficult•

CASES OF SMALLPOX REPORTED IN VARIOUS COUNTRIES AND TERRITORIES 1948-1957

Provisional figures M Variola major

кк A Variola minor

Data not available

1948 19

杯9

AFRICA

French Equatorial Africa

Gabon - - - - - - 8 1 . -

Middle Congo - l - 19 192 12 68 - - -

Ubangi Shari - 1 - - 595 898 38 49 ^{- ‘ _}

Chad 12 400 ^60 917 2789 697 563 258 56 57

Spanish West Africa - - - 1 - * * * * _- - * *

French West Africa

Ivory Coast 803 555 699 579 3006 116) 734 907 1556 4735

Dahomey 482 изв 522 7)6 539 352 252 16 46 409

Guinea 115 2 11 12 141 125 108 1)59 1071 1565

Upper Volta 449 109 242 330 248 99 183 563 515 1655

Mauritania 2 - 1 40 140 158 27 30 87

Niger 56l 890 1288 1007 423 598 1256 278 670 796

Senegal 9 8 2 4)9 521 444 160 20 555

Sudan 24 89 317 1321 2438 1578 652 893 9

斗

Algeria 422 146 102 86 56 67 73 18 7

Angola M 480 488 88 16 42 1)5 8 3 ： oo

A 125 125 148 75 96 - 5 9

： 丄丄

EB 21 /W P/

21

pa

ge 5

AN NE

X

AFRICA (continued) Basutoland

Bechuanalajid

Cameroons (French Adm.) Cape Verde Islands Belgian Congo M )

Л ) Ghana (ex-GoId Coast) French Somaliland Egypt

Ethiopia (and Eritrea) Gambia

Portuguese Guinea Kenya

Libya Madagascar

1948

97 7

2121 1269

16

24 5 133 216

CASES OP SMALLPOX REPORTED IN VARIOUS COÜNTRIEÍ

* Provisional figures Data not available

M Variola major A Variola minor

I95I

1 6 1 7 0 4

8 5 2

0 4 8

8 2 7 8 4 3 1

2

2

44

2

10 4

EB 21 /w p/ ro

l

pa

ge б

A n n e

x ;

1957

111

4

240 1779 178

2

392 15

755

2

1956"

2 0

4 9 4

1Л

6 5

: 9 3 2

* 15

¡96 1955

1

2 8

3-

5 4

1 0

2

.98 5 1 56 61 1' I954

4 177

^77 47)7

**

З67 107 150 195)

4 1

4 5

0 3 7 7 2 8

í 2 4 2

188 226 110

1952

7 7

2

0 5 6 о 9 2 ^ 1 一 2 56< 1

2

80 222 32

<

CASES OP SMALLPOX REPORTED IN VARIOUS COUNTRIES AND TERRITORIES 1948-1957 (continued)

1948 I95O

1951 1952

AFRICA (continued)

Morocco 13

18 6

2

2

Mauritius i ^{# * *}

Mozambique 955 1 501 58З

166 ^姊

28

Nigeria 5 L4 863 20 11

879 9 26o

200

Nyasaland 4 830 1 264 295 122 7 6 5 29 84 320

Northern Rhodesia

671

1 ^*» 150 42

Uganda 25

杯

218

Ruanda-Urundi 147 43 m 58I

:816 219

Sierra Leone 200 157 40 36 15 4*

斗

922

Somaliland (Brit•

Prot.) - . - - - • - 240 818 ^- - 3

Somaliland (ital.) ^{- - • • -} - ^- 757 195 ^-

Sudan 1 412 246 11o3 3 4 62 5 6 5 3²

3 030

- • -

2

Provisional figures

•îHf

Data not available Imported

1

18 months

2 Year ending 30 June

SB 21 /W P/

21

р а т о

е 7

A n n e

пятшша a t

19^8 1949 1950

1951

AFRICA (continued)

Swaziland 5 ^- 48 - - - - - - -

Tanganyika 1

206

885

Togoland (Pr.) 107 152

190 628

6

Tunisia

525

2

2

Union of South Africa 2 7 22 9б7У 1

钌

吵

80 11 8 8

Zanzibar - - - - 4 - ~ 3 56 1

AMERICA

Alaska ^-

Argentina

166

^斗462

186

Bolivia 8)1

805

Brazil

Federal District

219

斗

«-М-

State Capitals and

680

Territories 9^6

451 529

1 1 012 1 810

680

Canada - - -

i

Provisional figures

> w

§ OQ to

I

s

* * Data not available 18 months

Yeàr ending 30 June

CASES OP SMALLPOX REPORTED IN VARIOUS COUNTRIES AND TERRITORIES 1948-1957 (continued)

1948 1949 19ЗО 1951 1952 1953 1954 1955 1956* 1957*

AMERICA (continued)

