Influenza Epidemic Preparedness Program

Swine Influenza

Swine Influenza

SWINE INFLUENZA frightening you? CONCERNED about the health implications? Coughs and Sneezes Spread Diseases! Stop The Swine Flu from Spreading. Follow the advice to keep your family and friends safe from this virus and not become another victim. These simple cost free guidelines will help you to protect yourself from the swine flu.

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Pandemic Preparedness Guide

Inside this information dense guide youll discover: Water & Food: The 2 common water storage containers that are breading grounds for bacteria that could kill you so you know to avoid them. How 8 drops of this common household chemical will instantly sterilize any drinking water container (its not vinegar or ammonia) so your can drink safely. The 21 dried foods you Must have stored to remain self-contained until the threat passes so your family can eat when grocery stores are bare. How to reduce energy and heat to cook by 70% with this special pot that only costs about $17 at Wal-Mart (It also doubles as a sterilizer) so your cooking fuel last 3X longer. How to create an inner home cocoon so you dont have to heat or cool your entire house so you save on heat and energy when the power is out or sporadic. How to recharge batteries an Unlimited number of times just using the sun so you can power your devices forever. How to create a resilient community in your neighborhood Now so you are not alone in defending your area so you can keep the infected and even looters out. The one plant that will keep intruders from coming in through your windows and openings in your home so you remain safe. How to train your dog to act when strangers are near your home so you know when and how to protect yourself. 3 weird uses for a fire extinguisher in a pandemic. The formula for the Ultimate protection against infection, so even our youngest family members remain disease free. How to create an isolated environment for the sick so they dont get everyone else sick while you are waiting for emergency workers. The one kind of phone that is most likely to work in a disaster so you can have constant communication with the outside world even if the power is completely out The one way to Never communicate with your family in a crisis so you dont create panic and unrest in a tense situation.

Pandemic Preparedness Guide Summary


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Ebola Virus Disease

With recognition of new, deadly viral infections - such as Lassa fever, Marburg, Ebola, Congo-Crimean hemorrhagic fever, Rift Valley fever, and AIDS - the classic descriptions of diseases such as malaria and yellow fever must After the discoveries of Marburg virus in 1967 and Lassa virus in 1969 had jolted medical complacency, the Ebola virus in 1976 provoked convulsive shudders. Almost simultaneous outbreaks of a deadly infection occurred in neighboring regions of southern Sudan and northern Zaire, and along the Ebola River. The Sudan and Zaire foci are about 150 kilometers apart, and continual traffic passes between them.

Acquired immune deficiency syndrome

(AIDS), first identified in 1981, is an infectious disease characterized by failure of the body's immunologic system. Affected individuals become increasingly vulnerable to many normally harmless microorganisms, eventually leading to severe morbidity and high mortality. The infection, spread sexually and through blood, has a high fatality rate, approaching 100 percent. Caused by a human retrovirus known as HIV-1, AIDS can now be found throughout the world -in both industrialized countries and developing nations. Public-health officials throughout the world have focused attention on this pandemic and its potentially catastrophic impact on health, resources, and social structure. Treatments for the disease have been developed, but no cure or vaccine currently exists.

Severity of the hazard

For many end uses, PPE is rated based on the severity of the hazard. For example, body armor classification developed by the National Institute of Justice (NIJ) is used for the selection of the body armor based on the potential workplace hazard. European Union certification for PPE uses Type I-VI categories that are based on very broad hazard scenarios. Although there are ratings or classifications for the various types of hazards, there is no universal system to rate the severity of all hazards. In the future, there may be a system to assess the severity and rate it regardless of the type of hazard. For example, the extremely hazardous category may be defined to include all hazard scenarios that are life threatening in very small amounts. Thus, the extremely hazardous category may include SARS and anthrax from the biological category, nerve gas from chemical, ballistic from physical, and radioactive materials from radiological hazards. This type of rating would help in the testing...

Allochthonous Parasites in the Americas Previous Syntheses

Recently, the 1520 introduction of smallpox to the Americas has been a subject of some interest. It is a classic example of disease transmission and spatial diffusion. On the basis of information drawn from historical documents, Dobyns (1983) has argued that the virus became the initial New World pandemic, spreading as far south as Chile and as far north as the Canadian border. The Caribbean islands were the initial focus of infection in 1518. The virus was then carried to Mexico by a crew member of Panfilo de Narvaez's expedition. The large size and extreme density of aboriginal populations in the valley of Mexico encouraged the rapid dissemination of the virus.

Vulnerabilities To Human Trafficking And Prostitution

Violence against women, which increases women's vulnerability to trafficking, is at pandemic levels. Conservative international statistics indicate that at least one of three women has been beaten, coerced into sex, or otherwise abused in her lifetime.13 A World Health Organization study found that as many as 47 of women report that their first sexual experience was rape. In some communities laws prioritize family values over the rights of women to be free of sexual assault.14 Every year, as many as five thousand women around the world are victims of honor killings murders that are rationalized because a woman engaged in sex without community approval. Many societies have laws with loopholes that allow perpetrators to act with impunity. For example, in a number of countries, a rapist can go free under the penal code if he proposes to marry the victim, with women often blamed for having been raped by men.15

Technical textiles for protection

These figures would be substantially higher if we consider the protective textiles used in automotive (airbags, seat belts) and medical (antibacterial) applications. The protective textiles market is growing at an annual rate of 6.6 , and expected to grow faster in the post-9 11 scenario and also due to recent epidemics such as SARS and bird flu.

