Lessons and innovations from the West and Central African Smallpox Eradication Program.

In 1966, the Centers for Disease Control began training medical officers and public health advisors for a program that would encompass 20 countries of West and Central Africa with the objective of eradicating smallpox and controlling measles. The program was funded by the US Agency for International Development with a target of smallpox eradication within 5 years and the immunization of children from 6 months to 6 years of age against measles in all areas of every country. The 40 plus field staff were directed by a Regional Office in Lagos, Nigeria and a headquarters group in Atlanta, Georgia. The teams greatly expanded the knowledge of smallpox epidemiology, helped to expand the capabilities of Ministries of Health, pioneered the use of jet injectors to provide millions of immunizations, and expanded the use of surveillance/containment to become a primary strategy for interrupting smallpox transmission. Smallpox transmission was interrupted in three and one half years, a year and a half before the time targeted and under budget. Measles transmission was interrupted in one country, The Gambia, and significantly reduced in the other 19 countries.