DISEASE IN HUMAN HISTORY

PANDEMICS, OUTBREAKS AND DISEASES

PLAGUE OF JUSTINIAN• 541-542 Yersinia pestis

• rats on Egyptian grain boats Easter Roman Empire (Constantinople)

• approximately 25 million people dead

• Justinian contracted the disease- lived

• 5,000 people died per day in Constantinople, the empire’s capital

• By its end, about 40 percent of the city’s population was dead

• bodies were left in piles

• one-fourth of the Eastern Mediterranean populace died

• first recorded case of the bubonic plague

• Last recurrence was 750 ( no pandemic on similar scale until 14th century Europe)

BLACK PLAGUE

• Three types of plague bubonic, pneumonic, and septic

• First recorded outbreak in Eastern Roman empire (plague of Justinian) 541-542 25 million died

• rats from Egypt imported grain

• 50 million died from two centuries of recurrence

• 1346-1353 Black Death 75-200 million people in Eurasia and Europe originated in Mongolia/China in 1330s

• Third outbreak in mid 19th century in China in 1855 spread to India (12.5 million deaths over 30 years) , 2 million in China

• Outbreaks still occur in developing countries, endemic in 26 countries, deaths yearly are less than 200.

• Is in SW USA rare disease in humans in USA

THE BLACK DEATH1341-1351

GLOBAL POPULATION OF 450 MILLION

75 MILLION-200 MILLION DIED

HALF OF EUROPE

KNOWN AS BUBONIC PLAGUE

BACTERIA YERSINIA PESTIS

SPANISH FLU OUTBREAK OF 1918

• Kansas was first case

• H1N1 Influenza

• One in five mortality (20%) 50 million people worldwide

HIV

• Still a problem

• Originating in Cameroon and first recognized as a disease in 1981, the earliest documented case is believed to be in 1959 in the Congo. As of 2011 at least 60 million people had been infected by AIDS and 25 million had died. Today its impact varies widely across the world—while in 2008 an estimated 1.2 million Americans had HIV, Sub-Saharan Africa alone was home to 22.9 million cases, with one in five adults infected. About 35.3 million people were believed to have HIV in 2012.

SMALLPOX

• Virus

• Clinical evidence of smallpox found in medical writings from ancient India (as early as 1500 BC), and Ramses V (1145 BC) and China (1122 BC).

• Speculated that Egyptian traders brought smallpox to India during the 1st millennium BC

• Probably introduced into China during the 1st century AD from the southwest, and in the 6th century was carried from China to Japan.

• In Japan, the epidemic of 735–737 is believed to have killed as much as one-third of the population.

• In the Americas in the 15th century killing 80-90% of some native American tribes

• George Washington, Andrew Jackson, and Abraham Lincoln all survived smallpox

• Vaccination (cowpox) in 1796 by Edward Jenner World Health Organization in 1958 started an eradication program

• Last naturally occurring case reported in 1975 (1978 last cases from an outbreak in UK)

• Stocks of virus in USA and Russia

• Has been used as a biological weapon

• French and Indian war 1754-1763 by British against native Americans

• Possibly during Revolutionary war-1775-1783 as well)

ANTONINE PLAGUE (PANDEMIC)PLAGUE OF GALEN

• Named for Roman Emperor Marcus Aurelius Antoninus

• ruled during the outbreak along with co-regent Lucius Verus

• outbreak began in 165AD lasted to180 AD

• Five million people died thought to be smallpox

• Mesopotamian city of Seleucia (in modern-day Iraq)

• spread to Rome by soldiers returning from the city’s siege.

