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EPIDEMICS

Epidemics past, present and future



Epidemic: occurrence in a community or region of cases of a illness, specic health-related
behavior, or health-related event clearly in excess of normal expectancy.
It can be a:

infectious disease;

non-communicable disease (e.g. diabetes).



One case of smallpox is an epidemic (occurrence of smallpox = 0).

10.000 years ago: hunter-gatherers groups of 20-30 -> major epidemics cannot spread.

When humans settled down to a pastoral and agricultural existence infectious diseases started
breaking out.
Three factors were decisive:

lots of humans interacting with each other;

contact with domestic animals;

contact with rodents.



Movements of humans over long distances introduced new diseases. For example the discovery of
the New World brought smallpox and measles in America, and syphilis in Europe.

Pasteur: Germ Theory of Disease.
This has led:

antimicrobial therapy;

immunization;

water sanication.
All of this brought a reduce of epidemics.

Emerging infectious diseases (EID): that have newly appeared in the human population (HIV,
SARS).

Re-emerging infectious diseases: were previously known but are now rapidly increasing in
incidence or geographic distribution.

Zoonosis: infectious disease that can be transmitted from non-human animals to humans.

RNA virus: more prone to mutation.

Interactions between humans and microbes are modulated by:

ecological factors;

genetic, biological, physical and environmental factors;

social, political and economic factors.



Factors predisposing to infectious disease:

microbial factors;

climate and weather;

changes in ecosystem;

human demography, migrations and behavior;

breakdown in public health;

bioterrorism.
Microbes have a high speed of replication, they can adapt to adverse environments quickly and
can cross species.

The resistance to antibiotics can be caused by:

abuse and misuse of antibiotics;

antibiotics abuse in livestock industries.



Changes in climate and whether can modied the spreading of some infectious diseases.
Example: Hantavirus pulmonary syndrome. In 93 out-broke a severe respiratory disease in New
Mexico. It was detected a Hantavirus (deer mice were the reservoir hosts). Climate changes
increased the vegetation upon witch the deer mice feed leading to an increase of the number of the
deer mice (asymptomatic carriers of the disease). A contact with the infected secretion may lead to
the development of the disease.

In Argentina the clearing of forests for the cultivation of maize was associated with the spread of
the haemorrhagic fever (the cultivation increased the number of some rodents).

Eat bushmeat contributed to cross-species jumps of viruses (HIV-1).

The migrations help the spreading of EID, e.g. HIV-1 emergences when people migrate form Africa
to America (combined with changes in sexual lifestyle).

Other human behaviors (like drug abuse) contributed to the spread of some diseases (HIV,
hepatitis C).

Most of the novel emerging infectious diseases are arising form wild animals. Lots of animals cross
borders, so the risk of importing microbes is high.

Monkey-pox: exotic mammals were imported and sold in pet facilities with other domestic animals,
The domestic animals acquired monkey-pox infection form the mammals. 32 conrmed cases and
72 suspected cases of monkey-pox were found that year.

Asian tiger mosquito establish itself in North America, it is the vector for dengue and chikungunya.

Intensive animal husbandries facilitate infectious disease emergence (to add to the antimicrobial
resistance).

Feed cattle with brain and neural tissue (to add proteins in the diet) was associated with the spread
of a new prion (bovine spongiform encelophalopathy). In 1995 a novel prior disease were detected,
witch was the result of consuming bovine spongiform encephalopathy-infected cattle.

Organ transplant: may cause opportunistic infections in immune-compromised patients.

Air conditioning: led to the emergence of Legionnaires disease. It replicated itself in the cooling
towers, then the aerosols they produce lead to the dissemination of the infection.

Political instability, war and natural disaster can contributes to the re-emergence of infectious
diseases.

Bioterrorism: 2001: letters containing anthrax spores were mailed to important persons. 5 people
were killed and 17 infected.

Costs of the outbreak of an infectious disease:

15 billion for bovine spongiform encelophalopathy;

40 billion for SARS.