The Present and the Future

Although all three population groups have seen dramatic improvements in their health, disease ecologies continue to evolve. Today virus infections remain as serious public health problems, acting differentially on the genetic variation present on the continent. Often forgotten in this context is that perplexing virus, influenza. It is perplexing because of its mutational history, with each strain - Asian, Hong Kong, swine, and so forth - being distinct immunologically, and ever dangerous in light of the still readily recalled devastation caused by the 1918-20 pandemic. Recent work by Gerald Pyle, a medical geographer, epitomizes the promise of the application of geographic modeling to public health problems of tracing the diffusion of diseases such as this (Pyle 1986). The acquired immune deficiency syndrome (AIDS) has established itself as of prime concern and appears to be following much the same pattern of spread as the earlier urban-centered epi-

Acquired Immune Deficiency Syndrome AIDS

Although precise epidemiological data remain unknown, public health officials throughout the world have focused attention on this pandemic and its potentially catastrophic impact on health, resources, and social structure. Treatments for the disease have been developed, but there is currently no cure or vaccine.

Toward Societal Therapy

The enormity of the modern mental health crisis throws into doubt the value of psychotherapy as the front line of intervention. Epidemiological research indicates that there is a rising pandemic of psychopathology across the globe.2 The dimension of this problem is such that there is no possibility of individual therapists making a significant impact. It is estimated that, in the United States alone, over 50 million people suffer from a diagnosable mental emotional disorder.3 Despite the large psychotherapy industry in America, only a small percentage of psychologically disturbed individuals can be expected to be treated by way of psychotherapy.

The Epidemiological Transition

One area of common interest to both demographers and epidemiologists is to describe and forecast global patterns of health. Originally, demographers found it useful to describe stages in the demographic transition'' to refer to the change from high fertility and high mortality rates in ''traditional'' societies to a pattern of low fertility and low mortality rates in ''modern'' societies (Thompson 1929 Notestein 1945). Subsequently, Omran (1971) extended this framework to describe three stages in the ''mortality transition'' consisting of (1) the age of pestilence and famine, associated with the predominance of mortality from epidemic infectious diseases, malnutrition, and complications of pregnancy and childbirth (2) the age of receding pandemics, during which mortality fell and life expectancy increased5 and (3) the age of noncommunicable diseases, during which mortality came to be dominated by chronic degenerative diseases such as heart disease, stroke, and cancer. A fourth stage...

Implementation Results

Efforts to reduce mortality in the second half of the 20th century have brought about significant improvements in life expectancy at birth. In the developing countries in particular, this indicator has progressed considerably it was between 35 and 45 years in 1950 to 1955 (far behind industrialized countries), but reached the 60 to 70 years bracket in 1990 to 1995 (reducing the gap with more advanced countries) (Mesle and Vallin 2002). However, the progression of the HIV AIDS pandemic and the resurgence of old killers like tuberculosis (linked to HIV AIDS) and malaria appear to be reversing the gains achieved in mortality reduction, especially in sub-Saharan Africa. In many cases (e.g., in Southern Africa), the HIV AIDS epidemic will deplete the numbers of productive workers, create large numbers of widows and orphans, weaken the economies, and possibly cause HIV AIDS-related famines. In the most affected countries, the HIV AIDS crisis has shortened the life span and will modify...

Research Priorities Of The Handbook Of Population

Epidemiologists, in turn, have increasingly looked to population-based samples, rather than clinical samples, and have incorporated social determinants of disease into their studies. Kawachi and Subramanian suggest that cross-disciplinary research will be increasingly important over the coming years, with the AIDS pandemic, population aging, and the increasing disparities between rich and poor countries.

From the Sushruta Samhita ca 3000 bce

Penis Sup Dorsal Vein Cut Problems

It is unclear when the scourge of syphilis began. There was much confusion between syphilis and gonorrhea. It was thought that gonorrhea was the first stage of syphilis. The cause of these diseases was also unknown. Many believed that syphilis was caused by floods, eating disguised human meat, or drinking poisoned water. It was not until 1500, when syphilis was pandemic in Europe, that the venereal origins of both diseases were understood. It is now believed that syphilis was introduced on the European continent in 1492 by the returning sailors who had been traveling with Columbus. After France's invasion of Italy and the siege of Naples in 1495, syphilis became rampant throughout Europe. The King's pox and the French pox were common terms for syphilis.

