Pandemic Survival Guide

Pandemic Survival

This eBook shows you what it takes to survive the next pandemic. There is no doubt that in the future, the world will be hit with a huge pandemic, either from natural causes or from a terrorist attack. As you look through history, you will be hard-pressed to find any pandemic in history that has killed less than 1 million people. You do not want you or your family to be among those millions. And with the help of the information in this eBook, you have a way to survive the global pandemic that will come. Wishing it won't happen doesn't do anything Preparing for it gives you the tools to survive AND thrive. This book contains the two-pronged approach of John Hartman's years of research in figuring out how pandemics work and living through a dangerous flu outbreak. This gives you the methods to both avoid getting a virus in the first place, and how to strengthen your immune system should you come down with a virus. You don't have to lay down and die. You can fight the next pandemic. Read more here...

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Pandemic Influenza On Sclerosis in Governance

The unprecedented ferocity of World War I (1914-1918) saw the great powers of Europe galvanize their populations into total war and the Continent besieged by violence, chaos, and destruction. Ultimately, the conflict resulted in the disintegration of several empires witness the centrifugal fragmentation of Austria-Hungary, the dissolution of the Ottoman Empire, and the subjugation of Germany under the punitive Treaty of Versailles.1 The Great War, as it was also known, cut down a generation of young men in Europe and directly contributed to the emergence of a deadly influenza pandemic, known at the time as the Spanish Flu. The manifestations of pandemic influenza were horrific. Infected individuals exhibited heliotrope cyanosis, a bluish discoloration of the skin resulting from suffocation as their lungs filled with blood and fluid. The end result for the host was often systemic hemorrhaging, and ultimately death. I begin this chapter by examining the impact of the 1918 pandemic on...

Pandemic Influenzas Impact on World War I

With the notable exceptions of Crosby, Byerly, and Bessel, medical historians have perpetuated the ignorance of the impact of influenza on the war effort, and certainly on the outcome of the war. The historians Byron Farwell, Jennifer Keene, and Robert Ziegler have argued that the pandemic compromised the effectiveness of military forces during the war to a certain extent, but they have not gone so far as to argue that it had any effect on the outcome of the conflict.73 Given that the waves of pandemic influenza (as determined by pathogen-induced mortality) struck Austrian and German society (and their military forces) before they struck British society, we might expect that influenza debilitated the war effort of the Central Powers more than that of the Allies. Thus, it is variation in mortality and (perhaps even more important) in timing that indicates that Crosby was premature in concluding that all combatants were affected in the same manner. The balance of evidence accumulated...

The Swine Flu Affair and Its Repercussions

In the wake of the great pandemic of 1918-19, the twentieth century witnessed additional (and relatively minor) pandemics during 195782 and 19 6 8.83 The processes of emergence of pandemic influenza are cyclical and thus, contain a degree of periodicity.84 However, the Swine flu affair of 1976, which emanated from initial cases of flu-induced mortality in Fort Dix, New Jersey, generated problems in US domestic response to contagion that persist to this day. Despite dire warnings regarding the emergence of a novel strain of highly pathogenic influenza, the 1976 flu failed to generate the high levels of morbidity and mortality that had been predicted. However, profoundly negative repercussions did result from the vaccination program that was authorized by the US government, which rushed though a prototype vaccine without adequate testing before mass dissemination.85 Owing to the faulty production and insufficient testing of that vaccine, the provision of such vaccinations to the...

Severe acute respiratory syndrome SARS

SARS is a respiratory infection that can produce serious complications. Most cases identified have been in Asia, but there have been outbreaks elsewhere, including the United States and Canada. To date, there has been no evidence of SARS transmission through blood transfusion. However, the potential exists, because the virus associated with SARS is present in the blood of people who are sick. If it were possible for the virus to be present in blood before an individual becomes ill and for that person to donate blood, then that individual potentially could introduce the virus into the blood supply. To prevent this from occurring, blood collection facilities ask potential donors orally or in writing about recent travel to a SARS-affected country, a history of SARS infection, or possible exposure to SARS. Because the risk of contracting SARS through a blood transfusion theoretically exists during periods of SARS epidemics anywhere in the world, anyone who has traveled to a SARS-infected...

The Zoontic Origins of Coronaviruses Associated with SARS

Severe Acute Respiratory Syndrome (SARS) is a novel human illness caused by a previously unrecognized coronavirus (CoV) termed SARS-CoV MAR03 ROT03 . SARS-CoV may be of zoonotic origin. However as of today, there remain conflicting reports on the zoonotic origins of SARS CoV. Guan et al., 2003 GUA03 report that SARS CoV originated in small carnivores whereas Li et al., 2005 LI05 and Lau et al., (2005) LAU05 counter that SARS CoV originated in bats. Nevertheless preparing figures, some investigators who use distance methods choose to impart directionality by selecting an edge of the graph to serve as a root of the tree. The choice of root is crucial in depicting the polarity of host shifts and depicting clades. The rooting step has been executed variably by researchers comparing sequence data from CoVs isolated from humans with sequence data CoVs isolated from small carnivores. In the case of Guan et al. ( GUA03 see their Figs. 2 and S2 of their supplemental materials) and the Chinese...

Epidemic of Fear SARS and the Political Economy of Contagion in the Pacific

The SARS epidemic of 2002-03 provides another glimpse into the significance of emergent infectious disease as an agent of destabilization at both the domestic and international levels. During this outbreak, SARS generated significant levels of fear and psychological trauma in affected populations, impeded international trade and migration flows, and resulted in minor to moderate economic damage to the economies of affected Pacific Rim countries (particularly China and Canada). In this chapter, I argue that while the SARS epidemic may have generated moderate institutional change at the domestic level (particularly in China and Canada), it resulted in only ephemeral change at the level of global governance. In the domain of security, I argue that despite minor demographic effects, the epidemic generated moderate levels of fear-induced economic damage that constituted a direct threat to the material interests of affected states, particularly China, Hong Kong, and Singapore. Moreover, the...

Pandemic influenza

The public health response to the potential for pandemic influenza, although not a bioterror threat per se, represents an opportunity to implement some of the lessons learned from other, recent experiences in biodefense. While it is not clear that the cause of the current avian influenza epidemic, H5N1, will be the next pandemic strain (Bartlett and Hayden, 2005), the possibility of a future influenza pandemic appears to be all but certain (Mermel, 2005). H5N1 has met two of three criteria for a pandemic it represents a novel subtype of influenza to which the population is immunologically na ve, and it is capable of infecting humans (albeit in limited fashion to date) and causing potentially lethal disease (WHO, 2005). The remaining pandemic hurdle for the virus is the ability for efficient human-to-human transmission (Fauci, 2006). Given this, and the state of scientific knowledge that is currently available, we are in a much more favorable circumstance than our predecessors were at...

Kenneth H Mayer and HF Pizer

In the electronic media era, on almost any given day, it seems the news is highlighting a new infectious disease pathogen as the next great threat to humanity. In 2003 it was SARS. In 2006 it was avian influenza. Before that there were Legionnaires' disease and Toxic Shock Syndrome, and earlier tuberculosis was (as coined by Rene and Jean Dubos) known as the white plague (Dubos and Dubos, 1952). While the battle between humans and constantly evolving microbes is continuous, it would be wrong to be unduly pessimistic about the future. The microbes adapt to their hosts and humans respond. Each year, more people have access to modern medicines. Health programs expand to more communities, and more young professionals are trained in clinical care and public health. In response to the AIDS epidemic, the international health workforce is expanding and improving at an unprecedented pace. While more always needs to be done, there now is a historic commitment to improving health, especially in...

A brief history of travel and the movement of microbes

Aided by the modern steamship, which carried infected rats and fleas, a third bubonic plague pandemic circled the globe between 1884 and the early 1900s (Echenberg, 2002). Carried in grain wagons and other forms of transport, it moved inland from the port cities across southern China, reaching Hong Kong in 1894, Singapore and Bombay in 1896, Alexandria, Oporto, and Honolulu in 1899, Sydney, Buenos Aires, Rio de Janeiro, and San Francisco in 1900, and Cape Town in 1901. Many port cities had overcrowded urban tenements with impoverished populations, often immigrants, who were most often infected and were subjected to isolation, rejection, and stigmatization (Echenberg, 2002).

The impact of rumors and fear

The number of international tourist arrivals declined in 2003 in response to outbreaks of SARS and the associated travel advisories. The WTO reported that arrivals at some affected countries in Asia plunged to below 50 percent of their usual levels in April and May (WTO, 2005). Although the region rebounded quickly, SARS was responsible for a 9 percent overall loss in travel volume for Asia for the year 2003. Estimates of the global cost of SARS associated with lost economic activity have been estimated at about US 40 billion, and perhaps as high as US 54 billion (Lee and McKibbin, 2004).

