In the mood for wiping out vaccine-preventable diseases

News Q: How did you become interested in immunization? A: After I got my MD degree in 1966, I worked at a health centre in a small town in the Amazon region, then studied epidemiology and got involved in a new national centre for epidemiology , a kind of " Brazilian CDC " (Centers for Disease Control and Prevention). But the centre never took off because people working there were accused of being communists by the military dictatorship. Through the centre, I got involved in the smallpox campaign which had started in Brazil. In 1969 three other colleagues and I did some of the first trials of the surveillance and containment strategy. The smallpox programme in Brazil was based on mass vaccination but did not have enough resources to mass vaccinate people in every state. So we chose four states where we set up surveillance and containment units. I was in charge of the unit in Paraná, a state of some eight million people and where in 7 or 8 months we identified over 1000 smallpox cases and vaccinated their contacts, about 30 000 people. As a result, transmission was interrupted. We published the research in this journal. That was my first experience with an immunization programme. Q: What is surveillance and containment and how did you help to develop this approach? A: The smallpox programme in Brazil started in 1966 with mass vaccination campaigns, which aim to vaccinate every single person. But when Donald A Henderson came to Geneva to head the WHO Smallpox Eradication Programme – before I worked on smallpox – he and his team realized that some countries with high levels of vaccination coverage still had smallpox outbreaks and that mass vaccination was not working everywhere. They knew that people with smallpox had pock marks on their faces and that these people usually knew where they got infected, because they had seen someone else like that. They said that if you could trace the chain of transmission from one patient to another over several generations and vaccinate all of the people who had come into contact with the smallpox patients, you could stop the chain of transmission. That is how surveillance and containment works. In Brazil, surveillance and containment proved to be a fantastic strategy and it was tested in studies in West Africa and India with the same success. That's why it became the final …