GOOD WORK!

Ja­maica must now main­tain its pre­ven­tion, erad­i­ca­tion of in­fec­tious dis­eases

Jamaica Gleaner - - ENTERTAINMENT - Martin Henry Con­trib­u­tor Martin Henry is a univer­sity ad­min­is­tra­tor. Email yourhealth@glean­erjm.com

THE AMER­I­CAS have been of­fi­cially de­clared measles-free. The first of the six World Health Or­ga­ni­za­tion (WHO) re­gions to be des­ig­nated com­pletely free from en­demic trans­mis­sion of the dis­ease.

The his­toric an­nounce­ment was made by the In­ter­na­tional Ex­pert Com­mit­tee for Doc­u­ment­ing and Ver­i­fy­ing Measles, Rubella, and Con­gen­i­tal Rubella Syn­drome Elim­i­na­tion in the Amer­i­cas at the 55th Di­rect­ing Coun­cil of the Pan Amer­i­can Health Or­ga­ni­za­tion/World Health Or­ga­ni­za­tion (PAHO/WHO) in Septem­ber.

Measles is a viral dis­ease af­fect­ing mostly chil­dren, and though often mild, can cause se­vere health prob­lems, in­clud­ing pneu­mo­nia, brain swelling, blind­ness, en­cephali­tis, se­vere di­ar­rhoea, ear in­fec­tions, and even death.

Wip­ing out en­demic measles trans­mis­sion across the Amer­i­cas ends a 22-year ef­fort in­volv­ing mass vac­ci­na­tion against measles, mumps and rubella. Measles is one of the most con­ta­gious dis­eases. It is trans­mit­ted by air­borne droplets or via di­rect con­tact with se­cre­tions from the nose, mouth, and throat of in­fected in­di­vid­u­als.

Measles is the fifth in­fec­tious dis­ease which can be pre­vented by vac­ci­na­tion that has been elim­i­nated from the Amer­i­cas. The erad­i­ca­tion of measles fol­lows the re­gional erad­i­ca­tion of small­pox (1971), po­liomyeli­tis (1994), and rubella and con­gen­i­tal rubella syn­drome (2015).

MALARIA-FREE IN ’63

Shortly af­ter gain­ing In­de­pen­dence, Ja­maica was de­clared malaria-free in 1963. Malaria is caused by an amoeba-like pro­to­zoan trans­mit­ted by the Anophe­les mos­quito. A trans­mis­sion cy­cle es­tab­lished by Dr Ron­ald Ross in 1897, work­ing in In­dia.

An ag­gres­sive vec­tor-con­trol pro­gramme in Ja­maica over sev­eral years prior to 1963 led to the elim­i­na­tion of the dis­ease here. A WHO-backed Malaria Erad­i­ca­tion Pro­gramme was launched in 1957 and ran to 1963, the year of de­clared erad­i­ca­tion. Dr Her­bert Eldemire, the fa­ther of Pro­fes­sor Denise Eldemire-Shearer, was the min­is­ter of health when the dis­ease was de­clared erad­i­cated in Ja­maica.

Older read­ers will re­mem­ber the spray­man spray­ing a DDT so­lu­tion from house to house and nail­ing a disc on the front door when done. DDT, which had been so ef­fec­tive in the malaria cam­paign, has been banned around the world, be­gin­ning in the United States in 1972, for be­ing de­struc­tive to the en­vi­ron­ment. The de­tail­ing of the neg­a­tive en­vi­ron­men­tal im­pact of DDT by Rachel Car­son in her 1962 book, Silent Spring, marks the ge­n­e­sis of the mod­ern en­vi­ron­men­tal mass move­ment.

Malaria is still en­demic across the trop­i­cal Amer­i­cas and much of the rest of the world, de­liv­er­ing 214 mil­lion new cases last year and caus­ing 438,000 deaths.

In 2015, the global bur­den of malaria re­mained heav­ily con­cen­trated in 15 coun­tries, mainly in Africa. To­gether, these coun­tries ac­count for an es­ti­mated 80 per cent of global malaria cases and 78 per cent of deaths.

Within CARICOM, malaria is still en­dem­i­cally present in Belize and Guyana. And across the wider Caribbean in Haiti and the Do­mini­can Repub­lic. There are par­tic­u­larly high in­ci­dences in Columbia and Venezuela.

Small­pox is the first, and only, in­fec­tious dis­ease to be de­clared to­tally erad­i­cated on the planet. The Amer­i­cas was des­ig­nated small­pox-free in 1971. Small­pox is trans­mit­ted from per­son to per­son via in­fec­tive droplets dur­ing close con­tact with in­fected symp­to­matic peo­ple.

The last known nat­u­ral case of this viral in­fec­tion which has been a scourge of hu­mankind from time im­memo­rial was in So­ma­lia in 1977. The dis­ease was de­clared erad­i­cated in 1980 fol­low­ing a global im­mu­ni­sa­tion cam­paign led by the World Health Or­ga­ni­za­tion.

The next in­fec­tious dis­ease on the radar for global erad­i­ca­tion is po­liomyeli­tis, a viral in­fec­tion which can cause paral­y­sis. The WHO is a part­ner in the Global Po­lio Erad­i­ca­tion Ini­tia­tive, the largest pri­vatepub­lic part­ner­ship for health, which has re­duced po­lio by 99 per cent. The dis­ease re­mains en­demic in only three coun­tries, Afghanistan, Nige­ria and Pak­istan. There were only 74 re­ported cases in 2015.

CHOLERA COME­BACK

Cholera is now mak­ing a come­back in Haiti, fol­low­ing the bat­ter­ing of the coun­try by Hur­ri­cane Matthew. The wa­ter­borne bac­te­rial in­fec­tion which man­i­fests with se­vere di­ar­rhoea resur­faced in that coun­try af­ter the 2010 earth­quake, widely be­lieved to have been brought in by UN peace­keep­ers.

Ja­maica last saw cholera in the 1850s. There was a ma­jor out­break in 1851, which is es­ti­mated to have killed a tenth of the pop­u­la­tion, around 40,000 peo­ple out of 400,000. Cholera is an Old World Dis­ease with likely ori­gins on the In­dian sub­con­ti­nent be­cause of its preva­lence in that re­gion for cen­turies. It only ap­peared in the Amer­i­cas in the 1830s dur­ing the sec­ond of seven cholera pan­demics which have af­fected the world in the last 200 years. Ja­maica was af­fected by the sec­ond and third pan­demics, 1827-1835 and 1839-1856, and has not seen the dis­ease since. Its long ab­sence would leave the pop­u­la­tion par­tic­u­larly vul­ner­a­ble with­out im­mu­nity, as was the case in Haiti in 2010. With mod­ern treat­ment regimes, mor­tal­ity from cholera is very low and many peo­ple who pick up the bac­te­ria do not even de­velop symp­toms. Pre­ven­tion is bet­ter than cure and the best pre­ven­tive mea­sure against cholera is clean, treated wa­ter.

Ja­maica has built up an en­vi­able in­fec­tious dis­eases con­trol and erad­i­ca­tion pub­lichealth sys­tem which we must now main­tain and im­prove to keep the bugs out or, at least, un­der con­trol.

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