Basic reproductive rate

Infections produced by an infected individual in a susceptible population (Anderson and May, 1991). For an infection to be sustained in a new population, the basic reproductive rate must exceed one (May et al., 2001). The R0 for a specific infection may vary depending on time, place, and population. For example, in the pre-vaccine era the R0 for measles was 16-18 in England and Wales in 1950-68, and 5-6 in Kansas, USA, in 1918-21. A plausible explanation for the difference is differences in population density and mixing of populations. In the early 1980s, the R0 for HIV was 11-12 in Nairobi, Kenya, in a prostitute population and 2-5 in male homosexuals in England and Wales (Anderson and May, 1991). Based on detailed epidemiologic data from Singapore and other locations, Lipsitch and colleagues estimated that the reproductive number for SARS was about 3 (Lipsitch et al., 2003). SARS was barely containable using isolation and quarantine measures. One biological characteristic of SARS...

The Scope of the Problem

During the Cold War (1945-1991), issues of public health (with the exception of biological weaponry) were typically consigned to the realm of low politics. With the end of US-Soviet rivalry in the early 1990s, environmental change, terrorism, migration, and public health began to ascend on the international agenda. Public health victories against microbes reached a zenith in the mid 1970s with the development of powerful anti-microbial drugs. However, the pace and intensity of pathogen emergence has increased since that time with the proliferation of novel agents of contagion. In the late 1990s, the recognition that the HIV AIDS pandemic represented a significant threat to the economy, the governance, and perhaps the security of developing countries spurred the academic and policy communities into action against this emerging foe. In recent years, the BSE epizootic, the SARS contagion of 2003, and our increasing understanding of the influenza pandemic of 1918-19 have generated great...

Superspreading and heterogeneity of transmission

In SARS and some other infections, a few individuals seem to account for a disproportionate number of the secondary cases. In Singapore, for example, 162 (81 percent) of probable SARS patients showed no evidence of secondary transmission, whereas 5 persons each transmitted infection to 10 or more others (see Figure 1.5 CDC 2003). Lloyd-Smith and colleagues showed that heterogeneity in transmission, instead of being an anomalous event, was a common feature of disease spread (Lloyd-Smith et al., 2005). In several examples, 20 percent of the cases caused 80 percent of the transmission. This is of more than theoretical interest, as it can affect the course of an epidemic and can influence the choice of interventions to try to curb the spread of infection (Galvani and May, 2005). If highly contagious (or highly connected, for sexually transmitted infections) individuals can be identified, it may be possible to contain spread with fewer resources. Figure 1.5 Superspreaders. Probable SARS...

Use of predictive models

Models have been developed to simulate the estimated impact of infectious diseases, and some have focused on air travel or have integrated data about air travel into the models (Brockmann etal., 2005, 2006 Colizza etal., 2006). The rapid spread of SARS showed that estimates on the spread of modern epidemics need to consider the pattern of travel, the global aviation network, the number of flights departing from and arriving at airports, the number of passengers carried, and the size of aircraft (Hufnagel et al., 2004). Simulations can be used to model the potential impact of different interventions on the control of epidemics - for example through vaccination (where reducing the susceptible population leads to fewer reproducers ) as well as travel restrictions, and especially by isolation of largest cities. The present pattern of air travel is expected to alter the dynamics of an influenza pandemic compared to past pandemics. The pandemic influenza of 1918-19 spread by ships, over...

Geo Sentinel and other networks

GeoSentinel analysis of morbidity in travelers can provide guidance on identifying common illnesses in travelers and risk of travel to health (Freedman etal., 2006). Moreover, GeoSentinel has disseminated alerts regarding a number of diagnoses in returning travelers - leptospirosis in participants returning from Eco-Challenge in Borneo, Malaysia SARS in travelers returning to Canada from Asia and malaria in travelers to resorts in Punta Cana, Dominican Republic. Subsequent to these notifications, clinicians identified additional cases in travelers, and public health responses were initiated.

On Physis and Republican Theory

Such material-contextual factors continue to operate at both the domestic (or unit) level and the international (or system) level, freeing us of the dichotomization of modern political analysis into the domestic and system levels of analysis. While such divisions may suit intellectuals who seek parsimony, they are profoundly incapable of dealing with the many trans-boundary issues that now vex human societies. For example, emergent and re-emergent pathogens (e.g., SARS and HIV) originate within states, often function as global collective action problems, and ignore the porous political boundaries of sovereign states. In the same vein, environmental collective action problems (e.g., protection of the atmospheric and oceanic commons) routinely cross the unit system level boundary. Onuf argues that this division itself is a legacy of Weberian thought, notably its second modern phase . . . social thought and practice before modernity's second phase . . . made no clear distinction between...

Questions terminology and underlying principles

Parasites are ubiquitous in the lives of primates, and infectious diseases can cause devastating mortality in wild populations, including recent deaths arising from Ebola hemorrhagic fever and anthrax infections in African apes (Walsh et al. 2003b Leendertz 2004). An incredible diversity of parasites inhabits primate hosts, including sexually transmitted viruses, insect-borne protozoa that cause malaria, and helminths responsible for schistosomiasis and tapeworm infections. More than 50 different parasite species have been documented in some free-ranging primate species, such as olive and yellow baboons (Nunn et al. 2003a), and an individual primate may shed hundreds or thousands of parasite infectious stages over the course of a single day (Pitchford and Visser 1975 M ller-Graf et al. 1996 Nizeyi et al. 1999). Many of these infectious agents, such as simian immunodeficiency viruses (SIVs), are relatively benign in their natural hosts, and thus have virtually undetectable effects on...

Implications For The Biosphere

In figure 4.4 the ways in which raised rates of sediment accumulation subsidence could have affected the hydrosphere, lithosphere, biosphere, and fossil record across the Precambrian-Cambrian transition are summarized. Submergence of shallow shelves inevitably led to an expansion of habitat area and, as we have argued, also caused phosphorus- and silica-rich waters to invade platform interiors. It may be argued that these environmental changes had a major ecologic impact upon the biota, encouraging blooms of eutrophic plankton, which in turn may have favored the development of a wide range of suspension feeders and the migration of pandemic phosphatic and siliceous taxa (figure 4.4). The reciprocal uplift of hinterland margins, indicated by the strontium isotope curve and by the thick succession of siliciclastic sediments, may well have delivered yet more phosphorus and iron into the oceans, thereby sustaining or raising its productivity (Derry et al. 1994).

Availability of New Suitable Habitat on a Large Scale

One of the most dramatic instances of colonization of new habitat occurs not in physical space but in niche space. Organisms can increase the area of suitable habitat by evolving to use new areas. The global influenza pandemic of 1918, recently shown to be derived from avian influenza, is a spectacular example of a virus' evolution to take advantage of an entirely new host, and other deadly human diseases throughout history (including recent times) may have their origin in niche shifts of animal disease. Colonization of a completely new habitat type frequently occurs after colonization in physical space, as evidenced most clearly by adaptive radiation on species-poor islands. The lag between the initial colonization of a new area by an invasive species and the onset of rapid spatial spread is sometimes also attributed to genetic adaptation to the new environment. Genetic founder effects may also play a role in this adaptation process. In any case, niche shifts precipitated by physical...

Plague Yersinia pestis

. . . the pandemic and its recurrent epidemics were the solvents of classical Mediterranean civilization and were largely responsible for the formation of new political, social, and economic patterns . . . political power gradually shifted to the peoples of northern Europe, who were relatively unaffected by the epidemics, and, conversely, plague greatly weakened the Byzantine empire. Justinian's plans for re-establishing the Roman Empire were wrecked, and the diminished Byzantine armies were unable to defend the extensive frontiers. Hence, there was the successful resurgence of barbarian invasions. . . .38

Bruce A Wilcox Duane J Gubler and HF Pizer

The first evidence of the re-emergence of infectious disease occurred in the 1970s, but the process greatly accelerated in the latter two decades of the twentieth century. Old diseases that were once effectively controlled began to reappear in epidemic form - for example, dengue, Japanese encephalitis, West Nile Virus, epidemic polyarthritis, yellow fever, measles, plague, cholera, tuberculosis, leishmani-asis, malaria, etc. In addition, numerous newly recognized diseases began to cause epidemics, such as HIV AIDS, the hemorrhagic fevers (Marburg, Ebola, Lassa, hantavirus, Crimean-Congo, arenaviruses, dengue and yellow fever), avian influenza, Hendra and Nipah encephalitis, severe acute respiratory syndrome (SARS), Lyme disease, ehrlichiosis, and others. In addition to those factors mentioned above, resistance of bacterial pathogens to antibiotics, drug resistance in malaria parasites, insecticide resistance in mosquitoes, new medical technology (e.g. organ transplantation) and...

Risk parameters associated with urbanization

Linked to transportation networks connecting even the most distantly separated urban centers. So the possibility now exists that an infectious disease outbreak within a neighborhood will spread readily not only throughout the city and to the surrounding areas, but also across the country and beyond national borders. This is of course exactly the scenario describing the near pandemic of SARS in 2003. Once this novel pathogen, whose source may have been fruit bats in Southern China, emerged near the rapidly growing Guangzhou in Guangdong Province (China), it easily spread to Hong Kong by surface transportation, and to Singapore, Vietnam, and even Toronto by infected air travelers, in barely a few days. In 2004, approximately a billion people traveled by air, with an ever-increasing number of them going to and from fast-growing cities in the tropical developing world. From 1983 to 1994, the number of air passengers leaving the United States doubled from about 20 million to 40 million,...

