Download The Autobiography of an Infection Disease Pediatrician.

An Evolution to Public Health：
The Autobiography of an
Infection Disease Pediatrician.
Kenneth J. Bart , MD , MPH , MSHPM
Outline
 Curative v.s. Preventive Medicine
 Global Issues
 Development of Vaccines
 Criteria for Eradication
 US Experience
 Taiwan Experience
 Autobiography Sketch
Eradication
1801
Jenner
Smallpox
1911
Gorgas
Yellow Fever
1915
Rockefeller
Commission
Yellow Fever (Global)
1942
Soper
Aedes Egypti
1950
Soper
Smallpox (Americas)
1955
WHO
Malaria (Global)
1958
Zhdanov
Smallpox (Global)
1985
Macedo
Poliomyelitis (Americas)
Generally Expected Efficacy of a
Primary Series of Different Vaccines
Antigen
Diphtheria
Tetanus
Pertussis
Polio
Measles
Rubella
Mumps
HbCV
No. Doses
Expected Efficacy
3-4
3-4
3-4
3
≧95%
≧95%
70-90%
≧95%
1
1
1
≧95%
≧95%
≧90%
3-4
≧90%
Cost-Benefit of Measles, Mumps and
Rubella Vaccines
Vaccine
Benefit: Cost ratio
Measles+
11.9:1
Rubella+
7.7:1
Mumps+
6.7:1
Combined MMR+
14.4:1
Pertussis ++
Haemophilus influenzae type b ++
+ Amer J Public Health 1985;75:750
++Dev Biol Stand 1985;61:429
2.1-3.1:1
3.57:1
Epidemiological Basis for
Polio Eradication
 Poliovirus causes acute, non-persistent
infections
 Virus is transmitted only by infectious
humans or their waste
 Virus survival in the environment is finite
 Humans are the only reservoir
 Immunization with polio vaccine interrupts
virus transmission
Epidemiological Basis for
Measles Eradication
•
•
•
•
•
Measles affects humans only
No chronic carriers
Characteristic clinical illness
Highly effective measles vaccine
Herd immunity could prevent measles
Achievements Globally
U.S. & Taiwan
Disease
Smallpox
Country
Globally
Malaria
Taiwan, failed globally
Polio
Taiwan, Americas, West Pacific
Measles
Americas,? Taiwan
Rubella ,CRS
U.S.,? Taiwan
Neonatal Tetanus
U.S.,? Taiwan
Diphtheria
U.S.,? Taiwan