I. Introduction -- -- II. Smallpox Eradication In West and Central Africa -- A. Morbidity trends -- B. Current disease reporting -- c. Smallpox vaccination. -- -- III. Measles Control In West and Central Africa -- A. Morbidity trends and vaccination data -- B. Measles control in urban areas -- C. Measles control in larger geographic areas -- -- IV. Eradication Notes -- A. Epidemic Investigation -- 1. Nigeria - Gerere Hamlet -- 2. Brazil: a. Municipio of Parambu; b. Municipio of Livramento -- -- V. Special Report: Cultural resistance to smallpox vaccination West Africa.

Since the last issue of the SEP Report, a distinct suppressive effect of vaccination on the occurrence of both smallpox and measles has appeared in the 19 country West and Central African Region. Both are described in this issue. The results reflect laudably on the vigorous and effective efforts of the respective Ministries of Health responsible, and also on the collaboration and assistance of the two health unions OCOGE and OCEAC, the World Health Organization, and the USAID-USPHS technicians participating.

They also encourage an intensification of efforts to consolidate the gains made, and to take advantage of a unique opportunity, now emerging, to rid the area of smallpox within the next twelve months. In this regard the example of malaria eradication elsewhere in the world bears remembering; the elation of early success too frequently gave way to frustration in eliminating residual foci of disease, to discouragement of interest and relaxation of effort. As a result some countries, once close to malaria eradication have suffered a resurgence of malaria to pre-eradication levels. The same need not occur with smallpox eradication.

In the West and Central African Regional Smallpox Eradication and Measles Control effort, rapid and effective mass vaccination campaigns have begun to reap gratifying reductions in the occurrence of both diseases. However intensified disease surveillance, case detection, and outbreak containment concurrently with continuing mass vaccination efforts must play an increasingly predominate role if the objectives of smallpox eradication and measles control are to be reached.

David J. Sencer CDC Museum