Preparation, Control and Prevention of Pandemics - Term Paper Example

Introduction The communicable diseases have undergone many transformations over human history. As the life expectancy is increased in developed countries, along with it new infectious diseases also have emerged. As the global environment is changing at fast pace due to various issues such as migration, famine, fire, war, and terrorism the paths of disease transmission of infectious diseases are also varying and therefore, offering more challenges. Pandemic is a Greek word representing “all people”. Pandemic is much broader form of an epidemic. Pandemic is an epidemic which is not confined to certain population or geographical areas and, it is the spread of the disease worldwide. Some of the past examples of pandemics are small pox, tuberculosis to mot recent ones such as HIV pandemic and the 2009 flu pandemic. According to the World Health Organization (WHO), a pandemic is defined under the presence of three criteria of emergence and transmission: emergence of a disease unfamiliar to a population; agents infect humans, causing serious illness like bacteria, virus or fly; and agents spread easily and sustainably among humans (Segall, 2007, p. 5). The severity of the pandemic depends upon rapid recognition of the type of the strain and how fast the spread of the disease can be prevented. Stages of a pandemic The Centers of Disease Control and Prevention (CDC) has categorized pandemic into three stages: interpandemic (IP), pandemic alert period (PAP), pandemic period (PP). IP is the phase in which new disease is detected in population, in PAP the disease gets transmitted from one individual to another, PP is the widespread phase of the disease (Segall, 2007, p. 10). In 2009, WHO has further divided these into a six-phased approach for influenza pandemic: phases 1-3 (mainly animal infections and few human infections), phases 4 (sustained human to human transmission, phases 5-6 pandemic (widespread human infection), post peak (recurring events), post pandemic (disease activity at seasonal levels). These phases show stepwise approach for preparing, planning, and development activities for the response, mitigation efforts in the pandemic phase and then recovery period to maintain surveillance (WHO, 2009). Current Pandemics 2009 influenza A/H1N1 The year 2009 began with a new influenza pandemic form a strain of Influenza A virus subtype H1N1. At the end of April, the World Health Organizations pandemic alert level went to phase 5, and raised to highest level at 6 in June 2009 (BBC News. June 11, 2009). On 11 June 2009 Dr Margaret Chan, Director-General of the World Health Organization (WHO), declared this as first pandemic of the 21st Century which is detected early verifying 30,000 cases globally. HIV and AIDS Human immunodeficiency virus infection (HIV) is in the forefront of untreatable infectious disorder epidemiology and is contemplated a serious health problem. It is transmitted from Africa to Haiti, and then to United States. The first global spread was observed in 1969 (Los Angeles Times. October 30, 2007). Since then more than 65 million infections and 25 million deaths were reported globally. The infection rates are 25% in southern and eastern Africa, while prevalence rate of 29.1% was reported among South African pregnant women (Noble, 2006). The people who do not want to follow preventive education about safer sexual practices and bloodborne infection precautions are the most vulnerable to risk factors. Sponsored national awareness programs and antiretroviral therapy has reduced infection rates in several African countries. While in developing regions like Western and Central Europe, it was estimated that around 800,000 were infected with HIV which is comparatively less than countries in Asia and sub-Saharan Africa (Spink, June 02, 2009). Combination antiretroviral treatment was introduced in the mid-1990s, still due to late diagnosis, injection drug use, gay people’s sex, sex workers and migratory workers HIV infection is still offers immense challenges. The developing countries like China, and India could kill 31 million and 18 million people respectively; while in Africa mortality can be as high as 100 million by 2025 (Terry, June 4, 2006) Past examples of pandemics The diseases which jumped from animals to humans are zoonotic. Initially they were restricted initially to small population, but due to modernization and shrinking of the world, the transmission became epidemic, and then pandemic. Typhus (430 BC? – today): An endemic rickettsia transmits bacteria from rodent hosts to humans through mites, fleas and body lice. The arthropod vector transmitted by contaminated food, water, unhygienic conditions those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field. Even it affected large the health care providers who were nursing the sick (Colon; Impactlab, 2009 April 2009). Plague of Athens in 430 BC was a typhus epidemic caused by bacteria which killed 25% Athenian population in four years. It spread in Europe during 16th to the 19th centuries. English Civil War, the Thirty Years’ War and the Napoleonic Wars were affected by typhus epidemic. This war fever was widely propagated in Ireland between 1816-19, 1830, and during the Great Irish Famine between 1846 and 1849. In America, a typhus epidemic occurred at several places in 1837, 1843, between 1865 and 1873. The epidemic between 1918 and 1922 killed 3 million population. Typhus during World War I, had taken more than