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Eastern Mediterranean Region

Summary and Regional Information


For more information, see:
Smallpox and Its Eradication (Fenner et al, WHO, 1988)

Summary of Smallpox Status

Country Last endemic case Importations during SEP Certification Method Document

Asia

Afghanistan 1972 1973 30 Nov 1976 International Commission WHO/SE/77.89
Iran1 1963, 1972 1970 7 Dec 1978 Visit and report of WHO-designated expert/consultant WHO/SE/78.132 pp 6-7,21
Iraq1 1959, 1972 1971 17 Apr 1979 International Commission WHO/SE/78.127
Syrian Arab Republic1 1950 1972 22 Oct 1979 International Commission WHO/SE/78.126
Pakistan (West Pakistan) 1974 None post-1974 18 Dec 1976 International Commission WHO/SE/77.90

Horn of Africa

Djibouti (French Territory of Afars and Issas)2 1959 1971, 1972, 1973, 1974 26 Oct 1979 International Commission WHO/SE/79.147
Ethiopia3 1976 None post-1976 26 Oct 1979 International Commission WHO/SE/79.148
Somalia4 1962, 1977 1972, 1973, 1974, 1975 26 Oct 1979 International Commission WHO/SE/79.146
Sudan1 1962, 1972 1967 29 Nov 1978 International Commission WHO/SE/79.134
Yemen Arab Rep.5 1969 None post-1969 10 Jun 1979 International Commission WHO/SE/79.139
Yemen, Dem. Rep.5 1960 None 11 Jun 1979 International Commission WHO/SE/79.140

Arab Gulf States6

Bahrain 1957 None 7 Dec 1978 Visit and report of WHO-designated expert/consultant WHO/SE/78.132 pp 6-7,21
Kuwait 1957 1967 7 Dec 1978 Visit and report of WHO-designated expert/consultant WHO/SE/78.132 pp 6-7,21
Oman 1962 1967, 1968 7 Dec 1978 Visit and report of WHO-designated expert/consultant WHO/SE/78.132 pp 6-7,21
Qatar 1961 None 7 Dec 1978 Visit and report of WHO-designated expert/consultant WHO/SE/78.132 pp 6-7,21
Saudi Arabia 1961 1970, 1972 7 Dec 1978 Visit and report of WHO-designated expert/consultant WHO/SE/78.132 pp 6-7,21
United Arab Emirates (Trucial Sheikhdoms) Never endemic 1967, 1968, 1970, 1971 7 Dec 1978 Visit and report of WHO-designated expert/consultant WHO/SE/78.132 pp 6-7,21

  1. Iran, Iraq, Sudan (which then included South Sudan), and the Syrian Arab Republic were not included in the ISEP in 1967, having halted transmission in 1963, 1959, 1962. and 1950, respectively. But an importation in 1967 reestablished smallpox in Sudan and importations in 1970-72 reestablished it in Iran, Iraq, and Syria. Transmission in all four countries was interrupted in 1972. Iran, Sudan, and the Syrian Arab Republic were certified smallpox-free by International Commissions, but political events prohbited a visit by an International Commission to Iraq.
  2. Djibouti (the French Territory of the Afars and Issas until 1977) had no endemic smallpox, but experienced periodic importations from Ethiopia. These were controlled by containment vaccination; mass vaccination was conducted every 3 years.
  3. Ethiopia did not agree to participate in WHO's smallpox eradication programme until 1971, 4 years after the global eradication program began. Ethiopia was a member of the Eastern Mediterranean Region until 1977, when it joined the African Region. Eritrea was not an independent state during the ISEP.
  4. Somalia had reported its last endemic cases in 1962. However, importations from Ethiopia were frequent because of the shared border through the Ogaden Desert and its nomadic people. Reports of cases received in late September 1976, 7 weeks after the last outbreak in Ethiopia (potentially the last in the world), led to a declaration of a state of emergency by the government and a country-wide case search. Endemic smallpox was discovered throughout southern Somalia, and major epidemics followed. Somalia became the last country to be freed of smallpox.
  5. Yemen divided into Yemen and Democratic Yemen in 1967 after several years of civil war. Eradication programs delayed by the war began in 1969 and 1970, respectively. In 1971, four vaccinators from Democratic Yemen were killed by a land mine. The two states were reunited in 1979.
  6. The Arab countries of the Gulf area (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) had interrupted transmission by the early 1960s, but were subject to importations from pilgrims and migrant labor. The United Arab Emirates were known as the Trucial Sheikhdoms or Trucial States until Dec 1971.