Guillain Barre Syndrome

The etiology of Guillain-Barre syndrome is unknown, but increasing evidence suggests it is probably a humoral and cellular autoimmune disease induced by infection with a variety of microorganisms. The background rate of Guillain-Barre syndrome is one to two cases per 100,000 persons annually. Guillain-Barre syndrome has been associated with several vaccines. An influenza vaccine used in the mid-1970s (swine flu

Diseases of the Premodern Period in Japan

Effects of Plagues on Japanese Society The effects of the age of plagues (700-1050) on Japanese society and culture were many and varied. Parallels with the Black Death pandemic that struck western Europe in the fourteenth and fifteenth centuries are tempting to draw, and it may be true that pestilence stimulates the same human responses in widely disparate societies. In the social and economic realm, the epidemics were responsible for several phenomena. First, disease caused population stagnation. Sawada Goichi estimated the population of Japan at 6 million in the eighth century, and it is unlikely that population grew significantly through the year 1050 (Kito 1983). Sixth, the stagnation of population growth resulting from disease reduced the demand for manufactured goods. At the same time, because epidemics kill people but do not destroy wealth, survivors of the pandemic among the aristocracy were left with great riches. Reduced overall demand and the increased opulence of a few...

Historical examples of serious infections

Plague is an infectious disease, caused by the bacteria Yersinia pestis, which has a high fatality rate without treatment. Plague infections have occurred in three pandemics since the 6th century, the first of which was the 'plague of Justinian', named after the Roman Emperor. It started around 532 in Africa and then spread, reaching Constantinople in 541 and then Italy, France and Germany. The outbreak in Constantinople is described in detail by Procopius of Caesarea in records that have survived to this day (Zietz and Dunkelberg, 2004). The second plague pandemic started around 1332 and rapidly spread around the world it became known as the Black Death. It is estimated that this plague pandemic killed between 15 and 23.5 million Europeans, or 25 to 33 of the entire population. Many cities introduced quarantine measures, based upon the forty-day restriction on travel imposed in Marseille in 1384. The second plague pandemic continued sporadically until the early 18 th century, with...

Disease in the Premodern Period

The many economic changes that produced widespread poverty meant, of course, that large sections of the population were placed in situations where they were more susceptible to disease, through either direct exposure or poor resistance. Individuals were also less able to afford the medical care that might have promoted recovery from disease. Thus, in addition to famines, and problems directly related to nutritional deficiencies such as beriberi and rickets, the effects of poverty showed up in a range of other diseases. These included chronic respiratory disease, tuberculosis, and eye ailments. Infant children were one group particularly at risk, and this was reflected in high infant mortality rates, as in Malaya in the early part of the twentieth century (Manderson 1987). The conditions of poverty also meant that the effects of epidemic diseases, as in the -influenza pandemic of 1918, were considerably more pronounced among the non-European population of Southeast Asia (Brown 1987).

General Considerations

Nearly 65 million Americans have one or more forms of cardiovascular disease (CVD), and nearly 1 million die from such conditions each year. Although CVD death rates in the United States are declining, the illness is still the leading cause of death, by far, in the nation. It accounts for approximately 38.5 of all deaths, or 1 of every 2.6 deaths. CVD kills more Americans than the next seven causes combined, including cancer. CHD, stroke, high blood pressure, and congestive heart failure have been the leading causes of death in the United States every year since 1900, with the exception of 1918, when there was a worldwide flu pandemic. The National Center for Health Statistics reported that in 2004, there were 79,400,000 Americans with one or more forms of CVD. There are 72 million Americans with high blood pressure, 15.8 million with CHD, and 5.7 million who had suffered a stroke. There are 15.8 million people alive today who have a history of heart attack, angina pectoris, or both...

Prevention and Control

The medical profession, grappling with the great pandemic, labored under three major disadvantages First, in the 1890s one of the premier bacteriologists of the world, Richard F. J. Pfeiffer, thought he had discovered the causative organism, common It is possible that more is now known about the influenza virus than about any other virus, but its changing nature has defeated all efforts thus far to make a vaccine against the disease that will be effective for more than a few years at most. Vaccines were produced in the 1940s to protect the soldiers of World War II from a repetition of the pandemic that had killed so many of them in World War I, and influenza vaccines developed since have enabled millions, particularly the elderly, to live through epidemics without illness or with only minor illness. But the ability of the A virus to change and sometimes to change radically - as at the beginning of the 1957-8 and 1968 pandemics - and to race around the globe faster than suitable...

Infectious Diseases Smallpox

Influenza is also prominently mentioned in the Japanese sources from early times, and 27 influenza epidemics are described in contemporary accounts of the Tokugawa period. The Japanese accounts are similar to accounts of influenza epidemics elsewhere They describe a coughing epidemic that spread extremely rapidly, infecting everyone - young and old, male and female. As is typical of influenza, the mortality rate was highest among the very young and the very old. Influenza epidemics, like other imported epidemics, were said to enter Japan through the port of Nagasaki. In the seventeenth and eighteenth centuries, the timing of epidemics was different from those reported in Europe but by the nineteenth century, influenza epidemics were noted in both regions at very nearly the same time. It appears that two distinct regional dissemination systems for influenza may have merged during the early modern period as the frequency of contact and speed of transport between East and West increased....

