tion. In 1978, three countries out of 17 reported that no supervision could be provided for the tuberculosis pro-gram in the general health services. Of the rest, nine countries provided supervision under a program drawn up at the beginning of the year, and in the other five, supervision was provided without prior programming in response to the needs of the moment. Supervisory per-sonnel was specialized in tuberculosis in six countries, multipurpose health services in one, and both types in the other seven.
Health laboratories in most countries provide supervi-sion for smear examinations either directly, where the supervisor observes the work in visits to local laborator-ies, or indirectly, where the local laboratory periodically sends slides to the regional or central laboratory.
In general, program evaluations are done in national or regional seminars comprised of several political units in a country, and in some countries a yearly report of data and conclusions is published. However the quality and the operational or epidemiological emphasis of the evalu-ations vary from country to country and there is no stand-ard evaluation method generally accepted in the Americas.
gressing well and appears to have resulted in extended coverage, increased bacteriologic diagnosis, and reduced hospital treatment. The introduction of new and more po-tent drugs has decreased the duration of treatment. Super-vised administration of drugs has been recognized as feasi-ble and useful in controlling the completion of treatment and in lessening costs in short course chemotherapy through intermittent treatments schedules.
Abandonment of treatment by the patient, loss of con-tact by the health services, inadequate training of periph-eral genperiph-eral services personnel, and lack of supervision ap-pear to be the current major deficiencies of the programs. A more active management is needed to supervise and evaluate the programs, as well as to train and support the general health services personnel in order to achieve more effective tuberculosis control programs in the near future.
(Source: Tuberculosis Control Program, Communicable Diseases Unit, Division of Disease Prevention and Control, PAHO.)
Summary
Integration of tuberculosis control activities in the gen-eral health services of the Region of the Americas is
pro-.
Human Plague in 1980
In 1980 a total of 505 cases of human plague were re-ported to the World Health Organization, resulting in 56 deaths. The corresponding figures for 1979 were 881 cases and 30 deaths (Figure 1).
Cases of human plague in Africa were reported in four countries: Angola (for the first time since 1975), Kenya, Madagascar, and the United Republic of Tanzania. The
1980 totals (80 cases and 20 deaths) were roughly the
same as in previous years, except for 1979 when 471 cases and 12 deaths were reported.
In the Americas. an increase in the number of notified cases was observed, particularly in South America, where 142 cases and seven deaths were reported, com-pared with the 23 cases and two deaths recorded in 1979 (Table 1). This increase was due mainly to change in diag-nostic criteria in Brazil where 98 cases (and no deaths)
e
Table 1. Number of cases and deaths of human plague reported in the Americas, 1971-1980.
1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 Country C D C D C D C D C D C D C D C D C D C D
Bolivia 19 3 0 0 0 0 14 5 2 0 24 5 29 9 68 2 10 0 26 2 Brazil 146 2 169 13 152 ... 291 ... 496 5 97 ... 1 ... 11 ... 0 0 98 0 Ecuador 27 0 9 0 1 1 0 0 0 0 8 1 0 0 0 0 0 0 0 0 Peru 22 5 118 15 30 2 8 2 3 0 1 0 0 0 6 1 0 0 0 0 United States of
Americaa 2 0 1 0 2 0 8 1 20 4 16 3 18 2 12 2 13 2 18 5 Total 216 10 297 28 185 3 321 8 521 9 146 9 48 11 97 5 23 2 142 7
C = Cases. D = Deaths.
aRodent plague present. ... Data not available.
Figure 1. Number of cases and deaths of human plague in the world, 1971-1980.
4.422,
were reported in the northeastern States of Bahía, Ceará, and Pernambuco. In Bolivia, the La Paz Department re-ported 26 cases and two deaths between September and November in the localities of Mohima (20 cases) and Culata (six cases) in Franz Tamayo Province; a high den-sity of Pulex irritans was found in these areas. In the United States, 18 cases and five deaths were reported in California, Nevada, and New Mexico. Thirteen of these cases occurred between May and September in six coun-ties in New Mexico.
Asia recorded a reduction in morbidity in 1980, with 283 cases and 29 deaths, (compared with 387 cases and 16 deaths in 1979). Vietnam notified 180 cases and five deaths (as against 306 and eight deaths the year before).
Health administrations should be aware of the Techni-cal Guide for a System of Plague Surveillance and The Manual on Plague and Plague Surveillance and Control
(a report of an informal consultation of experts held in June 1979). These documents are available from the Bac-terial and Venereal Diseases Unit, WHO.
(Source: WHO, Weekly Epidemiological Record, 35:273-275, 1981.)