three million deaths in Russia (150,000 dying in Serbia alone), Poland and Romania. World War II epidemics was restricted to Eastern Europe, the Middle East and parts of Africa due to vaccine development for prevention of typhus (Colon; Impactlab, 2009 April 2009) Cholera (1817 – today): Cholera has displayed highest number (eight) of pandemics globally due to diseas causing agent ‘cholera bacterium’. First: 1817-1823, Second: 1829-1851, Third: 1852-1859, Fourth: 1863-1879, Fifth: 1881-1896, Sixth: 1899-1923: Seventh: 1961- 1970, and Eighth: 1991 to the present (Impactlab, 2009 April 2009). The contaminated kegs of water or in the excrement of infected victims or few of the survival of the past pandemic led to outbreak of subsequent pandemic and despite of advances in medical field, still a major killer. The origin of first cholera pandemic was Bengal, India where 10,000 fatalities from British army was reported. Then, due to colonization and trade China, Indonesia (1 million killed in Java) and the Caspian Sea became victim of this pandemic. 15 million population in India succumbed to death in 1817 and 1860; and 23 million died between 1865 and 1917; while in Russia 2 million deaths were declared (Beardslee, 2000). The outbreak of second pandemic reached to Russia, Hungary (about 100,000 deaths), Germany, England (claimed 22,000 lives) in 1831. A two-year outbreak began in England in October 1831 and claimed 22,000 lives. In another two year outbreak of cholera from 1848, took 52,000 deaths. Then immigrants extended the disease to North America from Europe. Then, it spread to Canada and entire United Sates claiming 150,000 lives between 1832 and 1849. The targeted area of third pandemic (killed over million) was mainly Russia, Indonesia and later attacked China and Japan in 1854. In 1858, Philippines, Korea were infected; while in 1859, Indian originated cholera spread to Iran, Iraq, Arabia and Russia. Fourth pandemic extended to Europe and Africa , and Russia. And also, 30,000 Mecca pilgrims, 50,000 Americans, 90,000 Russians died in this pandemic (Beardslee, 2000). Fifth pandemic destroyed 250,000 lives in Europe; 50,000 in America; 267,890 Russia (1892); 120,000 in Spain (New York Times, 1890); 90,000 in Japan 8606 deaths occurred due to Hamburg’s polluted water supply (Barry, 2004). In 1892, Waldemar Haffkine, a Ukrainian bacteriologist invented a human vaccine for cholera. (CBC news, 2008). The sixth pandemic succumbled more than 800,000 in India and then transmitted to the Middle East, northern Africa, Russia and parts of Europe (CBC news, 2008). The victims of seventh pandemic which originated in Indonesia were Asia, , Middle East, and the Soviet Union. Eight pandemic was originated in Peru in 1991. In 1992, new species of the cholera bacteria (O139) in Bangladesh was reported. In 1994, tens of thousands of people in Rwandan refugee camps of the Democratic Republic of Congo got killed due to cholera epidemic. In 2008, 500 people had died in an outbreak in Zimbabwe with 12,000 infected cases (CBC news, 2008). The modern-day sewage and water treatment system, safe and clean supply of water is the key to cholera prevention. Adequate chlorination of public water supplies, hygienic conditions have reduced the severity of this epidemic in developed countries, than underdeveloped countries due to infected water in war and natural disasters such as earthquakes and hurricanes (CBC news, 2008). Black Death (1340 – 1771): The most lethal pandemic The Black Death, or The Black Plague showed high mortality rate, and killed 75 million people worldwide out of which 20 million deaths (more than 50% population) in Europe alone. Its’ root continent were South-western or Central Asia and in 1340s attacked Europe. The fourteenth-century invasion of the Black Plague had a wide impact on Europe’s population and Europe’s social structure. The three types of plague showed characteristics manifestations with high fever (101-105 °F) in the affected individuals and infected individual died within a week. In, Bubonic plague, painful lymph node swellings with pus and blood, called buboes were seen at the base of the neck, and in the armpits and groin. Along with high fever; headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise were reported and mortality rate was upto 75%. The septicaemic plague is associated with blood poisoning, and lung infection is observed in pneumonic plague with mortality rate of ninety to ninety-five percent.. Until the 1700s this epidemic came with varying virulence and mortalities . In 1603, the plague victims were 38,000 Londoners. Other distinguished epidemics of 17th century were the Italian Plague of 1629-1631, the Great Plague of Seville (1647-1652), the Great Plague of London (1665-1666), the Great Plague of Vienna (1679) (Impactlab, 2009 April 2009). Small Pox (430 BC? – 1979): Smallpox is the only human contagious disease which is virtually died out. In the 20th century, more than 300 million persons died due to small pox, and killed most of the native inhabitants of the America after the first contacts with Europeans and Africans. The causative agents of small pox (Variola or Variola vera) are either of two viruses: Variola major and Variola minor. As the name suggests, V. major display a higher mortality rate of 30-35%, while V. minor exhibits ~1% mortality due to more lenient form of disease alastrim. The side effects like blindness due to corneal ulcerations and infertility in male survivors are infrequent; while distinguished