• At one point 2,000 Romans died each day

• Both the emperor and co-regent died

POLIO

• Poliovirus

• Ancient Egypt paintings and carvings depict withered limbs from polio

• Roman Emperor Claudius

• Sir Walter Scott

• Epidemics appeared around 1900 in USA and Europe

• Vaccines developed 1950 by Hilary Koprowski, 1952 by Jonas Salk, oral vaccine in 1958 by Sabin (used worldwide against all three strains of polio)

• World health Organization started campaign to eradicate polio in 1988 2012 completed

• Americas were polio free in 1994

CHOLERA OUTBREAKS• Vibrio cholera affects 3-5 million yearly

• First outbreak Bengal region of India, near Calcutta starting in 1817 through 1824

• The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa through trade routes

• The second pandemic 1827 to 1835

• The third pandemic erupted in 1839, persisted until 1856, extended to North Africa, and reached South America, for the first time

• The fourth pandemic lasted from 1863 to 1875 spread from India to Naples and Spain.

• The fifth pandemic was from 1881-1896 and started in India and spread to Europe, Asia, and South America.

• The sixth pandemic started in 1899 continued to 1923. These epidemics were less fatal due to a greater understanding of the cholera bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics, while other areas, like Germany in 1892 and Naples from 1910–1911, also experienced severe outbreaks.

• The final pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed El Tor, which still persists today in developing countries

• Since it became widespread in the 19th century, cholera has killed tens of millions of people.

• In Russia between 1847 and 1851, more than one million people It killed 150,000 Americans during the second pandemic. Between 1900 and 1920, perhaps eight million people died of cholera in India.

• Cholera became the first reportable disease in the United States due to the significant effects it had on health. In England John Snow first to identify the importance of contaminated water as its cause in 1854. Cholera is now no longer considered a pressing health threat in Europe and North America (filtration and chlorination) of water supplies, but still heavily affects populations in developing countries

• In the past, vessels flew a yellow quarantine flag if any crew members or passengers were suffering from cholera. No one aboard a vessel flying a yellow flag would be allowed ashore for an extended period, typically 30 to 40 days.[ In modern sets of maritime flags the flag is yellow and black.

TYPHUS• Infectious disease group (scrub typhus, epidemic, murine)

• Bacterial cause

• Orientia tsutsugamushi spread by chiggers

• Rickettsia prowazekii spread by body lice

• Rickettsia typhi spread by fleas

• Most important one is epidemic typhus

• Fever, rash, headaches, chills, flu-like symptoms can be fatal

• First description in 1489 at siege of Baza by Spanish (3,000 soldiers died in battle, 17, 000 from typhus)

• 1812 Napoleon’s retreat from Moscow (more soldiers died from typhus than killed by Russians)

• WWI ravaged Eastern front (10-40% mortality)

• 1922 epidemic in Russian territory 25-30 million cases

• WWII outbreaks in prison camps, concentration camps, etc. (Anne Frank died of typhus at Bergen-Belsen)

• Vaccine developed DDT

• Some outbreaks still occur in Africa, Middle east, Asia, Eastern Europe

MALARIA (BAD AIR)• Transmitted by mosquitoes

• Plasmodium sp protozoan

• Causes fever, tiredness, vomiting, seizures, chills, 10-15 days after bite, recurrence months late if untreated

• Throughout recorded history

• WHO estimates 214 million cases (438,000 deaths) in 2015

• Cinchona tree bark (quinine)

• DDT

• New antimalarials

YELLOW FEVER• Viral disease RNA virus Flavivirus (Yellow fever virus)

• Spread by mosquitoes (Aedes aegypti)

• 3-6 day incubation chills, fever, headache, backache, muscle pain, nausea, vomiting

• Origin appears to be Africa (East of Central) endemic with natives immune

• Outbreaks 1647 and 1648 in Caribbean brought by slave ships from Africa after 1492

• Called Yellow Fever in 1744

• Philadelphia outbreak in 1793 5,000 deaths

• Haiti 1790-1802 British soldiers 1853 New Orleans 7,849 people

• 1882-1889 French effort to build Panama Canal failed because of this disease

• Vaccination, mosquito control,

TUBERCULOSIS

• Mycobacterium tuberculosis

• Ancient disease

• May have originated in bovid species

• Folklore associated Vampires due to slow death

• Also called consumption

• Bacteria discovered by Robert Koch in 1882 Nobel prize

• Vaccine (Bacillus Calmette-Guerin) 1906 Albert Calmette and Camille Guerin

• Medication resistance

• Testing

• On the increase?