Dengue fever as a classic case study of the impact of urbanization

The war in the Pacific and Asian Theaters initiated the twentieth-century pandemic of dengue (Gubler, 1998b). Both the Allied and Japanese armies put hundreds of thousands of susceptible troops into the area. The movement of those troops, along with war materials, was responsible for all four dengue virus serotypes and A. aegypti mosquitoes being spread throughout the region. By the end of the war, dengue was hyperendemic (the co-circulation of multiple virus serotypes) in most countries of Asia.

Case Histories And Ecosystem Surveys

Structure activity relationships (SARs) are comparisons or relationships between a chemical structure, chemical substructure, or some physical or chemical property associated with that structure or substructure and a biological (e.g., acute toxicity) or chemical (e.g., hydrolysis) activity. When the result is expressed quantitatively, the relationship is a quantitative structure activity relationship (QSAR). Most SARs have been developed for predicting ecological effects of organic chemicals. For SARs that predict ecological effects Walker and Schulz (Chapter 33) provide examples, developmental approaches, universal principles, applications, and recommendations for new QSARs to predict ecotoxicological effects. Since most QSARS have been developed for freshwater aquatic organisms, it is recommended that additional QSARs be developed for predicting effects of chemicals on terrestrial and sediment-dwelling organisms. There is a critical need for these QSARs, especially given the high...

On the Political Suppression of Data

The effects of the contagion were historically downplayed by the medical community, who (like the Galenists of old) were acutely embarrassed by their impotence in the face of such an overwhelming epidemic. According to the medical historian Carol Byerly, the tendency of medical officers, army commanders, and federal officials to downplay the role of the influenza epidemic in the Great War, and the impact of disease on military populations in general, has encouraged American complacency about the ability of medicine to control disease outbreaks during war. 25 The German medical historian Wilfried Witte has noted that Prussian authorities went out of their way to downplay the severity of the pandemic during wartime, going so far as to repress the dissemination of data as best they could. Furthermore, existing data suggest that, while the majority of deaths were recorded in urban centers, there was significant debilitation and mortality in rural areas that likely went unrecorded because...

Large Scale Phylogenetic Analysis of Emerging Infectious Diseases

Microorganisms that cause infectious diseases present critical issues of national security, public health, and economic welfare. For example, in recent years, highly pathogenic strains of avian influenza have emerged in Asia, spread through Eastern Europe, and threaten to become pandemic. As demonstrated by the coordinated response to Severe Acute Respiratory Syndrome (SARS) and influenza, agents of infectious disease are being addressed via large-scale genomic sequencing. The goal of genomic sequencing projects are to rapidly put large amounts of data in the public domain to accelerate research on disease surveillance, treatment, and prevention. However, our ability to derive information from large comparative genomic datasets lags far behind acquisition. Here we review the computational challenges of comparative genomic analyses, specifically sequence alignment and reconstruction of phylogenetic trees. We present novel analytical results on two important infectious...

Parasites introduce a potentially important mechanism for densitydependent regulation

Influenza pandemic of 1918-1920, historically the estimates for the global death toll have been around the 20 million mark (Anderson and May, 1991 Porter, 1997), however, more recent studies of contemporary records suggest a figure of 50 million or more (Johnson and Mueller, 2002). As I wrote the first draft of this chapter (June 2005) there was a growing concern about the possible effects of the next influenza pandemic in a crowded world of over 6 billion people (Osterholm, 2005), indeed it is very plausible that some readers of this book could die in such a future pandemic (emeritus professors should probably worry more than university students, as in many influenza outbreaks the elderly are particularly at risk, although the 1918-1920 pandemic apparently did not follow this pattern). Crowded populations are more susceptible to such virulent microparasites, indeed this is why many authors assume that these microparasites were less important in human history before the development of...

Patterns of diversity in benthic assemblages

One of Britain's most illustrious nineteenth-century naturalists, Edward Forbes, predicted in 1843 that no animal life would be found below a depth of 550 m since there was no light and the pressure was too great. Forbes had overlooked the work of Sir John Ross and his nephew Sir James Clark Ross, who as early as 1817 had obtained many living animals from depths of 1800 m in Baffin Bay, Canada. In 1869, the Sars (1872) (father Michael and son, Georg Ossian), trawled up a variety of marine life from depths greater than 550 m off the Norwegian Lofoten Islands. Forbes's views, however, were influential, and there was still no general acceptance that life existed at great depths. Thus, when the Royal Society set the aims for the Challenger expedition, one of the problems to be tackled was the distribution of organic life at all depths of the ocean and on the seabed. This expedition, which lasted from 1872 to 1876, was the first truly scientific oceanographic expedition it obtained in all...

Hivaids State Capacity and National Security Lessons from Zimbabwe1

The HIV AIDS pandemic continues to spread inexorably throughout the developing countries, proliferating from its established base in sub-Saharan Africa to infect millions in India, Eastern Europe, and East Asia. In 2005 the pandemic claimed 2.8 million lives and generated 4.1 million new infections, bringing the number of people currently infected to 38.6 million.2 Despite the increasing production of anti-viral therapies, access to them remains limited in the developing countries, and resistant strains of HIV have begun to proliferate. According to UNAIDS' 2006 Report on the Global AIDS Epidemic, the contagion is showing signs of slowing as increases in incidence begin to plateau in certain countries. However, a deeper analysis of UNAIDS' annual data on incidence and prevalence suggests otherwise. Specifically, while there may be selected geographically specific pockets of stabilization (and even amelioration) of HIV, the larger story is one of a pandemic that continues to expand...

Dengue Dengue Hemorrhagic Fever

Dengue is an old disease the principal urban vector, Aedes aegypti, and the viruses were spread around the world as commerce and the shipping industry expanded in the 17th, 18th, and 19th centuries. Major epidemics of DF occurred as port cities were urbanized and became infested with Ae. aegypti. Because the viruses depended on the shipping industry for spread, however, epidemics in different geographic regions were sporadic, occurring at 10-40-year intervals. The disease pattern changed with the ecological disruption in Southeast Asia during and after World War II. The economic development, population growth and uncontrolled urbanization in the post-war years created ideal conditions for increased transmission and spread of urban mosquito-borne diseases, initiating a global pandemic of dengue. With increased epidemic transmission, and the movement of people within and between countries, hyperendemicity (the co-circulation of multiple DENV serotypes) developed in Southeast Asian...

Health and State Capacity

In the context of the HIV AIDS epidemic this is of utmost importance as it helps to explain differential outcomes in the ability of governments to respond to the epidemic and maintain economic and political stability. For example, Botswana has much better political leadership and higher empirical levels of state capacity than Zimbabwe,19 despite having a slightly higher HIV seroprevalence rate. It is probable that this combination of effective political leadership and higher endogenous capacity (due to revenues from mineral exports) has moderated the negative effects of the pandemic, whereas Zimbabwe is seeing significant socio-economic destabilization as a result of HIV AIDS.

Health and National Security

The definition of national security has changed over the years to include terrorism, resource scarcity, migration, and now threats to population health. During the first session of the United Nations Security Council of July 17, 2000, the UN adopted Resolution 1308 (2000) and declared the HIV AIDS pandemic a threat to global security. This represents the first time in history that an issue of public health has been elevated to such status, and it illustrates the recent transformation in thinking about new threats to security in the post-Cold War era. While it is now increasingly understood that the AIDS pandemic constitutes a threat to the prosperity, cohesion, and perhaps the security of countries, the process by which the disease destabilizes societies, economies, governance structures, and the national security apparatus remains opaque. Let us delineate the mechanisms by which the contagion undermines prosperity, effective governance, and security. First, the pandemic has...

Behavioral Adaptations

In humans viruses have the ability to undermine the natural defense system of their victim. One of the best-studied examples is the human immune deficiency virus (HIV) but also other viruses, such as the Ebola virus or the herpes virus, are efficiently disrupting the effective defense arsenal of the mammal's immune system. The HI-virus indeed reduces the number of lymphocytes, for example T-helper cells and macrophages, as it infects exactly these immune cells which are otherwise responsible for fighting viral infections. Eventually, the demise of the human immune system culminates in the acquired immune deficiency syndrome (AIDS). Also other viruses, which cause a persistent infection, for example, viruses of the herpes family, are able to hide from the immune system. Infected cells normally present viral peptides on their

Abnormal Microbial Infection

Indeed, within the past millennia, microbial disease has proven to be a formidable adversary, one that has the potential to decimate the human population if left unchecked. During the Middle Ages and extending into the nineteenth century, diseases such as bubonic plague, cholera, and typhoid swept through Europe, causing massive mortality. The influenza pandemic at the end of World War I, for example, killed more people than the war itself.

Responding to the challenges ahead

Maintaining a safe blood supply will require constant vigilance on the part of blood-banking and public health officials. No one could have predicted the enormous challenges created by the AIDS pandemic, and no doubt new challenges will arise in the years ahead. One such relatively new concern is terrorism (see Chapter 12). Officials in the United States are concerned about the possibility that terrorists could obtain access to the smallpox virus and use it against the public. Before 1972, vaccinia, the live virus used in smallpox vaccinations, was routinely administered to Americans. Smallpox can be highly infectious - for example, a scab at the inoculation site can contain infectious virus, so it is possible for a scab that spontaneously separates from the skin to inadvertently infect close contacts that touch the vaccination site or dressing. Another area of concern is blood-banking. In response to this potential threat, the United States Department of Health and Human Services...