Epidemiology and Risk Factors HIV1 is transmitted

The World Health Organization estimates that from the beginning of the pandemic until January 1, 1996, 30.6 million people worldwide have been infected with HIV-1. Of these, 27.4 million were adults (15.8 million men 11.7 million women) and 3.2 million were children. An estimated 10.4 million persons have developed AIDS, and 9.2 million people have died from AIDS. In the United States, since the beginning of the epidemic until June 1996, greater than 440,000 cases of AIDS had been reported to the CDC, and about 350,000 from North America have died. It is estimated that between 1 to 1.5 million people in the United States are HIV-1 infected. Statistical models of HIV-1 transmission in the United States suggest that transmission peaked among homosexual males in 1984 and among intravenous drug users between 1984 to 1986. Transmission by heterosexual contact is stable or increasing. y A progressively larger proportion of recent AIDS cases is in women.

Cryptococcosis epidemiology

Cryptococcus neoformans is an encapsulated yeast that can infect apparently normal hosts but is more frequently associated with severe infections in immunocompromised patients. C. neoformans is divided into two varieties based on serotype C. neoformans var. neoformans (serotypes a and d) and C. neoformans var. gatti (serotypes b and c). C. neoformans var. gatti is found predominantly in tropical and subtropical climates associated with eucalyptus trees, whereas C. neoformans var. neoformans is found worldwide and is associated with pigeon droppings and other avian excreta. Before the AIDS pandemic, cryptococcosis was a relatively uncommon disease but became a leading cause of meningitis among HIV-infected patients. Although the incidence of this infection has declined somewhat with the widespread use ofhighly active antiret-roviral therapy (HAART), C. neoformans remains an important pathogen in immuno-compromised patients, including cancer patients who often present with the pulmonary...

Treatment and Prevention

Plasmapheresis with plasma from recovered patients has been tried as treatment. Interpretation of limited trials (at the tail end of the epidemics) indicates little hope of an effective therapy. No drugs have been effective. A hospital staff member attending an Ebola patient (from Africa) in a hospital in England became ill and soon was gravely ill. Interferon and immune plasma were both given and the patient recovered. A possible vaccine remains a dream. Interestingly, 11 of 11 blood donors for plasmapheresis had microfilariae, although no protozoa, in their blood. It should be emphasized that most of the Ebola patients who came to a clinic or a hospital had had several days of treatment with an antimalarial drug, often followed by typhoid treatment or antibiotics of whatever kind available. Malarial parasites could hardly be expected to be found under such circumstances.

The Later Middle Ages

In 1347, the plague began its journey through Europe. When the pandemic ended in 1350, a third of the population of Europe was dead. The population of Europe on the eve of the epidemic has been estimated at 75 million. Although life expectancy at birth was only around 30 years, the very high infant mortality rate artificially lowered this relative to the life expectancy of a person who reached adulthood. Women tended to fare worse, probably as a result of childbirth, although some authors also cite tuberculosis and malaria (Russell 1977). Before the year 1000, no city in medieval Europe had a population exceeding 20,000. In 1340, the largest European cities were Venice, Paris, Florence, and Genoa, each with populations around 100,000. Closely behind were cities such as London, Barcelona, Bologna, Brescia, Ghent, and Cordoba, each of which had populations over 50,000 (Beloch 1937, 1940, 1961

Pathology and Diagnosis

Several pathologists deemed the differential diagnosis of Ebola infection to be extremely difficult in settings where there might be malaria, Lassa fever, Marburg disease, yellow fever, Congo-Crimean hemorrhagic fever, typhoid fever, infectious hepatitis, leptospirosis, brucellosis, and other fevers. Some other pathologists felt the lesions observed to be adequately specific to permit an Ebola diagnosis.

History and Geography

Nineteenth Century The Pandemics Macnamara, who evaluated all these many reports of the appearance of the disease, concluded that we are, I think justified in arriving at the conclusion that it was nothing new for cholera to spread over India in an epidemic form prior to 1817 and 1819. At this point, something drastically new did occur, as cholera escaped the bounds of India and initiated the waves of pandemics that were to engulf the world. This change in cholera's pattern of activity has led a few to conclude that a new disease arose in Bengal in 1817, a contention Pollitzer (1959) regards as untenable, observing the following The First Pandemic. In any event, in March 1817, a death from cholera took place in Fort William, but because it was a solitary case no notice was taken of it. By July, however, outbreaks occurred in several districts in the Province of Bengal. The first notice of this in the Proceedings of the Bengal Medical Board was a letter from Robert Tytler, civil...

Etiology and Epidemiology

The causative agents of influenza are three myxovi-ruses, the influenza viruses A, B, and C. The B and C viruses are associated with sporadic epidemics among children and young adults, and do not cause pandemics. The A virus is the cause of most cases during and between pandemics. It exists and has existed in a number of subtypes, which usually do not induce cross-immunity to one another. In most instances, influenza viruses pass from person to person by breath-borne droplets, and from animal to animal by this and other routes. Although the disease can spread in warm weather, its epidemics among humans in the temperate zones usually appear in the winters, when people gather together in schools, houses, buses, and so forth under conditions of poor ventilation. Geographically, the malady spreads as fast as its victims travel, which in our time can mean circumnavigation of the globe in a few months, with the pandemic veering to the north and south of the tropics with the changing seasons.