Chile 5 4 2 744

斗7

一 -

Colombia 7 356 3

Oko k 818

081

Costa Rica

Cuba 1 ^*

*** 2

3 ^{- - -}

麵. . • - -

一

Ecuador 3 892 664 251 174 665 708 2 516 1 888 674 7

枓

United States 57 49 39 11 2 1 k ^{- - - -}

British Guiana - - 1 11 - - - - - -

Haiti - - - - - - - - - -

Honduras ^{* * * *} 82 105 ^{* * * * * * *你 -}

British Honduras ^{* *} 1 - • - - - - - -

Jamaica Martinique

一 - - - 1 - - - - -

Mexico l 541 1 060

762 ^普

Nicaragua

Panama _- - - - - - - - -

Provisional figures

* * Data not available

* * Imported

Year ending June

EB 21 /W P/

21

pa ge

vo

A n n e

x

1948

1949

AMERICA (continued) ^{• - .} Panama Canal Zone

Paraguay 1 451

175

Peru 7 105

6 305

1)6

Puerto Rico -

Dominican Republic - - - - - - - - - -

E l Salvador

1 ) A Trinidad & Tobago A

1 ) ^{- - - - - - - -}

一

Uruguay- - 9 ^- 16 7 1 47 42

Venezuela 6 358 5 947

2 l8l 28o

ASIA

并將

_奸

Aden Colony 2 7 2 - - 67 ^{- - -}

Aden Protectorate - - - - - - - ^« 65

Afghanistan 393

612

_！

i 331 1 - 152 5 1 - 65

Provisional figures

* * Data not available Imported

Variola minor

1948 1949 、1950 > 1951 1952 ‘ 1955 J 1 9 Й - 1955 . 1956* I957*

ASIA (continued) ^...

Bahrein - 17 33 ^- - ^• бх

Burma 5 905 3 465 10 222 2 748 2 ЛИ ^‘ 21б 1 673 4 223 I.675 .‘

North Borneo ^{* *} 1

I.675 .‘

Cambodia 956 128 720 1 748 1 788 _{. . ш} ..-

；

Ceylon 8 1 4 M , 2 5 2 1 ^{- “ ‘ 、 ‘-‘} 2 1

China - Formosa 288 625 7 8 7 14 9 •в

Cyprus > ф

Korea … 1 197 10 085 2 549 43 213 1 313 5 349 782 2 9 French Settlements

in India 1 767 ) 1 3 5 177 5 2 6 ‘ 16

Federation of Malaya 521

斗6

Hong Kong 8 il 1 ^- - - _ -

India 72 852 L57 352 251 З80 75 318 Зб 640 46 6oj 932 45 166 66 706

Portuguese India 564 498 196 49 69 3 8 63 1 2

Indonesia ^{* *} 52 228 LOI 575 9 812 2 584 1 879 1 577 2 943 1 ^79 Iraq 1 740 707 272 469 157 2 5 1 22 72 1 179 1 852 . I r a n 1 182 509 439 259 237 m * « 542 1 616 547

* Provisional figures у y.

Data not available

1948 19^9 1950 1951

1952

ASIA (continued)

Israel ^{* *} 14

11

Japan 29 124 5

86 2

2

Jordan 42 194

Laos

29

16

Lebanon

175

101 108

Macao

Pakistan

12

807 22

14 589

2

2б1

Philippines

282

Singapore 5

Syria

902

2

Thailand 514 107 348 50 2 1 117 3

Timor - 3 - - - _

Turkey 39 73 7 152 - - ^{- -} - 128

V i e t Nam 1 581

250

2

256 86

Qatar «« * * * *

'X

X

,

斗

Trucial Oman ^{• * * * ** **} * * * * * * - 2

Muscat and Oman * » * * * * * * * « * * ** _- 22 4

* Provisional figures Data not available Imported

EB 21

>I

>/

21

раояе

1Ю

A n n e

x

CASES OP SMALLPOX REPORTED IN VARIOUS COUNTRIES AND TERRITORIES 1948-1957 (continued)

1948 19

斗

Kuwait ^{* * * * * * * * * * * * * *} - 8

ЕШОГЕ

Germany, Federal

Republic of 1 ^{- - - -} _一 1 ^{* * *}

Austria - _一 - - - - - - - -

Belgium 1 1 - - • - - - -

Denmark - - - - - - - _一 -

Spain 20 2 1 1 2

一 -

一

Finland - - - - - - - - - -

France 3 2 - - 75 ^- 15 85 ^{- -}

Greece - 13 ^{- - - - - - -}

工

Iceland - - - - - - - -

一 -

Italy 9 К 1 - - - -

一 - 8

Luxembourg • -

一 - - - - - - -

Malta

Provisional figures Data not available Imported

EB 21 /W P/

21

p a

g e

15

A n n c

p x

CASES OF SMALLPOX REPORTED IN VARIOUS С01ШЖЕЗ AND OSRRITORISS 1948-1957 (continued)

19 斗 8 . 19^9 1950 1951 1952 1953 195^ 1955 1956* 1957*

E U R O P E (continued)

N o r w a y - - ^- - ^« - _一 - - -

Netherlands

一 - - 52 - - 40 - -

一

P o r t u g a l ЗЗб 54 65 78 3 6 9 ^{- - - -}

United Kingdom

England and W a l e s ( 1 6 ^

19 ) 8 27 135 3 0 ^-

Scotland - - 19 ^{- -} 一 • - - -

Northern Ireland - - - - - - -

一 - -

Sweden - - - - - -

*

- ^- -

Switzerland Yugoslavia

OCEANIA

Australia H a w a i i

N e w Zealand

Netherlands N e w Guinea _- - 3 ^- - - - - - -

F r e n c h Oceania

Provisional figures Imported

EB 21 /W P/

21

р а о т

е I

t

A n n e

x