Applied Phylogenetics

Here we focus on cases in which phylogenetic analyses have helped researchers to understand the evolution and spread of infectious diseases. We provide exemplar cases in which phylogenetic analyses of viral genomes have been crucial to understand complex patterns of transmission among animal and human hosts Severe Acute Respiratory Syndrome (SARS) KSI03 and influenza WEB92 .

Phylogenetic Analysis in the Context of Emerging Infectious Disease Research

A researcher performing a single phylogenetic analysis makes a vast number of comparisons, thus evaluating simultaneously many alternative hypotheses. These hypotheses include the evaluation of pathways of transmission among several hosts and the polarity of the transmission events. For example, experimentalists report that small carnivores in Chinese markets have been exposed to SARS-CoV GUA03 and the virus can infect domestic cats MAR04 . On their own these data do not necessarily reconstruct the history of the zoonotic and genomic events that underlie the SARS epidemic. Furthermore, whether or not interspecies transmission is observed or enhanced under controlled laboratory conditions, phylogenetic research is distinct as it can address whether the genomic record has evidence to support a hypothesis for a particular transmission pathway. For example, if phylogenetic analysis reveals multiple independent events of human to avian transmission of influenza viruses without intermediate...

Evolution of Influenza

Two major classes of influenza epidemics are recognized in humans seasonal outbreaks and large-scale epidemics known as pandemics WEB92 . Seasonal influenza is a significant public health concern causing 36,000 deaths and 200,000 hospitalizations in the United States in an average year GER05 . Elderly and children account for many of these severe cases of seasonal influenza. Much of the population has partial immunity to seasonal influenza strains that are typically descendents of strains circulating in previous years. Pandemics are often caused by infection, replication, and transmission among the human population with influenza strains of zoonotic origin to which few people have prior immunity. Pandemics are rare but can affect the entire human population, irrespective of an individual's predisposition to respiratory diseases. In fact, the 1918 pandemic disproportionately affected young adults TAU06 , suggesting that older adults may have had some immunity. There have been three...

Hantavirus Pulmonary Syndrome

Hantavirus pulmonary syndrome (HPS) was first noticed in the southwestern United States in 1993 by physicians treating victims with symptoms frightfully similar to those of Ebola (Section 12.7.9). Patients were suffering from an initial fever followed by the abrupt onset of acute pulmonary edema and shock. This outbreak involved 53 infections, with 32 fatalities. A rapid, systematic epidemiological study eventually determined that the responsible agent was a hantavirus, with the deer mouse as the principal reservoir. Infection usually stems from inhalation of aerosolized dried mouse feces or urine.

Effects on Regional Stability

With increasing HIV AIDS infection throughout sub-Saharan Africa, the pandemic threatens to destabilize many countries in the region, including Botswana, South Africa, Zambia, Angola, Malawi, Namibia, and Mozambique. The epidemic is also burgeoning in Nigeria, Kenya, Tanzania, Swaziland, and Lesotho. As the pandemic crests in the region, it increases the potential for the economic and political destabilization of the Southern Cone of Africa. This bodes ill for the spread and consolidation of democracy and provides fertile ground for the spread and consolidation of radical and or terrorist operations. One important element in the discussion of infectious disease's impact on national security is its possible effect on the relative power of states, particularly within a regional context. Certainly the HIV AIDS epidemic will reduce Zimbabwe's absolute power over the long term, with its profound and negative effects on the country's military and its economy. With respect to Zimbabwe's...

Theoretical Ramifications

The empirical destruction of human life from Variant Creutzfeld-Jacob Disease has in fact proved to be rather minimal, certainly as compared to banes such as the global HIV AIDS pandemic. One might note that the destruction wrought by the epizootic BSE has proven to be empirically quite devastating to herds of cattle, originally in the United Kingdom, and ultimately throughout the European Union. This ultimately serves to reinforce psychological analysis of the BSE pandemic. In this case, extreme levels of uncertainty regarding modes of transmission, the likelihood of becoming infected, and the slow and horrid death associated with VCJD all combined to generate exceptional levels of fear in the general population. Such high levels of affect only served to exacerbate the economic damage done by the spread of the disease, as panic served to destabilize markets. Ergo, the affective psychological component (fear, anxiety) associated with this form of contagion is of exceptional...

Demographic Impact and Etiology

Despite the fact that the SARS epidemic threatened the prosperity of seriously affected countries, and posed a grave threat to the health of populations in the region, it was successfully contained with relatively little mortality. Specifically, the epidemic resulted in 8,096 cases of infection (morbidity) and 774 deaths (mortality) between November 1, 2002 and August 7, 2003,1 exhibiting a mortality rate of approximately 10.88 percent of those infected. The SARS coronavirus is a novel zoonosis that recently crossed over from its natural animal reservoirs into the human ecology, presumably in late 2002.2 Specifically, the SARS coronavirus resides in bat populations in Southeast Asia,3 which bite and transmit the virus to palm civets (Paguma larvata), whereupon strains that infect civets possess a greater capacity to then infect individual humans and thereafter become endogenized within the human ecology.4 The moderate level of economic damage generated by the epidemic was not so much...

Alien Human Diseases and Their Evolution

The influenza virus apparently evolves in two ways. Within each subtype, mutations occur in the hemagglutinin gene, a process known as antigenic drift. These slightly altered forms of the virus enable it to escape strong control by antibodies to former strains of the virus. This requires the creation of new vaccines annually to protect humans. Occasionally, new subtypes that differ to a greater degree in hemagglutinin structure, originating by recombination between different strains in a nonhuman animal host, enter the human population, an event known as antigenic shift.The major human flu pandemics of 1918,1957,1968, and 1977 were due to such shifts. The recent year-to-year changes that require new vaccines are the result of antigenic drift. Discovery of this form of influenza led public health authorities to order the killing of more than 1 million chickens, perhaps preventing a human pandemic. The modern world is ideally suited as an evolutionary stage for viral diseases that are...

Psychological Impacts

As was argued above, contagion is historically associated with generating profound levels of affect (i.e. fear and anxiety) within affected populations, particularly in the face of a novel pathogen which generates great uncertainty and inhibits effective risk assessment. Uncertainty and fear result in suboptimal decision making which may in turn result in very real damage to a country's material interests. The SARS epidemic provides a vivid illustration of this dynamic, as the emergence of the novel, virulent, and transmissible SARS coronavirus generated profound levels of anxiety and significant economic damage throughout the countries of the Pacific Rim. This fear was compounded by the fact that public health officials originally suspected that SARS might be a novel and virulent strain of influenza. As a novel pathogen, SARS presented an enigma to public health personnel who were largely unaware of the symptoms, routes of transmission and effective prevention of transmission during...

Model complexity and data

Epidemiological models of specific systems are most successful when calibrated by high-quality data and a good quantitative understanding of the natural history of infection. This was the case for both foot and mouth disease and childhood infections such as measles in England and Wales. Specifically, these systems provided both an estimate of patterns of host susceptibility at epide-miologically meaningful spatio-temporal scales (farms for foot and mouth disease cities for measles) and disease-incidence data. Together, these elements allow a key calibration how the (imperfectly known) host-contact network determines the pattern of transmission. In contrast, recent models of smallpox and pandemic influenza (Halloran et al., 2002 Ferguson et al., 2005) while often well constructed using cutting-edge modelling techniques are necessarily hampered by a lack of epidemiological data and therefore an incomplete quantitative understanding of the precise transmission network. The public health...

Economic Impacts China

In general, the economic shock was far greater for those economies with a prominent service sector and which possessed a larger share of impacted industries (i.e., retail sale and tourism) within that sector. This may explain why Hong Kong, with its losses accounting for 2.9 percent of GDP, suffered the worst. In early April 2003, Stephan Roach, an economist with the firm Morgan Stanley, estimated the global economic cost of SARS at circa US 30 billion.20 The Far Eastern Economic Review later estimated initial SARS-related damage to regional GDP growth at US 10.6-15 billion. If SARS had continued to spread, quarantines could have affected manufacturing, which accounts for approximately 30 percent of Asia's GDP (minus Japan), by closing factories and slowing trade. If the costs of premature deaths of income-earners, lost workdays of sick employees, and health care were factored into the equation, the eventual bill for the region could total almost 50...

Viral hemorrhagic fevers

Specific agents of VHF may also be associated with specific target organ effects. These pathogens include the agents of Ebola, Marburg, Lassa fever, Rift Valley fever, and Congo-Crimean hemorrhagic fever. Blood and other body fluids from infected patients are extremely infectious, and person-to-person air-borne transmission may occur therefore, strict contact and air-borne precautions should be instituted in these cases (Borio et al., 2002). Treatment is largely supportive, and includes the early use of vasopressors as needed. Ribavirin is effective against some forms of VHF, but not those caused by Ebola and Marburg viruses. Nonetheless, this drug should be initiated empirically in patients presenting with a syndrome consistent with VHF until the etiology is confirmed.