Epidemiology Distribution and Incidence

The epidemic of a highly fatal disease (later named Ebola virus disease) began in June 1976, with an index case in Nzara, southern Sudan, among workers in a cotton factory. This patient went to a large hospital in Maridi, where the disease spread rapidly among hospital patients and staff. The epidemic ran its course by November 1976. There were 148 deaths in 284 detected cases (52 percent mortality). In 1979 a further outbreak occurred in southern Sudan, with fewer cases and a small number of deaths. Complacency was shattered in the United States and internationally in early November 1989 when an epidemic, confirmed to be caused by Ebola virus, Epidemiologists have been active in trying to trace the origins of the Ebola virus and the distribution of the infection throughout Africa, locate host vertebrates other than humans, as well as learn methods of transmission to humans and the ways the virus is maintained and propagated in nature. Table VIII.42.1 summarizes these data. Although...

Encephalitis Lethargica

Foremost among recorded encephalitis epidemics was the global pandemic of encephalitis lethargica that emerged in and from Europe during the last years of the Great War and occurred in successive waves throughout the world during the following decade. Although the diagnosis of encephalitis lethargica is sometimes applied to sporadically occurring cases of inflammation of the brain having a strong lethargic or stuporous aspect, this discussion focuses upon the encephalitis pandemic that accompanied and followed the 1918 influenza pandemic.

Distribution and Incidence

In seemingly every year, there are at least some cases of influenza in every populated continent and in most of the large islands of the world. During epidemics, which occur somewhere almost annually, the malady sweeps large regions, even entire continents. During pandemics, a number of which have occurred every century for several hundred years, the disease infects a large percentage of the world's population and, ever since the 1889-90 pandemic, in all probability a majority of that population. Not everyone so infected becomes clinically sick, but nonetheless influenza pandemics are among the most vast and awesome of all earthly phenomena. The disease strikes so many so quickly and over such vast areas that the eighteenth-century Italians blamed it on the influence of heavenly bodies and called it influenza.

Diseases of Sub Saharan Africa since 1860

In fact, many continue to believe that tropical Africa has a well-deserved reputation as a vast breeding ground and dispersal center for dozens of diseases and thus would subscribe to the recent assertion that Africa is a sick continent, full of sick and . . . starving people (Prins 1989). This view has been reinforced by scientific speculation concerning the appearance of so-called exotic new diseases like Ebola, Marburg, and Lassa fevers in the 1960s and 1970s (Westwood 1980 Vella 1985). The HIV viruses that cause the acquired immune deficiency syndrome (AIDS) are the most recent additions to this list.

Diseases and Epidemics

It is said that the first pandemic of the early nineteenth century remained geographically in Asia, though it approached Europe, and it may have touched Africa at Zanzibar. The following second, third, and fourth pandemics affected the entire world, though with considerable regional variations the areas of incidence receded significantly in the fifth and sixth pandemics.

Disease Source Material

Whether explicitly stated or not, the identification of parasites responsible for past epidemics is always indirect. The truth of this statement is dramatized by the 1918 influenza pandemic that killed millions of people in less than a year and a half (Jordan 1927). Despite early-twentieth-century advances in public health, microbiology, and immunology, an understanding of the variations of the influenza viruses was not attained until the 1970s (Mackenzie 1980 Stuart-Harris 1981). In 1918 and 1919 suggestions regarding the source of the disease ranged

Disease Patterns of 190060

The most explosive and most destructive epidemic ever to strike Africa was the influenza pandemic of 1918-19. Introduced at Sierra Leone in late August 1918, and to ports around the continent in the next several weeks, the disease spread rapidly inland over the newly constructed colonial roads, railroads, and river transport systems. Diffusion was especially rapid on the southern African rail system and on the river steamers in the Belgian Congo. Indeed, so quickly did the disease move by these means, that places in the Congo only 100 miles from the coast were first attacked by way of the Union of South Africa. Almost every inhabited spot on the continent was struck in a matter of 6 or 7 months, graphic proof that the old isolation was gone forever and that the continent was an epidemiological unit closely linked to the rest of the world. Approximately 2 million people - about 2 percent of the population - died during the epidemic.

Chronic Infectious Diseases

Foremost among these may have been syphilis. Imported, at some time during the late fifteenth century, possibly with the Spanish colonization of the Americas, possibly with earlier Portuguese conquests in western Africa, syphilis suddenly appeared in the mid-1490s, uncharacteristically as a pustular rash, a large pox in contrast to the small pox. Within half a century, however, syphilitic patients suffered the same general pathology that untreated victims would in the twentieth century, including long, chronic bouts with ulcers and fistulae. The records of both the initial pandemic wave and individual cases of syphilis from 1550 to 1800 are intertwined with heightened moral concerns and fears of stigmatiza-tion, so that it is difficult to assess the prevalence of syphilis during this period. Police and public health officers of the nineteenth century took an aggressive interest in the control of syphilis, especially in the control of prostitution. They thereby generated our earliest...

Attempts at Control and Prevention

The Black Death was in many ways a completely unprecedented experience for those who suffered through it. Plague had virtually disappeared from the Middle East and Europe during the centuries between the end of the first pandemic in the eighth century and the beginning of the second pandemic, and although the first half of the fourteenth century had been marked by a number of epidemics of other diseases, none approached the Black Death in de-structiveness and universality. Contemporaries reacted vigorously against the disease, attempting to halt its spread, mitigate its virulence, and alleviate the suffering it provoked. For the most part, however, their responses took traditional forms Rather than developing new strategies for managing the crisis, they fell back on established measures, though in many cases they applied these with unprecedented rigor.