History of Biological Warfare

• Scythians dipped arrows in manure or dead

• Assyrians ergot of rye in wells

• 1346 (Siege of Kaffa)Tartar army

– hurled corpses of soldiers who died of plague into city

• 15th century Pizzaro

– used Variola contaminated clothing against South American

Indians

• French and Indian War

– Smallpox blankets given to Indians by the English

Development of Bioweapons Programs(Post

WWI)• Germans - first national biological warfare program

– Using a scientific foundation

• continued to develop biological agents for use

• against livestock as well as humans

• Japanese -next group• Prior to World War II

• developed and tested bioweapons on the Chinese mainland

• tested on human subjects

• British– in WWII

– made anthrax cakes to drop on German cattle

– United States and Canada during WWII

• Studied Rinderpest ( Cattle)

• U.S. Military Developed

• Feathers Bombs Laced with

– Hog Cholera

– Newcastle Virus to Poultry

– 1969 President Nixon Ended US Biological

Warfare Programs at

• Pine Bluff Arsenal

• Fort Detrick in Maryland

International Trade and Traffic

• World trade tripled over last 20 years, will double

again in the next decade

• Exports and imports of agricultural products

climbing –

– Chicken meat 15X increase in 30 years

– Dairy products 17X increase in 30 years

• Tourism fastest growing sector of global economy

– 700M international tourists per year

– 1.3 million+ people enter the U.S. daily

– 38,000+ animals

foreign diseases, public health

Agroterrorism

• The purpose of agroterror is to cause

economic destruction

• Trade-damaging diseases

Wilson et al. In Emerging Diseases of Animals, ASM Press, 2000, pp. 23-58

Distribution of Farms in 2002• In this country, over two

million farms span over one billion acres

• In many cases, farms or livestock operations can be easily accessed and are therefore vulnerable

• Lack of awareness of risk

Farm-to-Fork

Continuum

Farm Production

Pre-harvest Food Post-harvest Food

Consumption

Retail Markets

Distribution

Inputs

Transportation

Processing

Foot and Mouth Disease

Foot and Mouth Disease

Foot and Mouth Disease

Potential FMD Disease Spread

After a simulated terrorist attack at 5 Locations

Day: 123456789101112131415161718192021222330

Day 5 Disease First Detected

Even if a national “stop Movement” of all susceptible animals is ordered on Day 8, by

the time the disease is eradicated the nation could still lose 23.6 million animals!

States Infected: 5121519232730333537383940

Heartwater Disease

Rinderpest

Viral Hemorrhagic Disease of

Rabbits

Swine Diseases (FAD)

• Hog Cholera

– Goose step

– Conjunctivitis

Contagious Bovine

Pleuropneumonia

CBPP

HIGHLY PATHOGENIC

AVIAN INFLUENZA

The Netherlands, 2003

• H7N7, outbreak began March

2003

• 100M euros loss; 28M birds

culled

• Spread to Belgium, Germany

• >80 cases of conjunctivitis, 1

death

Orthomyxoviridae

Avian Influenza• RNA virus

• Pleomorphic

• 3 types (A,B,C)

– B and C are restricted to humans

– A is found in people, pigs, horses, seals, many birds

• Segmented Genome

– 8 segments -10 proteins

– two are expressed externally Hemagglutinin (HA) and the neuraminidase(N) 16 HA and 9 N types

– highly prone to recombination

– A type viruses mutate more rapidly than B or C

Shorebirds

Avian Influenza Reservoir

WaterfowlPasserines

High Path

Avian Influenza• Small to medium size RNA virus

• 3 types (A,B,C)