Effect on International Health Governance

Before the emergence of SARS, international health regimes (as governed by the International Health Regulations) were badly dated, for two reasons. First, since their inception in 1951, the IHR had not been revised adequately in the face of other emerging novel pathogens. The member states of the WHO had last formally revised the IHR in 1969. Yet since 1970 humanity has witnessed the emergence of more than 30 previously unknown pathogens, and none of those were covered by the IHR in 2003, when they only required member states to report the incidence of smallpox, cholera, plague, and yellow fever. Further, under the provisions of the IHR the reporting of pathogen-induced morbidity and mortality remained the exclusive domain of sovereign member states. Countries have long sought to suppress the flow of information regarding The WHO was instrumental in building the Global Outbreak Alert and Response Network, which was effectively mobilized to deal with the SARS contagion. Developed in...

War as a Disease Amplifier

Previous works have addressed the idea that infectious disease may manifest in epidemic or pandemic form through processes of amplification through ecological change.1 Despite their analytical shortcomings, Galenic perspectives which specify that chronic poverty and the inequitable distribution of resources function as the principal (if not sole) variable involved in the spread of contagion are currently in vogue.2 Poverty certainly does serve as an amplifier of pathogenic infection, however, it is not alone in this function as other variables, including ecological change, trade, migration, natural disasters,3 and war may also serve as disease amplifiers. This chapter is primarily concerned with the effects of war (both inter-state and intra-state) on the emergence and proliferation of infectious disease. In it I argue that the processes of inter-state war and civil conflict create conditions directly conducive to the emergence, proliferation, and mutation of pathogens among both...

Using Satellites Monitoring to Identify Ecological Niches Conducive to Disease Outbreaks

Another example is Ebola hemorrhagic fever. Ebola is encountered in the tropical forest areas of Africa, but despite its notoriety as a highly fatal disease it remains a mystery in many respects. Though the first known Ebola epidemic occurred in Sudan in 1976, scientists have still not identified how the virus is transmitted or what animals might host it. In an effort to identify conditions under which the virus appears, scientists examined satellite data of tropical areas of Gabon and the Congo afflicted in 1994-96. They noted a sharp change from persistent dry conditions to wetter conditions over a 1-2 month period prior to the outbreaks, suggesting these dry to wet changes might be a 'trigger event'. However, it is cautioned that additional work is needed to verify the existence of the climatic trigger for Ebola. To quote Tucker ''It's fortunate for those affected by Ebola that we have so few outbreaks to study, but it makes the job of associating outbreaks with specific antecedent...

Epidemiologic settings

The epidemiologic settings in which network descriptions have the longest history of use involve sexually transmitted infections (STIs), such as gonorrhea or the human immunodeficiency virus (HIV).8-14 Here there are natural, well-defined, network structures (sexual partnership networks) which have long been exploited by public health bodies in their attempts to track and control outbreaks of STIs. Network models have more recently been employed to describe the spread of a wider range of infections such as measles, SARS or foot and mouth disease (FMD).15-18 Increased interest in bioterrorism has also spurred much research, with the spread of smallpox coming under particular scrutiny.19'20

The Argument and Its Limits in Brief

This is difficult to appreciate today - fortunately. We have recently experienced a golden age of health and longevity never before attained in human history. Certainly it has been much more golden for some than others, and lately in some countries the modern trend is now in reverse and life expectancies are in decline. If the AIDS pandemic goes unchecked or is joined by other infections running rampant, it may be that the golden age will come to a close. But for the moment, we must recognize how unusual the last century or so has been for human health, and for our human ability to bend the rest of the biosphere to our will - within limits and not without unintended consequences -and remember that it was not always so.6

Anthony J McMichael and Rosalie E Woodruff

In recent decades there has been a well-recognized and widespread upturn in the rate of emergence, incidence, and spread of infectious diseases in all regions of the world. Many long-established infectious diseases have increased their geographic range and incidence. Antimicrobial resistance is becoming more prevalent. Of particular significance, over the past three decades there has been a succession of apparently new (mostly viral) infectious diseases. These include HIV AIDS, Ebola virus, legionellosis, hepatitis C, hantavirus pulmonary syndrome, Nipah virus, Severe Acute Respiratory Syndrome (SARS), and, most recently, H5N1 avian influenza.

On Mortality from CoInfection

World War I saw the infection of German and Austrian populations by influenza, which then opened the way for subsequent epidemics of pneumonia and tuberculosis. This makes any such strict accounting of influenza-induced mortality rather problematic, in that the secondary effects of the pandemic persisted for some time. This reinforces the position taken by the political scientist Hazem Ghobarah et al. that the public health costs of wars (and complex emergencies) are likely complex, attenuated, and difficult to estimate.

Jonathan Cohen and Joseph J Amon

We begin this chapter by exploring the fundamental obligation of governments to protect health, drawing on both historical state practice and explicit obligations under international human rights law. We note that this obligation extends not only to the provision of health care or to the control of infectious disease outbreaks, but also to the cessation of human rights violations that contribute to poor health or disease risk. We then review recent attempts to quantify the relationship between good (or bad) governance and public health, noting that such quantification is often limited by confounding factors and methodological limitations. By reference to three infectious diseases - HIV and AIDS, Guinea Worm, and SARS -we explore some of the causal mechanisms by which human rights abuses might fuel disease spread and or constrain the ability of governments to arrest disease. We conclude by reflecting on the importance of developing a coherent framework for understanding the precise...

Effects at the Domestic State Level Demographic

Infectious disease may generate significant negative outcomes for human health, ranging from debilitation to the death of the human host. Such outcomes range from a sickened population to widespread mortality and the consequent contraction of the population, or the pathogen-specific contraction of defined age cohorts within a given population. For example, the mortality generated by HIV AIDS is most pronounced in the 15-45 age cohort. Epidemics may also generate pressures for rapid out-migration from affected areas, as people attempt to flee the source of the infection. Of the case studies, HIV AIDS exhibits profound negative impacts in the domain of demography, particularly as it continues to destroy entire cohorts of young adults and leaves behind massive orphan populations in a climate of destitution. The global demographic impact of the 1918 pandemic influenza was equally significant (at circa 50 million dead), again with a concentration of mortality in the cohort of young (and...

Heterogeneities and dynamical complexities

Dispersal, and potential natural barriers to host movement. Spatial simulations could point to sites for implementing physical barriers or intensive vaccination efforts to slow or stop pathogen spread (Russell et al. 2005). Detailed records of habitat use, spatial distributions, and between-group contact necessary for such simulations already exist for several wild primate species (Waser 1976 Kappeler 1998b Di Fiore 2003 Dias and Strier 2003), and these can be augmented by gene flow estimates derived from molecular data (Gagneux et al. 2001). In other cases, monitoring data that track the spatial spread of novel pathogens like Ebola virus can be used to parameterize models, and thus used to predict where new outbreaks might occur and how fast the pathogen will spread in populations of susceptible hosts.

Bjorg Palsdottir Susan H Baker and Andr Jacques Neusy

Today, the social ecology of infectious diseases links the fates of peoples and ecosystems around the globe. Because the world has not dealt with a pandemic caused by a highly contagious, rapidly spreading infectious disease since the 1918 influenza epidemic, assessment of today's true organizational response capacity is speculative at best. Hurricane Katrina, which hit the Gulf Coast of the United States in 2005, illustrates that capacity on paper does not always reflect how people and plans perform during emergencies. The potential for a global outbreak of avian flu in the near future makes the topic politically sensitive, and the existing figures and plans moving targets.

Effects at the International Level Economic

Outbreaks of infectious disease (e.g., SARS) have the potential to induce the destabilization of regional economies, and to generate a drag on the productivity of the global economy. Outbreaks will typically impede the flow of trade goods from infected to uninfected regions, and such goods may be subject to quarantine or outright embargo. Such pathogen-induced impediments to the flow of goods and persons are exacerbated by fear and panic, which may be manipulated by domestic economic interest groups (as in the BSE affair) or by the global media. In certain cases (such as that of SARS) one may observe the complete embargo of possibly infected goods until the etiology of the pathogen, and its vectors of transmission, can be determined with some precision. Infectious disease may also undermine foreign investment in seriously affected regions because of perceptions of economic and political instability (e.g., HIV AIDS), and fears that a firm's workers may succumb to the

On Capacity Power and Legitimacy

The state through taxation, and correspondingly limit the capacity of the government to honor the social contract by delivering crucial public services. This will then negatively affect public perceptions of the government's legitimacy. Furthermore, as contagion erodes the human capital resources of affected bureaucracies, it will generate institutional fragility, sclerosis, and even paralysis. Over the longer term, as evident in the HIV AIDS pandemic, the debilitation and or mortality of enlisted ranks and of officers creates enormous problems in continuity for military institutions and for law enforcement. Therefore, disease undermines the coherence of the state and its ability to carry out its bureaucratic functions. The failure of the state to deliver public goods in a timely and effective manner will erode the perceived legitimacy of the regime in the eyes of the people.