Diabetes Mellitus

Diabetes is a rapidly growing worldwide pandemic, and cigarette smoking is responsible for about 10 of the incidence of type 2 diabetes. A dose-response relationship exists, with the risk increasing in direct proportion to the number of cigarettes smoked. People who smoke more than one pack a day have about double the risk for diabetes as nonsmokers, and the risk is still 1.5 times greater for those who smoke only 1 to 14 cigarettes a day (Manson et al., 2000 Willi et al., 2007). Smoking increases the risk for development of the metabolic syndrome and its attendant cardiovascular consequences (Chiolero et al., 2008).


Pattern III countries, including North Africa, the Middle East, Eastern Europe, Asia, and the Pacific, initially experienced less morbidity and mortality from the pandemic. Apparently, HIV-1 was not present in these areas until the mid-1980s. The nature of world travel, however, has diminished the significance of geographic isolation as a means of protecting a population from contact with a pathogen.


Because HIV is related to other recently isolated primate retroviruses, such as simian T lym-photropic virus (STLV)-III in African green monkeys, many have speculated that HIV originated in Africa. Antibodies to HIV were discovered in stored blood dating back to 1959 in Zaire. According to experts, it is likely that HIV has existed for many years in isolated groups in central Africa. Because outside contacts were minimal, the virus rarely spread, and epidemics could not be sustained. Once a sizable reservoir of infection was established, however, HIV became pandemic. As with other sexually transmitted diseases, such as syphilis, no country wished the stigma of association with the virus's origin. Because biomedical technologies to prevent transmission appear to be some years away, the principal public-health approaches to controlling the pandemic rest on education and behavior modification. Heightened awareness of the dangers of unprotected anal intercourse among gay men, for example,...

Assess hazards

In case of serious new threats, decisions regarding protective clothing may have to be made in a very short time frame. For example, decisions had to be made immediately regarding selection of appropriate personal protective equipment for protection against viruses such as severe acute respiratory syndrome (SARS) and anthrax. In those two scenarios, assessing the hazards was the crucial first step in the selection of the protective clothing.

Type of hazards

Biological hazards are divided by the type of microorganism and the mode of contamination. In the medical field, the primary potential risk to the individual is exposure to hazardous bacteria and viruses through contact with contaminated blood and other potentially hazardous body fluids. Surrogate microbes are commonly used to assess the penetration of extremely hazardous substances such as Hepatitis (B and C) and Human Immunodeficiency Viruses. The other risk is exposure to hazardous airborne pathogens such as influenza and the SARS viruses. Airborne pathogens may pose a risk to the general public, in addition to medical personnel. The hazard may be due to natural causes or as a result of bio-terrorism. As the use of biological agents poses a threat in wars, protective clothing materials are also used to protect military personnel.

Black Death

The Black Death is the name given to the great pandemic of plague that ravaged parts of Asia, the Middle East, North Africa, and Europe in the mid-fourteenth century. Contemporaries knew it by many names, including the Great Pestilence, the Great Mortality, and the Universal Plague. This epidemic was the first and most devastating of the second known cycle of widespread plague, which recurred in waves through the eighteenth century. Some later and milder plagues seem to have also involved other diseases, including influenza, smallpox, and dysentery. Nonetheless, most historians agree that the Black Death was a massive epidemic of plague (a disease of rodents - caused by the bacillus Yersinia pestis - that is transmitted to humans by fleas). The Black Death manifested itself most commonly as bubonic plague but also appeared in the forms of pneumonic plague and septicemic plague.


There is at present no specific cure effective against this viral disease. In mild cases, symptoms disappear in 7-10 days, although physical or mental depression may occasionally persist. Influenzal pneumonia is rare but often fatal. Bronchitis, sinusitis, and bacterial pneumonia are among the more common complications, and the last can be fatal if untreated. Influenza is generally benign, and even in pandemic years, mortality is usually low - 1 percent or less - the disease being truly life-threatening for only the very young, the immunosuppressed, and the elderly. However, this infection is so contagious that in most years multitudes contract it, and thus the number of deaths in absolute terms is usually quite high. The sequelae of influenza are often difficult to define, but evidence indicates that the 1920s global pandemic of encephalitis lethargica had its origin in the great pandemic of 1918-19.


The Severe Acute Respiratory Syndrome (SARS) epidemic in 2002-2003 highlighted discriminatory problems against employees with the illness or perceived illness. In Hong Kong, two Indonesian domestic helpers were fired by their employers because the maids had contracted the SARS virus (but had recovered) while working for their bosses (HK employers, 2003). In Australia and New Zealand, many corporate giants forced their employees who had traveled to a SARS-affected area into quarantine periods on annual, sick, or unpaid leaves, even though the employees did not exhibit any SARS symptoms (Mclntyre, 2003 Pollard, 2003). There were outcries from migrant workers or trade unions in these countries, urging authorities to take actions against employers who had used the SARS crisis to discriminate against employees.

