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Smallpox in the Republic of Guinea, West Africa

I. History and Epidemiology

J. G. Breman^*, A. B. Alécaut AND J. M. Lane

Smallpox was probably introduced into Guinea as well as into the rest of West and Central Africa after 700 A.D. when Islamic invaders began their western and southern penetrations. Specific references to the disease along the "Guinea coast" are found in documents published as early as 1664. Periodic epidemics of smallpox occurred in Guinea at 10-year intervals since records began being kept in 1925 by the League of Nations. The epidemic interval decreased to 5 to 7 years in the 1950's. An annual attack rate of 19.4 reported cases per 100,000 persons occurred in Guinea throughout this century before the beginning of the regional West and Central African Smallpox Eradication and Measles Control Program in December 1967. The overall case fatality rate was 9.4%. The real annual incidence was at least 20 times the reported incidence. The cases occurred mainly in dry season months. From December 1967 to January 1969, persons less than 15 comprised 57.3% of the cases. Females with smallpox predominated over males, 56.9% to 43.1%. Ninety-six percent of those affected lived in villages of less than 1,000. Sierra Leone and Guinea had the two highest variola attack rates in the world in 1967. The most severely affected areas were in the northern districts of Sierra Leone and the southwestern regions of Guinea. These countries have close geographic and cultural ties, and several importations of smallpox from Sierra Leone into Guinea were identified.

Accepted for publication January 22, 1977.

^* Medical Epidemiologist, Bureau of Smallpox Eradication, Center for Disease Control, Atlanta, Georgia, attached to Organisation de Coordination et de Coopération pour la lutte contre les Grandes Endémies (O.C.C.G.E.), Bobo Dioulasso, Upper Volta. Presently assigned to Field Services Division, Bureau of Epidemiology, Center for Disease Control, Michigan Department of Public Health, Lansing, Michigan 48914.

Director, Service National des Grandes Endémies, Ministère de la Santé Publique et du Domaine Social, Conakry, Republic of Guinea.

Director, Bureau of Smallpox Eradication, Center for Disease Control, Atlanta, Georgia 30333.