On Emergence and Non Linear Change

The balance of the evidence suggests that epidemics and pandemics may exhibit emergent properties. Thus, emphasizing the connectivity between domains, the processes of violent conflict and inter-state warfare may interact with increasing speed of travel, increasing magnitude of trade, burgeoning population pools in mega-cities, and ecological degradation to facilitate the continuing emergence of zoonotic pathogens, and their endogenization within the human ecology. Therefore, we are likely to be confronted with many novel (and pathogenic) microbial agents in the centuries to come.7 On reflection, punctuated-equilibrium theory appears to offer some utility in explaining the political outcomes associated with visitations of contagion. At the level of the sovereign state, the broad spectrum of political history clearly indicates that outbreaks of epidemic disease often resulted in rapid debilitation of military forces, in destabilization of relations between society and the state, and...

Narrowly utilitarian considerations

There are, however, additional reasons for seeking a better understanding of the species richness and taxonomic details of neglected biota, especially invertebrates. For one thing, most of the benefits of modern medicine are oriented to the developed world (Kremer and Glennerster, 2004) the protozoan and helminth parasites which cause mortality and morbidity in developing countries deserve more taxonomic attention, both to themselves and to their vectors and (in some instances) non-human animal reservoirs. The transmutation of what was once traditional and local bushmeat consumption into a full-blown and indeed globalizing industry underlines this point in a different way (Bell et al., 2005). HIV-1, HIV-2, and SARS are three viruses which made it into human populations this way. How many are yet to come

New training paradigms

The theme of this book, and a growing consensus in the scientific community, is that the determinants of infectious diseases are much more complex than the traditional host-pathogen interaction, and that social, economic, ecological, and political factors are powerful forces. This is particularly well illustrated by emerging and re-emerging infectious disease problems such as HIV AIDS, SARS, Nipah virus, malaria, antimicrobial resistant pathogens, and others. Recognition of the complexity of infectious disease determinants has led to a call for trans-disciplinary and system-based approaches to understanding and dealing with these issues. Most often, this has taken the form of assembling a collaborative multidisciplinary team to address an identified problem and develop a common conceptual framework or action plan. In addition to integration across the different areas of knowledge (horizontal integration), there is greater recognition of the need for vertical integration - i.e....

The World Health Organization

At the time of writing, the WHO operates in three management clusters and seven technical clusters Communicable Diseases Non-communicable Diseases and Mental Health HIV AIDS, TB and Malaria Sustainable Development and Healthy Environments Health Technology and Pharmaceuticals Family and Community Health and Evidence and Information for Policy. With the exception of HIV AIDS, tuberculosis and malaria, and immunization and childhood vaccines, all WHO's epidemic-related activities fall under the auspices of the Communicable Disease Cluster - and, more specifically, under the Department of Epidemic and Pandemic Alert and Response. Initially the WHO's budget was based on member contributions, which were determined by a formula based on population size and gross national product (Walt, 2005). By the 1970s, high-income member states had raised the level of extra-budgetary funding for specific projects. Increasingly seen as donors, their influence grew, challenging the WHO's relative...

About the Editors

Dr Mayer is the Director of the Brown and Tufts Universities' Fogarty (NIH) AIDS International Research and Training Program, which has trained almost 100 laboratory and clinical investigators from East Asia. He has worked increasingly in India and has participated in many regional conferences on biological and behavioral approaches to prevention research, and the development of community-based clinical research activities in Asia. He is currently a consultant with the Clinton Foundation's HIV AIDS Initiative, designed to increase the capacity to provide comprehensive care for people living with HIV across the globe. Dr Mayer co-edited (with H.F. Pizer) The Emergence of AIDS Impact on Immunology, Microbiology, and Public Health, published in 2000 by the American Public Health Association Press, and The AIDS Pandemic Impact on Science and Society, published in 2005 by the Academic Press (Elsevier). H.F. Pizer, BA, PA is a medical writer, health-care consultant, and physician assistant....

Vehicles of travel

Outbreaks in travelers can be traced to infection acquired in the vehicle of travel - en route transmission. Food-borne outbreaks (e.g. salmonellosis, shigellosis, cholera, staphylococcal food poisoning, and others) have been linked to food or beverages served on flights (Mangili and Gendreau, 2005). Infections transmitted directly from person to person, and those that are airborne, also pose a risk to airplane travelers. Published reports describe transmission of tuberculosis, SARS, measles, and influenza on aircraft. In one outbreak, 72 percent of 54 passengers on a plane that had been grounded for Three hours because of a failed air-circulation system developed influenza-like illness influenza A was documented (Moser et al., 1979). Norovirus, a cause of acute gastroenteritis, has probably also been transmitted on an airplane (Widdowson et al., 2005). Following a single 3-hour flight between Hong Kong and Beijing that included an ill passenger who later died of SARS, confirmed or...

Plan of the Book

In chapter 2, I analyze the effects of the influenza pandemic of 191819 on various affected societies. In the domain of demography, the chapter illustrates the differential mortality generated by the waves of contagion that swept the planet. The chapter then examines the possibility that the pandemic affected the various combatants in World War I in different fashions, based on the statistical data presented herein. Previously unpublished data from German and Austrian archives reveal the malign effects of the virus on the military forces and the people of the Central Powers during this period. Analysis of the data suggests that the epidemic eroded the Central Powers' capacity to continue the conflict, and that it may have accelerated their capitulation and or disintegration. The data presented herein also raise the possibility that the first serious episode of influenza-induced mortality occurred in Austria in the spring of 1917, not in the United States in the spring of 1918....

Conclusions

Travel has played an essential role in the movement of HIV AIDS throughout the world. Rapid international air travel moved the virus that causes SARS to multiple countries within weeks. Travel has been and will continue to be important in the movement of human influenza. Recent experiences with SARS and avian influenza underscore several observations

Demographic Impact

During the final year of the Great War, pandemic influenza affected and debilitated circa 25 percent of the global population, typically resulting The pandemic, Alfred Crosby concludes, Crosby's argument is based on a reading of US mortality data however, the data presented below indicate that the pandemic did not affect all the protagonists equally. The balance of evidence indicates that the virus generated differential mortality across the spectrum of affected societies. The very fact that mortality varied so greatly across cultures leads to the conclusion that the pandemic had differential impacts on the various combatants involved in the war. A second point is that there was considerable temporal variation in the waves of pandemic influenza that circulated the world in 1918-19, and that it struck and debilitated the Central Powers before it struck the Allies. 4.6 percent.6 Considering this estimate in terms of rates, Crosby noted that (according to US Public Health Service surveys...

Etiology

Recent evidence suggests that the 1918 influenza was in fact an H1N1 variant, and therefore genetically similar to the virus currently spreading throughout avian populations in East and Southeast Asia. The 1918 virus likely originated in avian species, crossed over into the human ecology through processes of zoonotic transmission, then continued to evolve and mutate within human populations. This helps to account for the three waves of the pandemic that circled the world in 1918, each progressively more lethal, and likely intensified by the conditions of World War I. The orthodox epidemiological history traces the origins of the pandemic to Camp Funston (near Fort Riley, in Kansas) during March 1918, after which it appeared at Camp Oglethorpe in Georgia and then at Camp Devens in Massachusetts.22 With troop transport vessels serving as vectors of both incubation and distribution, the flu then supposedly traveled to the battlefields of Europe, whereupon it infected thousands of...

Effects on the State

The profound morbidity and mortality induced by the pandemic affected the armed forces of the various combatants in different fashions. Much as countries exhibited differential mortality from the contagion, the armed forces of states exhibited varying death rates. Comparative analyses of the causes of death for military forces, measuring mortality from disease versus that suffered in action, are illustrative. On the Allied side, US forces experienced the most severe impacts of the contagion, with a rough 1 1 ratio of deaths from disease to battlefield injuries.30 French forces saw a much lower mortality ratio (roughly 1 6), and in British forces the ratio was approximately 1 10.31 Such variance in mortality contradicts Crosby's postulate that all the belligerents were affected to the same degree by the pandemic. It also demonstrates that the British and French forces may have had more acquired immunity to the pathogen than their American counterparts.

The United States

During the supposed first wave of pandemic influenza that appeared in the United States during the spring of 1918, initial mortality in military training facilities hovered around 10 per thousand. Such mortality eventually declined to mere 2.3 per thousand by mid September of 1918.32 However, the most virulent strain arrived soon after that point, and on October 11, 1918, mortality soared to 206 per thousand.33 The morbidity and mortality associated with the pandemic had profoundly deleterious consequences for the operational capacity of many US military units. In September 1918, US Brigadier General Charles Richard commented to his peers Epidemic influenza . . . has become a very serious menace and threatens not only to retard the military program, but to exact a heavy toll in human life. . . . 34 In the US experience, pandemic influenza induced absenteeism, loss of morale, and logistical chaos throughout the military infrastructure. The historian James Seidule argues that influenza...