skin scars are the most commonly observed adverse effect which remains for a longer duration (Impactlab, 2009 April 2009). In the 18th century, more than 60 million Europeans died due to small pox. The mortality was 30% in which 80% of the children under 5 years of age, demised from the disease, and 30% of the survivors became blind. The fight between Aztecs and Cortés in Mexico, ended by killing 25% of Aztec population not by cannons but this viral epidemic contracted from a Spanish small pox infected invader. WHO reported 2 million deaths out of 15 million infected individual in 1967. Due to international surveillance and successful vaccination programs during the 19th and 20th centuries, WHO declared the complete eradication of small pox in 1979 (Impactlab, 2009 April 2009). Influenza The dynamic and complex nature of influenza virus had resulted in three pandemics and several "pandemic scares" during the 20th century alone. This drift attribute of influenza virus has led to reinfection in following years. The entire influenza pandemic showed characteristic symptoms like fever, extreme chills, and fatigue were often accompanied by fluid in the lungs (HHS, 2004). 1918: Spanish Flu Mortality rate of Spanish flu was over 20 million people from 20 to 40 percent of the infected global population. Within a span of less than a year from September 1918 500,000 deaths from the flu occurred in the U.S. alone. The infected individual died within the first few days itself due to pneumonial complications from the flu caused by bacteria. Both healthy adults (20 to 50 years old) as well as the usual high-risk groups were susceptible to this strain of influenza virus (HHS, 2004). 1957: Asian Flu Asian flu originated in Far East in 1957. The rapid identification of Asian influenza pandemic immediately ensure steps towards combating this pandemic by vaccine production and increased surveillance for flu outbreaks. After the small outbreaks, high risk individuals including elderly people, pregnant women, and school going children were targets who spread the disease easily. In 1957, the A/H1N1 virus was modified to the new strain A/H2N2. During September 1957 and March 1958, most of the deaths occurred where elderly people had highest rate of mortality. This pandemic nearly ended in December 1957, which flared up again as second wave during January and February 1958 and total death toll was 69,800 people in the U.S and worldwide, the total reached 2 million (HHS, 2004). 1968: Hong Kong Flu Hong Kong influenza pandemic began in Hong Kong in early 1968; while widespread flu occurred in the U.S. in December, and January. The Hong Kong Flu (H3N2) outbreak took 33,800 deaths in the United States and 1 million deaths worldwide; where elderly people had highest rate of mortality. This flu was considered as the mildest pandemic in the 20th century because of number of reasons. The reasons might include: increased immunity against the Hong Kong flu due to previous Asian flu infections; pandemic began in December vacations of children, restricted its spread; improved medical care and antibiotics that are more effective for treating secondary bacterial infections (HHS, 2004). 1976: Swine Flu Scare Swine Flu or "killer flu" affected Fort Dix area and it never spread might be due to mass vaccination campaign in the United States (HHS, 2004). 1977: Russian Flu Scare Influenza A/H1N1 viruses that was present prior to 1957, was isolated in northern China and it spread quickly across the world by January 1978. The susceptible age groups were children and young adults (< 23 years) worldwide; being elderly population resistant to this flu. Vaccine for prevention of this virus was included for the years1978-79 (HHS, 2004). 1997: Avian Flu Scare Avian flu occurred in 1997 in Hong Kong due to the avian A/H5N1 flu virus and recurred in 1999 caused by novel avian flu virus A/H9N2. It transmitted directly from infected chickens to humans primarily children and young adults, and therefore a mass slaughter of chickens (approximately 1.5 million) was done in Hong Kong to limit its spread. Only 6 out of 18 infected individuals died in 1997. Both of the viruses have high potential to start pandemic due to their continued presence in birds, their drift capacity and the ability to infect humans (HHS, 2004). Tuberculosis Tuberculosis is also referred as the white plague, wasting diseases or consumption and is a treatable disease. The deadliest disease tuberculosis causes 2 million deaths annually. The figure is indicative of 7% TB deaths, if all the deaths globally are considered. Out of this more than 25% deaths could be prevented (Johnson 2009). The pathogen Mycobacterium tuberculosis is responsible for tuberculosis (TB). The person carrying the dormant tuberculosis germs is prone to tuberculosis, if they become active and multiply. This is an airborne disease and people exposed to infected droplet nuclei get easily infected. It spreads through activities like cough, sneeze, laugh, sing etc. of the disease carrying person. When the disease seemed to be virtually died out in 1970s, it was a complete shock when resurgence of the tuberculosis was found in the mid-1980s. There was a dramatic increase in TB patients until 1992. The multi drug resistant cases were also on rise. WHO announced TB a global public health crisis in 1993. The upsurge in communicable disease was attributed to several factors like HIV epidemic in 1980s, aging of the world population, immigration to developed countries