– B and C are restricted to humans

– A is found in people, pigs, horses, many birds

• Segmented Genome

– 8 segments codes for 10 proteins

– two proteins are expressed externally

• Hemagglutinin (H 1- H 16)

• Neuraminidase (N 1-N 9)

• 144 possible HN combinations

– highly prone to recombination

– A type viruses mutate more rapidly than B or C

Lesions

Highly Pathogenic Avian Influenza

SPANISH FLU OUTBREAK OF 1918

• Kansas was first case

• H1N1 Influenza

• One in five mortality (20%) 50 million people worldwide

Past Pandemics (1918-19)

• 1918-19, "Spanish flu," [A (H1N1)], caused the highest

number of known flu deaths

– more than 500,000 people died in the United States, 20 million to 50

million people worldwide. Many people died within the first few days

after infection and others died of complications soon after. Nearly half

of those who died were young, healthy adults.

– Thought to be an avian strain

Past Pandemics

• 1957-58, "Asian flu," [A (H2N2)], caused about

70,000 deaths in the United States. First identified in

China in late February 1957, the Asian flu spread to

the United States by June 1957.

• 1 million total deaths

Past Pandemics

• 1968-69, "Hong Kong flu," [A (H3N2)], caused approximately 34,000 deaths in the United States. This virus was first detected in Hong Kong in early 1968 and spread to the United States later that year. Type A (H3N2) viruses still circulate today.

• 1-4 million deaths worldwide

• Both the 1957-58 and 1968-69 pandemic viruses were a result of the reassortment of a human virus with an avian influenza virus. The origin of the 1918 pandemic virus is not clear.

AI in Humans since 1997

• H5N1, Hong Kong, 1997 : Avian influenza A (H5N1) in poultry and humans. First time an avian influenza virus had ever been found to transmit directly from birds to humans. – 18 people were hospitalized and six of them died. Authorities killed

about 1.5 million chickens to remove the source of the virus. Scientists determined that the virus spread primarily from birds to humans, though rare person-to-person infection was noted.

•

Exotic Newcastle

(END)

Exotic Newcastle Disease (END)

Clinicopathologic Forms:

• Velogenic (most virulent form)

– Viscerotropic velogenic (VVND)

– Neurotropic velogenic (NVND)

• Mesogenic (intermediate form)

• Lentogenic (mild form, vaccines)

Exotic Newcastle Disease (END)

• Viscerotropic Velogenic Newcastle Disease

• The most severe form of Newcastle disease and is likely the most serious disease of poultry throughout the world.

• Highly contagious disease

• Incubation period 2-15 days (commonly 2-6 days in chickens)

• Host range – all birds

• OIE List A Disease

• Paramyxoviridae (APMV-1)

Index Case

9-25-02

Submitted at 6 pm to San Bernardino Lab

by Private Practitioner --- history of mucoid

discharge from mouth, difficulty breathing,

some swollen sinuses, 8-10/200 have died,

suspected Coryza or Mycoplasma

9-26-02

Submissions necropsied

10-1-02

NVSL confirms END

--HA/HI = APMV type 1

--ICPI = 1.75

(.7 or greater = virulent/exotic)

Paramyxoviridae• RNA Virus

– Single stranded (-)

– Non-segmented

• Enveloped

• Pleomorphic

• Surface Glycoproteins

– F protein (fusion protein)

– HN (APMV)

– G (APV)

• Host specificity except for APMV-1

– Zoonotic

END Inland/Desert Incident Command Post

Colton Building

END Inland/Desert Incident Command Post

Norton Air Force Base

California Department of Food and Agriculture

California Department of Food and Agriculture

Premises Under Quarantine

Bird and equipment movement on or off this property is prohibited until the quarantine is released.

Cost of END

• 18,000+ premises quarantined

• 3.5M birds depopulated

• 4 states affected

• 1,600 person task force

• >$100M in containment costs

Now just think, about how many germs could be on

the surface of your hands!!

Photo microgram of germs

What about your clothing, shoes, and hands