WHO: Regional Information

Smallpox Survellance Reports: see either individual countries or the complete list

Year Title Authors Source URL
1954 Campaign against smallpox. Annex: Smallpox outbreaks in EMRO since 1939 Regional Committee for the Eastern Mediterranean, 4th Session, 1954 RC4/EM/7 WHO: 10665/121222
1959 Smallpox control Regional Committee for the Eastern Mediterranean, 9th Session, 1959 EM/RC9/5; EM/RC9/5.Add.1 DAH: Chesney Med Arch
1961 Smallpox control and eradication Regional Committee for the Eastern Mediterranean. 11th Session, 1961 EM/RC11/5 DAH: Chesney Med Arch
1966 Smallpox eradication: Difficulties encountered Regional Committee for the Eastern Mediterranean, 16th Session, 15 Jun 1966 EM/RC16/5 DAH: Chesney Med Arch
1968 EMRO Projections: 1968, 1969, 1970
Meeting of Regional Advisers on Smallpox Eradication. Rio de Janeiro, Brazil, 3-10 Apr 1968
DAH personal papers DAH: Chesney Med Arch
1970 Status of the smallpox eradication programmes in the Eastern Mediterranean Region
Inter-Regional Seminar on Surveillance and Assessment in Smallpox Eradication, New Delhi, 30 Nov-5 Dec 1970
Shafa E WHO/SE/71.30 pp 24-30 WHO: 10665/67488

Historical Smallpox: Non-Endemic Countries

* Cited in Smallpox and its Eradication, Fenner et al, WHO 1988

Year Title Authors Source URL

Egypt

*1966 [Paleopathological and epigraphic observations on the problem of smallpox in ancient Egypt] German Regoly-Merei G Sudhoffs Arch 1966 50(4): 411-7
1966 [Paleographic and paleopathologic data on the problem of smallpox in ancient Egypt and China] Hungarian Regoly-Merei G Orv Hetil 1966 107(15): 702-7
1984 Palaeontology of smallpox Zuckerman AJ Lancet 1984 324(8417-8418): 1454 DOI: 10.1016/s0140-6736(84)91637-4
1985 Smallpox entombed Hopkins DR Lancet 1985 325(8421): 175 DOI: 10.1016/s0140-6736(85)91953-1
2007 On the origin of smallpox: correlating variola phylogenics with historical smallpox records Li Y, Carroll DS, Gardner SN, Walsh MC, Vitalis EA, Damon IK Proc Natl Acad Sci U S A 2007 104(40): 15787-92 DOI: 10.1073/pnas.0609268104
PMC: PMC2000395

Lebanon

1957 [Lebanese epidemic of smallpox: December 1956 & January 1957] French Chehab C Rev Med Moyen Orient 1957 14(4): 312-4
1957 Clinical summary on the Lebanese epidemic of smallpox of 1956 Farhat J Rev Med Moyen Orient 1957 14(4): 328-34
1957 [The campaign against smallpox by governmental authorities since the recent Lebanese epidemic of smallpox: Beyrouth, December 1956-January 1957] French Anouti J Rev Med Moyen Orient 1957 14(4): 314-22
1957 [The Municipality of Beirut facing the smallpox epidemic] French Khoury N Rev Med Moyen Orient 1957 14(4): 322-8

Libya

*1948 Smallpox in Tripolitania, 1946: an epidemiological and clinical study of 500 cases, including trials of penicillin treatment: Kaposi varicelliform eruption] Dixon CW J Hyg (Lond) 1948 46(4): 351-77 DOI: 10.1017/s0022172400036536
PMC: PMC2235158

Morocco

1956 [Attempted immunotherapy of smallpox and immunoprevention of typhus fever practiced at Cocard Hospital in 1941] French Couzi G Maroc Med 1956 35(377): 966-8

Palestine

2007 Public health, culture, and colonial medicine: smallpox and variolation in Palestine during the British Mandate Davidovitch N, Greenberg Z Public Health Rep 2007 122(3): 398-406 DOI: 10.1177/003335490712200314
PMC: PMC1847484
1949 [Smallpox in Palestine during the years 1921-1946] Harefuah 1949 36(10): 120
1952 [Small-pox and its prevention in Palestine in 1949 and 1950] French Sansonnens R, Bishara A Rev Med Suisse Romande 1952 72(Suppl): 94-107

Tunisia

1962 [Summary review of antivariolar vaccinal immunity and its aspect in the young Tunisian child] French Schneider R, Durand M Arch Inst Pasteur Tunis 1962 39: 7-22
1963 [New statistics on anti-smallpox vaccinal immunity in young Tunisian children] French Schneider R, Benosman F, Durand M Arch Inst Pasteur Tunis 1963 40: 391-4