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 1801JennerSmallpox 1911GorgasYellow Fever 1915 Rockefeller Commission Yellow Fever (Global) 1942SoperAedes Egypti 1950SoperSmallpox (Americas) 1955WHOMalaria (Global) 1958ZhdanovSmallpox (Global) 1985Macedo Poliomyelitis (Americas)

Generally Expected Efficacy of a Primary Series of Different Vaccines AntigenNo. DosesExpected Efficacy Diphtheria3-4 ≧ 95% Tetanus3-4 ≧ 95% Pertussis % Polio3 ≧ 95% Measles1 ≧ 95% Rubella1 ≧ 95% Mumps1 ≧ 90% HbCV3-4 ≧ 90%

Cost-Benefit of Measles, Mumps and Rubella Vaccines VaccineBenefit: Cost ratio Measles+11.9:1 Rubella+7.7:1 Mumps+6.7:1 Combined MMR+14.4:1 Pertussis :1 Haemophilus influenzae type b :1 + Amer J Public Health 1985;75:750 ++Dev Biol Stand 1985;61:429

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

Measles affects humans only No chronic carriers Characteristic clinical illness Highly effective measles vaccine Herd immunity could prevent measles Epidemiological Basis for Measles Eradication

Achievements Globally U.S. & Taiwan DiseaseCountry SmallpoxGlobally MalariaTaiwan, failed globally Polio Taiwan, Americas, West Pacific MeaslesAmericas,? Taiwan Rubella,CRSU.S.,? Taiwan Neonatal TetanusU.S.,? Taiwan DiphtheriaU.S.,? Taiwan