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From the Centers for Disease Control and Prevention
January 21, 1998

Smallpox Surveillance—Worldwide

JAMA. 1998;279(3):190. doi:10.1001/jama.279.3.190-JWR0121-2-1

Editor's Note: As part of its continuing commemoration of CDC's 50th anniversary in July 1996, MMWR is reprinting selected MMWR articles of historical interest to public health, accompanied by current editorial notes. Reprinted below are the reports published January 6, 1978, and May 5, 1978, describing the final case of naturally acquired smallpox and steps toward certifying countries as smallpox-free.

MMWR. 1997;46:990-994

1 figure omitted

A TOTAL of 3,234 cases of smallpox have been reported from Eastern Africa to the World Health Organization (WHO) in the period January 1-December 6, 1977. Since October 16, 1975—more than 2 years ago—when a case occurred in Bangladesh, smallpox has been detected only in Ethiopia, Kenya, and Somalia, 3 countries which together with Djibouti are linked by the Ogaden Desert to form one epidemiologic unit.

To date, the last known case of smallpox occurred in Somalia on October 26 in the Merca District. The source of this case was a known outbreak in the nearby district of Kurtuware. All 211 contacts were traced, revaccinated, and kept under surveillance. There have been no secondary cases. As of December 6, there were 6 pending outbreaks* in Somalia—the one in Merca and 5 in Bardere.

During October and November surveillance in Somalia has been severely hampered by heavy rains that have made it difficult or impossible to travel by vehicle. Since work has had to be continued on foot, there have been some delays in reporting and incomplete search coverage in certain areas. To combat this, personnel have been concentrated in those areas considered to be at highest risk of having undetected foci or where information is most limited. Currently there are 1,670 national staff and 24 WHO epidemiologists involved in the program. Increased mobility with restoration of complete active searches will be necessary to ensure that all foci have been detected. Accordingly, intensified activities are planned during the dry season, January through April 1978.

The last known case of smallpox in Ethiopia occurred on August 9, 1976, in El Kere Region. In Kenya, the last case was on February 5, 1977, in the Mandera District.

Reported by:

The World Health Organization in the Weekly Epidemiological Record 52:389-391, 1977.

*An outbreak is defined as one or more cases; a pending outbreak is one in which 6 weeks has not elapsed since the onset of rash of the last case.