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

1915Rockefeller

CommissionYellow 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

AntigenNo.

DosesExpected Efficacy

Diphtheria 3-4 ≧95%

Tetanus 3-4 ≧95%

Pertussis 3-4 70-90%

Polio 3 ≧95%

Measles 1 ≧95%

Rubella 1 ≧95%

Mumps 1 ≧90%

HbCV 3-4 ≧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 ++ 2.1-3.1:1

Haemophilus influenzae type b ++ 3.57:1 　+ 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 finiteHumans 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

Disease Country

Smallpox 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