Next Steps

The cross-fertilization of demography and epidemiology is happening at a crucial stage in the evolution of human health. New threats and challenges to global health, such as the AIDS pandemic, the worldwide aging of the population, and the widening economic gulf between rich and poor countries associated with globalization, demand analytical approaches and strategic responses that are simultaneously rooted in the historical concerns of demographers with whole populations, as well as the more individual and biological focus of epidemiologists.

Population Policy

Three sets of issues dominated the global population policy agenda during most of the last half of the 20th century. In the less-developed countries, population policies focused on the economic, social, and environmental impacts of rapid population growth and on measures to reduce high fertility rates that had failed to adjust to falling and sometimes rather low mortality rates. In the more-developed countries, policy was focused on immigration and population aging that resulted from fertility declines and, in some countries, the implications of subreplacement fertility. In the final decade of the century, policy attention was also drawn, particularly in sub-Saharan Africa, to the demographic, economic, and social implications of the HIV AIDS pandemic and the resurgence of tuberculosis and malaria.

Artists with AIDS

AIDS (acquired immunodeficiency syndrome) is a pandemic but nowhere is it more prevalent than in Africa. Thirteen South African women, members of the Bambanani Women's Group, contracted AIDS and made art in response to their illness. Their names are Babalwa Cekiso, Thobani, Nomawethu, Victoria, Noloyiso, Nondumiso Hlwele, Thozama, Bongiwe, Bulelwa Nokwe, Ntombizodwa Somlayi, Ncedeka, Maria, and Nomonde,. Their creativity was part of the Memory Box Project from the University of Cape Town. It was originally intended to be expressive arts therapy for dying individuals to help alleviate stress and build a legacy to leave their children. Then with the introduction of ARVs (antiretroviral medication), the women started to recover. Despite the sometimes violent prejudice against people who are HIV positive, the women used their art as a political statement to highlight the importance of extending medical care to other low-income individuals with AIDS. They also want to encourage those...

Neuromyelitis Optica

Devic's syndrome occurs in patients of varied ages (range, 1 to 73). The mean age at onset of monophasic Devic's syndrome is 27, whereas relapsing NMO (see later) tends to occur in an older age group (mean age at onset of 43). Monophasic Devic's syndrome affects males and females equally, whereas relapsing NMO affects females predominantly (F M, 3.8 1). One third of patients have a preceding infection within a few weeks of neurological symptom onset. Most commonly this is a nonspecific upper respiratory tract infection, flu, or gastroenteritis. The most common specific infections preceding the development of Devic's syndrome are chickenpox and pulmonary tuberculosis. Devic's syndrome has also followed vaccination for swine flu and mumps. Only a few instances of the familial occurrence of Devic's syndrome have been reported, and in one of these families a unique mitochondrial mutation was found. Devic's syndrome is said to be more common in Japan and East...


Tobaccosis is the foremost plague of the twentieth century and thus joins the most fearsome plagues that devastated humanity during this millennium such as the Black Death, smallpox, malaria, yellow fever, Asiatic cholera, and tuberculosis. But unlike microparasitic plagues, whose victims experienced pathognomonic disease manifestations within days or weeks of exposure, tobaccosis is an extraordinarily insidious disease entity of long latency resulting from exposure to tobacco for many years or decades and manifested by increased occurrence of any of a broad spectrum of neoplastic and degenerative diseases ordinarily associated with advanced age. Thus, the powerfully malignant nature and magnitude of the tobaccosis pandemic went largely undetected during the first four centuries of its global march and it is only late in the fifth century of the post-Columbian world's exposure to tobacco that the extent of tobacco's depredations is being fully revealed. Because of its leadership in...


With the advances in technology that revolutionize everyday lifestyles and industrialization all around the world, obesity has become a modern-day global pandemic. Moreover, as obesity is predicted to reach record numbers in the near future and fertility rates continue to plummet, scientists have began to link the two together. They have revealed that as much as half of all fertility problems come from male-factor defects.

Vni73 Influenza

There is at present no specific cure that is effective against this viral disease. In mild cases the acute symptoms disappear in 7 to 10 days, although general physical and mental depression may occasionally persist. Influenzal pneumonia is rare, but often fatal. Bronchitis, sinusitis, and bacterial pneumonia are among the more common complications, and the last can be fatal, but seldom is if properly treated. Influenza is generally benign, and even in pandemic years, the mortality rate is usually low 1 percent or less-the disease being a real threat to life for only the very young, the immunosuppressed, and the elderly. However, this infection is so contagious that in most years multitudes contract it, and thus the number of deaths in absolute terms is usually quite high. Influenza, combined with pneumonia, is one of the 10 leading causes of death in the United States in the 1980s. The sequelae of influenza are often hard to discern and define - prolonged mental depression, for...