Britain and France

According to Byerly, the influenza pandemic induced approximately 225,000 deaths among civilians in the United Kingdom.52 The British Expeditionary Forces saw approximately 313,000 cases (morbidity) of influenza during 1918, although incomplete records suggest that this estimate may be on the conservative side.53 Current estimates of French civilian flu-induced mortality are approximately 135,000, and France lost circa 30,000 soldiers to the virus over the course of the pandemic.54 Crosby argues that, in September 1918 alone, French forces in the combat zone exhibited over 25,000 cases of influenza, and that the rear-area soldiers, not the men in actual combat, bore the brunt of the pandemic. The incidence of Flu in the French Army in the interior areas, for instance, was three to twelve times higher than in the French army at or near the battlefront. 55 This suggests that the

Germany

The emergence of the virulent form of the contagion in the spring of 1918 coincided with the German Offensive of the Somme. During this period, the German Chief of Staff, General Erich Von Ludendorff, complained vociferously about the deleterious effects of the influenza on German military efficacy. The Somme offensive, which began on March 21, 1918, began to sputter in May as the virus increasingly debilitated German troops and crippled their units. In late June of that year, Ludendorff noted that over 2000 men in each division were suffering from influenza, that the supply system was breaking down, and that troops were underfed. Infection spread rapidly. By late July, Ludendorff specifically blamed the pandemic for nullifying the German drive. 57 According to the historian Richard Bessel, the influenza outbreaks in among the (German) troops in June and July 1918, left very great numbers of sick and wounded in their wake of the 1.4 million German soldiers who participated in the...

Austria Hungary

The pandemic visited considerable suffering and destruction on the Central Powers and, as the data cited in figure 3.4 indicate, may have also resulted in limiting the martial power and the stable governance of Austria-Hungary. The data suggest that the Austrians witnessed a previously unacknowledged regional epidemic of considerable influenza-induced mortality during the first and second quarters of 1917, significantly predating the viral waves that began in the spring of 1918 in the United States. This revelation suggests that a precursor epidemic, of unknown origins, apparently swept through Austria (and perhaps other regions of Central Europe) in the spring of 1917. This provides empirical evidence to reinforce John Oxford's hypothesis that the virus may have emerged in sporadic epidemic form before 1918.71 What is apparent in the Viennese case is that the Austrian people did not experience the two increasingly lethal waves of pandemic influenza that swept the world in the spring...

Scapegoating

The history of disease, particularly during its manifestation in European societies, is riddled with fear-induced desires to target minorities as the carriers, instigators, or vectors of disease transmission. It seems a common frailty that humans find it expedient to blame the psychological other for visitations of contagion, even pandemic influenza. Despite the fact that the strain may have originated in Kansas (or Austria, for that matter), it was subsequently labeled the Spanish Flu. This designation resulted from the fact that Spain, a neutral party during the conflict, was not actively engaged in the censorship of the reporting of the epidemic at that time. Citizens on the Allied side began to envisage the contagion as some nefarious and demonic weapon conjured by the Germans to

Governance

At the domestic level, influenza had a sclerotic effect on governance within severely affected countries, overwhelming the capacity of the state (and often the society) to deal with the debilitation and mortality generated by the contagion. Crosby estimates that the influenza pandemic of 1918-19 generated at least 550,000 excess deaths in the United States (i.e., over and above those deaths that would typically result on an annual basis).75 As one would expect, one of the first sectors of US society to be overcome was the health sector. Hospitals did not possess the requisite surge capacity to deal with such a huge influx of ill patients. Specifically, hospitals did not possess the necessary beds and supplies, nor did they have adequate reserves of medical personnel (nurses and doctors) on hand to deal with the surge in infected civilians. Moreover, lacking adequate protection, many health providers themselves succumbed to the illness, and thereby became an additional burden on those...

Bacterial Diseases

Classic case of success breeding failure. Briefly, because the Indian Health Service had successfully controlled epidemic plague in India for over 30 years (the last confirmed human plague case prior to 1994 was in 1966), laboratory, clinical, and epidemiologic capacity to diagnose and control plague had deteriorated. Thus, when the Surat outbreak occurred, the clinical and laboratory diagnosis was confused, creating lack of confidence in public health agencies and ultimately panic when it was finally announced that the disease was pneumonic plague. Within a few weeks in early October 1994, an estimated 500,000 people fled Surat, a city of about 2 million people at that time. Many of these people traveled to other urban areas in India, and within days, newspapers were reporting plague cases in other cities. The World Health Organization implemented Article 11 of the International Health Regulations (WHO 1983) for the first time in 33 years because it was thought that people with...

The Future

Moreover, the next pandemic has implications for the food security of affected countries, as it has already resulted in the culling of millions of birds. Joseph Domenech, chief veterinary officer of the United Nations Food and Agriculture Organization, has cautioned that the spread of the epidemic may undercut nutrition If a poultry epidemic should develop Early in 2006, the US Congress authorized 3.8 billion for the purchase of more vaccine and Tamiflu from the Swiss firm Roche and from the British firm GlaxoSmithKline.101 The central problem emanates from the global competition to procure a rather limited supply of anti-viral prophylaxis, while global production capacity remains inadequate. Compounding the problem, the US federal government has asked the states to create their own individual stockpiles, which may encourage hoarding by wealthier states (such as California and New York). There is currently no federal legal architecture that can compel these states to share their...

Yellow Fever

If YF was introduced to the Asia-Pacific, the initial cases would most likely be misdiagnosed as DHF, leptospirosis, rickettsiosis, hantavirus disease, or malaria, thus potentially allowing it to spread and become established in widespread areas before it was identified. Thus, YF virus could be introduced and become established in Asia-Pacific countries weeks to months before it was recognized. Even after it is diagnosed, it is not likely that an effective control program could be mounted because most countries in the region do not have effective Aedes aegypti control programs. Once recognized as YF, it would likely cause overreaction and panic on the part of the press, the public, and health officials. Regardless of whether YF virus caused a major epidemic in this region, there would be a major public health emergency, creating social disruption and great economic loss to all countries of the region, making the Indian plague epidemic of 1994 (Fritz et al. 1996 John 1999 WHO 1994) and...

Orphans

Given that HIV AIDS generates significant mortality with the 15-45 age range of the population, one might expect the pandemic to generate significant cohorts of orphans who have lost one or both parents to AIDS. UNAIDS estimates the number of Zimbabwean children who have lost one or both parents to AIDS at 1,100,000 as of 2005 (up from 600,000 in 2000).27 In 2000 the US National Intelligence Council report concluded

Marguerite A Neill

Both acute and chronic illness may occur following consumption of tainted food (Tauxe and Neill, 2006). While diarrheal illness has traditionally been considered the main manifestation of food-borne disease, several other clinical manifestations are now recognized, ranging from hepatitis, sepsis, meningitis, and paralysis to chronic neurologic disease (see Table 8.1). The microbial agents that cause these illnesses are diverse, and include bacteria, mycobacteria, viruses, parasites, and probably prions. Since 1990, eleven emerging pathogens to humans have been recognized (Nipah, Hendra, Hanta, West Nile, avian influenza and SARS viruses, Escherichia coli O157 H7, Vibrio choierae O139, Cyclospora, cryptosporidium, and variant Creutzfeld-Jacob disease, or vCJD). All but two (V choierae O139, Cyclospora) came from zoonotic sources, and of the nine with zoonotic origin three have been food-borne (E. coii O157 H7, Cyclospora and, probably, vCJD). While many factors converge to facilitate...

Influenza

Although generally perceived by the public to be a recurring, endemic, non-life-threatening problem, viral influenza ranks high on the list of diseases with epidemic potential. During years with high levels of influenza incidence, tens of thousands of fatalities may be experienced in the United States. During the World War I pandemic of 1918, it has been estimated that 40 to 50 million victims died worldwide, more than died directly from the war itself

Plague

Epidemics of this disease repeatedly killed more than a fourth of the population of Europe during the Middle Ages and thus is partly responsible for this period being referred to as the Dark Ages there. Only malaria and tuberculosis have been more deadly. The original onset of the Black Death midway through the fourteenth century has been linked to the Crusaders, whose return across the Mediterranean brought the black rat (Rattus rattus) as a hidden stowaway on their ships. The resulting first pandemic spread of plague throughout Europe and parts of Asia is believed to have killed as much as three-fourths of the population in a period of less than 20 years. The disease is still prevalent in some areas of the world (an outbreak occurred in India in 1994), but antibiotics have greatly reduced the mortality rate. The few cases that occur in the United States each year are mainly in the southwest, where the disease appears to be endemic (but usually not fatal) among ground squirrels and...

Host Shifts in HA

Multiple direct avian-to-human shifts appear to occur in the case of the putative pandemic strains of influenza A (subtype H5N1) that have spread across Eurasia since 1997 WHO05 . In addition to being highly pathogenic, these H5N1 strains have independently infected other hosts such as felids and pigs in several instances.

Conclusion

Immunization has fundamentally altered the global infectious disease ecology. Powerful pathogens, once so prevalent that they toppled empires and laid waste to communities and cultures, are now only a distant memory. Smallpox today only exists in laboratories, and its danger now comes from its perceived threat if employed as a biological weapon. Polio persists in only a few corners of the world just 50 years after development of a vaccine. The indigenous transmission of measles has been drastically reduced throughout the Western Hemisphere. Congenital rubella has been eliminated from the United States and, in much of the world, entire organizations and institutions no longer exist as a result of successful disease elimination through immunization. In developed nations, orthopedic and rehabilitation hospitals have evolved into acute care children's hospitals or have gone out of business altogether, and charitable institutions (such as the March of Dimes) that were once solely dedicated...