from countries where TB is common, the spread of TB in certain settings (for example, correctional facilities and homeless shelters), change in social structure and inadequate funding for TB control and other public health efforts i.e. deterioration of health care system (Dias-Baptista et al 2008).It has been estimated that around 33% of world population is infected with tuberculosis germs. It has been reported that about 9 million people can suffer from tuberculosis disease in a year. The disease is most prevalent in resource-limited countries, but since it has not yet been completely uprooted, the chances of outbreak of the disease in other countries including United States can not be neglected (LoBue, Sizemore, & Castro 2009). When the tuberculosis infection in the person gets successfully treated, it is referred as ‘primary tuberculosis’. This cured person still contains noninfectious, but live mycobacterium TB infected individual can transmit the infection to almost 10 to 15 other people annually (Johnson 2009). Therefore, despite advances in medical technology, tuberculosis (TB) still remains a global pandemic (Kelly, 2009, Jul 20). Biological Warfare and pandemic Bioterrorism is an alleged or attempted biological warfare attack on the humanity leading to terrible consequences. It has been reported that they were used in historical warfare to harm people and armies. The crude use of filth and cadavers, animal carcasses, contagion, and polluting sources of water of the enemy were used in history through the many European wars, during the American Civil War, and even into the 20th century in order to combat the opposing army (Riedel, 2004). The most potent weapons used were the infectious victims such as plague victims (Black Death) were utilized during Caffa victory, the battle between Russian troops and Swedish forces in Reval. Small pox was used as weapon on South American natives, during French-Indian War (1754–1767) etc. Due to advances in genetic engineering, modern trend of biological warfare started (Riedel, 2004). During World War I, Germans were accused for use of disease-producing bacteria, such as Bacillus anthracis (anthrax) and Pseudomonas pseudomallei (glanders), to the USA and other countries. They were also responsible to spread cholera in Italy and plague in St. Petersburg in Russia (Riedel, 2004). During World War II, Japanese experiment (1932 and 1945) on bioterrorism resulted in death of 10,000 prisoners due to gas gangrene, anthrax, meningococcal infection, cholera, dysentery, or plague. This problem has continued into present times. Therefore, to tackle such devastating effects of biological weapons a strong global norm should be there to eliminate the programs associated with the development of such weapons (Riedel, 2004). Preparation, Control and Prevention Inspite of the developments in drug treatment and strategies, pandemic offers unmet challenges. To reduce the enormous global burden and long-term goal of better control of communicable diseases, there is a need for international surveillance, timely vaccine development and production, and the ability to administer vaccine to large numbers of people in a short amount of time. Moreover, the strategies regarding effective communication systems and emergency response systems should be properly designed and administered for managing a pandemic (HHS, 2006). There is a need to focus on many vital aspects of responding to the next pandemic (HHS, 2006). The objective of prevention technique should be reducing an individuals susceptibility to disease by teaching people, vulnerable groups and health care providers about the disease and transmission. Special precautionary measures should be employed such as prohibition of overcrowding, maintenance of good ventilation, isolation of infectious individual to avoid transmission to others (Alves-Dunkerson J. & Dunkerson D.). To reduce propagation of pandemic, legislative, political, and cultural factors should be considered to fund educational programs and improve living conditions of the most vulnerable population. Financial and nutritional back up, HIV counseling, enhancing the public health infrastructure to effectively implement pandemic-affiliated programs (HHS, 2006), and to reduce obstacles in prevention and treatment programs are also considered very important issues (Alves-Dunkerson J. & Dunkerson D.). References Alves-Dunkerson J. & Dunkerson D. 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Medical Newstoday, [internet] 02 Nov. Available at: http://www.medicalnewstoday.com/articles/169461.php [Accessed 10 November 2009]. Impactlab, 2009. April 2009. Available at: http://www.impactlab.com/2009/04/27/7-worst-pandemics-in-history/ Johnson, T. 2009. Drug-resistant TB may ‘spiral out of control, U.N. says, McClatchy Newspapers. Posted on Wednesday, 04.01.09. Available at: http://www.miamiherald.com/news/world/AP/story/979014.html Kelly, K., 2009, Jul 20. Tuberculosis Facts and Information. http://www.disabled-world.com/health/tuberculosis.php LoBue, P. Sizemore, C. & Castro K. G., 2009. Plan to Combat Extensively Drug-Resistant Tuberculosis Recommendations of the Federal Tuberculosis Task Force. February 13, 2009 / 58(RR03); pp1-43. The virus reached the U.S. by way of Haiti, genetic study shows.. Los Angeles Times. October 30, 2007. Available at: http://articles.latimes.com/2007/oct/30/science/sci-aids30 The cholera in Spain. 1890. New York Times, [internet]. 20 June. 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