There have been three major plague pandemics in recorded history the plague of Justinian in the mid-sixth century, the Black Death in the mid-fourteenth century, and the Bombay plague in the late nineteenth century. Apart from the high mortality rates and the social dislocation caused by these pandemics, each initiated a long series of plague epidemics with significant cumulative effects. In 1347 plague dramatically reappeared in the Middle East, being carried overland from central Asia to the Crimea in 1346. From the Black Sea region, it was transported by Italian merchants to Constantinople and from there to the major Mediterranean ports. Egypt was infected by the autumn of 1347 and Syria by the following spring. In addition, the plague spread inland the central Middle East may have been infected from southern Russia as well. There is, incidentally, no evidence for the theory that the pandemic was transmitted from India via the Persian Gulf and the Red Sea to the Middle East and...

Other Epidemics

During the Renaissance period, influenza pandemics recurred frequently enough to be well described by the fifteenth century. At least three influenza epidemics were quite severe during the sixteenth century, those of 1510,1557-8, and 1580. The last in particular resembled the devastating influenza of 1918, in that the first wave occurred in the summer and early fall, and morbidity and mortality were high among young adults. The periodic influenza in the seventeenth century has not been a subject of scholarly study, though the epidemics of 1627 and 1663 seem to have been quite lethal. In contrast, epidemics of the eighteenth century have received considerable attention. K. David Patterson (1986) points to two epidemic periods in particular, from 1729 to 1733 and from 1781 to 1782, that mirror sixteenth-century pandemic influenza, suggesting that worldwide distribution of this common infectious disease antedated advances in global transportation.


Because descriptions of Marburg virus pathology are equally applicable to Ebola virus, some pathologists feel that the findings are not distinctive enough to permit a positive diagnosis of either on the basis of pathology alone, especially in regions where there are many causes of fever and death. Ebola virus infection is considerably more fatal in humans than is the Marburg virus. In the four secondary Marburg cases studied, it was clear that their clinical course was less severe than that seen in primary cases, and there was no mortality.

Middle Ages

In response to repeated and deadly plague epidemics - the first pandemic struck Europe between 1348 and 1350 - northern Italian city-states instituted a series of public health measures designed to protect the healthy elite from the ravages of the disease. Because poisonous miasma was blamed for the humoral imbalance that caused susceptibility to plague, authorities isolated ships whose crews and cargoes were suspected of carrying miasma. The isolation - or so-called quarantenaria necessary to neutralize the offending particles lasted for 40 days. Venice and Ragusa were among the first cities to implement such measures, the former in 1348, the latter in 1377. Burial regulations, the control of water supplies, the cleansing or burning of contaminated possessions - all inaugurated a comprehensive sanitary program widely adopted by other European cities in ensuing centuries.

Disease Patterns

Verely in the sixth-century plague of Justinian, and repeatedly thereafter. Because Procopius had placed the origin of that pandemic in Egypt, the Nile Valley became identified in Europe's popular and professional imagination as the cradle of plague. However, the recurring epidemics of bubonic plague in this region were initially imported. Infected fleas on rats infesting the holds of cargo ships transmitted the infection to domestic rats in Mediterranean port cities and established endemic loci for the disease. Only the coast is naturally vulnerable to plague. Inland areas are too hot or too cold, and above all too dry to be susceptible to enzootic plague. However, irrigation systems acted as networks for transmitting infective fleas by providing harborage for rats in the embankments of canals. Epidemics flared periodically whenever optimum weather conditions - high humidity and moderate temperatures - coincided with an adequate rat-flea density. After the adoption of quarantine...

Disease and Commerce

In the late second century A.D. both Rome and China were probably overwhelmed by pestilence. In Rome the so-called Antonine plagues of A.D. 165-80 were followed less than a century later by another round of empirewide pandemic. Although it is impossible, at this distance, to determine what diseases entered Rome and caused such havoc during these times, opinion has long centered on smallpox or something similar or ancestral to it as the primary agent (Hirsch 1883 McNeill 1976). No doubt, however, other newly introduced infections (including, probably, measles) were present as well. The result was severe and prolonged population decline and, perhaps consequently, political upheaval.

Subject Index

Bleeding disorders, 55-57 brucellosis, 59 bubonic plague, 63 cancer, 65 cholera, 77 cystic fibrosis, 84 cytomegalovirus infection, 85 dengue, 86 diabetes, 89-92 Down syndrome, 98 dracunculiasis, 98-100 Ebola virus, 107-109 echinococcosis, 110 emphysema, 113 encephalitis, 115 fascioliasis, 123 favism, 124 filariasis, 125, 127 fungal infections, 129, 131 fungus poisoning, 134 gallstones, 135 gonorrhea, 151 gout, 156 in Bolivian hemorrhagic fever, 39 in Ebola virus disease, 108 in gonorrhea, 232 granular, 230-31 from herpes simplex, 161 history, 232-34 tuberculosis, 337, 339, 341 tularemia, 343-344 typhus, epidemic, 354 typhus, scrub, 356 urolithiasis, 357 Korea beriberi, 45 cholera, 77 diabetes, 89 fasciolopsiasis, 123 paragonimiasis, 240 typhus, epidemic, 354 typhus, scrub, 356 eastern equine encephalitis (EEE), 35, 36, 38 East India Company, 296 Ebers Papyrus, 99, 102, 162, 167, 232, 246 Ebola hemorrhagic fever (EHF), 109 Ebola virus disease, 107-10, 208 echinococcosis, 110...