Background

Literature on the political dimensions of the epidemic remains exceedingly sparse. The microbiologist Elizabeth Prescott argued that the SARS epidemic illustrates the increasingly acute nature of complex interdependence among countries in the domain of public health, and provides us with lessons that may help countries in their efforts to prevent bioterrorist attacks. She observed that the emergence of the contagion illuminated significant and vital weaknesses in global and local preparedness for surprise outbreaks. 6 The political scientists Melissa Curley and Nicholas Thomas argued that infectious diseases (the SARS outbreak in particular) represented a significant and growing threat to human security in Southeast Asia. The legal scholar David Fidler has also conceptualized SARS as a threat to the material interests of the state, which aligns with the republican Realist model presented in this work.7 The emergence of the SARS pathogen in China and later in Canada demonstrates that...

History

According to the political scientist Yanzhong Huang, the first SARS case is thought to have occurred in Foshan, a city southwest of Guangzhou in Guangdong province, in mid November 2002. 8 The index case was the physician Liu Jianlun, who inadvertently fomented a global chain of transmission when he traveled to Hong Kong and stayed at the now infamous Metropole Hotel. Liu then infected other travelers who subsequently spread the disease throughout the Pacific Rim countries. On March 12, 2003, the World Health Organization issued a global outbreak alert and initiated international surveillance efforts to track the contagion. By that point the pathogen had spread throughout the countries of the Pacific Rim, with the greatest incidence of cases in China (5,327), followed by Hong Kong (1,755), Taiwan (665), Canada (251), Singapore (238), Vietnam (63), and the United States (33), respectively.9 On April 16 the WHO took the unprecedented step of publicly chastising Beijing for misleading...

Canada

The SARS epidemic generated moderate damage to the Canadian economy, but this damage was brief. At the sectoral level, the SARS epidemic had a pronounced negative effect on the Canadian economy in the second and third quarters of 2003. Industries that bore the brunt of the contagion included tourism and hospitality, and the film industry. Toronto's billion-dollar-a-year film, television, and commercial business was badly damaged by the epidemic of 2003, as foreign production houses withdrew their operations from the city. According to Joe Hal-stead, then Toronto's commissioner of economic development, the SARS epidemic resulted in a decline of production, resulting in a loss of 163 million (roughly 18 percent) for the film sector in 2003. Commercial production in the city exhibited a similar decline of 32.8 million in 2003 (roughly 20 percent).22 These statistics were compiled from permit applications that production houses must file with the City of Toronto. Tourism in Ontario also...

Reindeer and Caribou

Rangifers were introduced into western Alaska during the 1890s, when Presbyterian missionary Sheldon Jackson, observing starvation among the Inupiat people, organized a U.S. federal government assistance program for the importation of Siberian reindeer and the training of native apprentices by immigrant Saami herdsmen. In fact, the historical evidence suggests that starvation was not particularly rampant in Alaska and that there was no pressing economic need for reindeer herding. But the discovery of gold near Nome at the turn of the century and the ensuing Gold Rush created a market demand for Rangifers to be used as draft animals. An incipient Eskimo aristocracy arose, in which a local woman known as Sinrock Mary became for a time the largest herd owner and the most powerful economic player in Arctic Alaska. From 1915, large seasonal gatherings of people and animals known as reindeer fairs flourished for a few brief years, until the devastating influenza epidemic of 1918. When the...

International

Partially because of the profound economic impact of SARS, partially because of the fear it had created among their citizens, heads of state, diplomats and politicians became involved early and visibly, fully participating in outbreak control through frequent press briefings, declarations, and provision of political and economic support to the global containment effort. As the SARS epidemic intensified, the ten member states of ASEAN (the Association of Southeast Asian Nations) grew increasingly aware of the threat the contagion posed to their people and their economies. Anxiety in this region actually was intensified by earlier shocks to governance in the region, such as the Asian economic crisis of 1997-98, as well as the regional environmental haze issue that resulted from ubiquitous fires throughout the region during the same time period. Indeed, fear arose in Singapore that SARS could provoke its worst economic crisis since the country had gained independence.35 While such...

On Health and Power

Thus, modern conceptualizations of health and security emanate from the republican political tradition, and its descendent Realism, which emphasizes state survival through the maximization of power. Realist theory stipulates that the state will act in its own material self-interests, or in the interests of those dominant factions that constitute and or control the machinery of the state. The theory also assumes that the international system is anarchical, and that the condition of competitive anarchy precludes significant cooperation between states unless such cooperation is in their own material and or ideational self-interest. This hegemonic theory explains the evolution of international public health regimes (such as the International Health Regulations) as purely derivative of the material interests of the great powers.22 Hegemonic theories of regime formation and evolution also help to explain the rapid revision of the International Health Regulations in the wake of SARS. Given...

Mechanisms

Furthermore, I argue, certain pathogens constitute significant and perhaps imminent threats to security, whereas other agents do not. For example, the re-emergence of a devastating H1N1 influenza virus, which in 1918 killed 50 million people, crippled armies, destabilized economies, and contributed to sclerotic governance, surely constitutes a direct threat to all countries. Globalization may, in fact, result in a pandemic of even greater scope and perhaps even greater lethality. On the other end of the spectrum is Lyme disease, which is endemic, is not transmissible from human to human, and often can be treated by antibiotic prophylaxis. I find it inconceivable to argue that Lyme disease constitutes a threat to the security of any polity. The following criteria constitute benchmarks for evaluating whether a pathogen constitutes a security threat to a given sovereign state

Case studies

A clearer way to illustrate the relationship between governance and infectious disease is through case studies. This section highlights three diverse examples of infectious diseases, and explains how governance influenced their spread. In the first example, of Guinea worm disease, we will discuss how the neglect of rural and often ethnically marginalized populations led to a disease with a simple life-cycle and relatively easy means of eradication being undercounted and largely ignored despite significant personal, community level, and national economic and health impacts. In the second example, HIV AIDS, we will discuss how a disease of socially marginalized populations (for example, injection drug users and, in sub Saharan Africa, women) was both initially ignored and subsequently poorly controlled by governments with poor records on human rights and governance. In the third example, we will discuss how the lack of political freedoms in China led to poor recognition and handling of...

Psychological

The psychological effects of emergent pathogens on the body politic typically include significant levels of uncertainty and difficulties in accurate estimation of risk, contributing to profound emotional responses (notably fear, anxiety, and anger). This affective bias consequently impedes Pareto-optimal rationality. Affective distortions may also facilitate the construction of negative images of the other, resulting in stigmatization of the ill, persecution of minorities, and diffuse inter-ethnic or inter-class violence. Emotion may also combine with information that conflicts with individual belief structures to generate cognitive dissonance, wherein individuals engage in denial of the discrepant information in order to minimize psychological pain. Of the four modern cases examined herein, both the SARS and BSE epidemics exhibited considerable psychological impacts through the generation of fear, anxiety, and panic and the stigmatization of domestic minorities and foreign...

Guinea worm

SARS The case of Severe Acute Respiratory Syndrome (SARS) in China illustrates how a lack of democratic freedoms can render a country unable to respond promptly to a new health crisis. In 2003, when SARS first emerged in the southern Chinese province of Guangdong, the Chinese Government's immediate response was to cover up, rather than reveal, both the scope and severity of the disease. The government's censorship of news about the spread of SARS ultimately accelerated the spread of the disease (The Economist, 2003a Rosenthal, 2003) by limiting the information available both to citizens (who needed information on precautions and care) and to national and international government health authorities (who needed information to inform decision-making and improve their understanding of a poorly understood disease). Further hindering an effective response, the government threatened citizens with execution and lengthy imprisonment should they become infected with or knowingly spread SARS...

The private sector

Both private and public health facilities will be impacted and possibly overwhelmed by an infectious pandemic (Garrett, 2005). Therefore, defining and strengthening the role of the private sector in relation to the public sector is imperative. In a global pandemic, a situation might be envisioned in which up to 50 percent of the workforce could become sick, there could be widespread panic, borders could close, and the global economy might shut down. During a global influenza epidemic of 12 to 36 months, there could be significant negative impact on air, ground, and shipping industries essential for the transport of health-care respond-ers, pharmaceuticals, food, water, and other supplies. The ability of other industries and services - such as banks, media outlets, public works and engineering, firefighting, energy suppliers, law enforcement, schools and child-care facilities, producers and distributors of food and essential goods - to deliver services is also vital. According to a...

Recommendations

The best way to curtail future epidemics (and pandemics) is to augment the endogenous capacity of health-care infrastructure and to improve the basal health of populations, particularly throughout the developing countries. Such investments are logical because the fundamental conditions for disease emergence are accelerating as a result of the processes of globalization (increased population density, ecological degradation, rapid transportation technologies, and mass migration), yet in many developing areas disease surveillance and containment capacity is low or nonexistent. Given that global public health can be understood as a public good, the costs of providing such goods (epidemiological surveillance and containment) should be borne by the international community, although continued diplomatic leadership by a hegemonic coalition of states will doubtless remain central. Further, developed countries should possess (or develop) a level of surge capacity to deal with epidemic events...

Swine Influenza

Swine Influenza

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