Challenges Eradicating a disease has proven challenging for a variety of reasons, not least of all it has been difficult to conceptualize and define what exactly eradication of disease really means.
The Smallpox Eradication Program was deemed highly successful. This outcome was achieved on account of the fact a vaccination program could be administered in a straightforward way. The Guinea worm and polio eradication programs followed on from the SEP, but these efforts were unfortunately met with varying success, though in the case of polio the disease is now present in only a few countries – a far cry from the figure of close to 50 nations when the disease was endemic.
One way to define eradication that has been accepted by the WHO and various other organizations is the “permanent reduction to zero of the worldwide incidences of infection caused by a specific agent as a result of deliberate efforts” . Moreover, it is not possible to gain access to all parts of the world for the purpose of surveillance or for prophylaxis. This is usually due to political and military reasons. The effects of climate change may shift the geographical remit for disease occurrence. This factor has already presented us with a challenge in the case of polio.Somalia, on the horn of Africa, still has polio.
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Addressing the routine failure to clinically identify monogenic cases of common disease - Genome MedicineChanges in medical practice are needed to improve the diagnosis of monogenic forms of selected common diseases. This article seeks to focus attention on the need for universal genetic testing in common diseases for which the recommended clinical management of patients with specific monogenic forms of disease diverges from standard management and has evidence for improved outcomes.We review evidence from genomic screening of large patient cohorts, which has confirmed that important monogenic case identification failures are commonplace in routine clinical care. These case identification failures constitute diagnostic misattributions, where the care of individuals with monogenic disease defaults to the treatment plan offered to those with polygenic or non-genetic forms of the disease.The number of identifiable and actionable monogenic forms of common diseases is increasing with time. Here, we provide six examples of common diseases for which universal genetic test implementation would drive improved care. We examine the evidence to support genetic testing for common diseases, and discuss barriers to widespread implementation. Finally, we propose recommendations for changes to genetic testing and care delivery aimed at reducing diagnostic misattributions, to serve as a starting point for further evaluation and development of evidence-based guidelines for implementation.
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