Pandemics
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Pandemics Leonard Bryan B. Paet Tyrel Jonas H. Mora
Environmental Science 1 WFR 1st Semester, AY 2008 – 2009
Outline What are Pandemics? Past Pandemics Pandemics of the 20th Century Pandemic Severity Index Being Ready for Pandemics
Pandemic s
Definition
Pandemic s
Wikipedia: Pandemic is an epidemic of infectious disease that spreads through human populations across a large region, for example a continent, or even worldwide. Merriam-Webster Online: [Pandemic is a disease] occurring over a wide geographic area and affecting an exceptionally high proportion of the population.
Definition
Pandemic s
Common Definition: Pandemic is an epidemic that becomes very widespread and affects a whole region, a continent, or the world. What is an epidemic? An epidemic affects more than the expected number of cases of disease occurring in a community or region during a given period of time.
Definition
Pandemic s
According to the World Health Organization (WHO), a pandemic can start when three conditions have been met: the emergence of a disease new to the population. the agent infects humans, causing serious illness. the agent spreads easily and sustainably among humans.
Pandemic s How they Start and How they Spread
A pandemic usually start whenever a new or “novel” virus to which the general population has no immunity appears. result of mutation or and antigen shift in presently available viruses the novel virus also must spread easily from person to person for a pandemic to occur
Pandemic s How they Start and How they Spread
It’s most likely that no one will have immunity, or antibodies to protect people against the new virus anyone who is exposed to the virus —young or old, healthy or weak— could get sick if the new virus is related to some virus that circulated long ago, older people might have some level of immunity
Their Potential Impact
Pandemic s
how virulent the virus is how fast it spreads across the population how effective the efforts for pandemic prevention and response turn out A pandemic’s impact shouldn’t be measured only by the amount of deaths that it will produce.
History
Pandemic s
Plague during Peloponnesian War: war between Athens and Sparta in 430 BC Thucydides (Greek Historian): "People in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath."
History
Pandemic s
Plague during Peloponnesian War: killed 40% of Athens’ population killed the leaders of Athens and many of its army The word pandemic is derived from: Greek word pan meaning all, and demos meaning people In January 2006, researchers from the University of Athens analyzed teeth recovered from a mass grave underneath the city, and confirmed the presence of bacteria responsible for typhoid.
History
Pandemic s
Antonine Plague:
spread throughout Europe The disease was said to have been carried by Roman soldiers returning from their campaigns from the eastern portion of the Roman Empire back in AD165. It killed 5 million people, 25% of those who were infected by the disease.
History
Pandemic s
Antonine Plague:
It killed Marcus Aurelius Antoninus, a Roman emperor, of whom the plague was named after Antoninus: “Weep not for me; think rather of the pestilence and the deaths of so many others.”
History
Pandemic s
Antonine Plague:
Symptoms: fever, diarrhea, and inflammation of the pharynx, along with dry or pustular eruptions of the skin after nine days. (account by Greek physician and writer Galen) Scholars that the disease is likely to be smallpox. A second outbreak occurred between AD251 and 266, and at its height some 5,000 people were said to be dying in Rome every day.
History
Pandemic s
Plague of Justinian:
swiped Europe in 6th century AD (500s) named after Byzantine Emperor Justinian I killed about 40% of Constantinople’s population (Istanbul today) found out to be caused by fleas carried in the backs of ship-borne rats
History
Pandemic s
Plague of Justinian: killed 10,000 people in the city every day (account by Byzantine historian Procopius) world’s first encounter with a bubonic plague Bubonic plague is a bacterial disease plague caused by the bacteria Yersinia pestis famous symptom of bubonic plague is swollen lymph nodes, called buboes An infected person would not live by 24 hours
History
Pandemic s
Black Death:
In 1300s, the bubonic plague returned to Europe Name derived from the blackening of the skin which victims suffered through hemorrhaging under the skin
History
Pandemic s
Black Death:
killed a total of 25 million people, 25% of Europe’s population reached Middle East and Asia, making it the very first recorded plague to be labeled as a global pandemic has been described as the deadliest pandemic in human history
History
Pandemic s
Black Death:
some of the iconic images that can be remembered during the Black Death are the plague doctors Bubonic plague outbreaks occurred repeatedly in Europe, reportedly gathering strength with each generation, until the 1700s worldwide death toll for the bubonic plague had reached a dizzying 137 million
History
Pandemic s
Cholera:
Endemic to India, the disease spread along trade routes all over the world except Antarctica It had affected urban areas worse, where poor sanitation provided a perfect breeding ground for Vibrio cholerae, the bacteria causing the disease Symptoms: acute diarrhea, rapid dehydration, rapid pulse, dry skin, tiredness, abdominal cramps, nausea, and vomiting
History
Pandemic s
Cholera: The First Pandemic began in 1816 in Bengal, India and it spread across India, China and Caspian Sea until 1826 The Second Pandemic affected Europe and Northern America from 1821-1851 The Third Pandemic primarily affected Russia during 1852-1860 (about 1 million deaths were recorded) The Fourth Pandemic affected Europe and Africa from 1863-1875 and in 1866, it spread to North America
History
Pandemic s
Cholera: The Fifth Pandemic killed 8,600 in 1892 after the water supply of Hamburg, Germany was contaminated The Sixth Pandemic badly affected Russia during 1899 to 1923. The pandemic could have spread in Europe but improving public health systems are believed to have helped preventing it from spreading The Seventh Pandemic, the last of cholera pandemics, began in Indonesia in 1961. It reached Bangladesh, India and Russia before it stopped in 1966
History
Pandemic s
Influenza:
16th century: some outbreaks in Africa and Europe 19th century: Asiatic flu 1918: Spanish Flu It started in three far-flung locations in 1918: Brest, in France; Boston in the US; and Freetown in Sierra Leone. It moved across the globe with breathtaking speed, killing 25 million people in the course of six months; a fifth of the world's population was infected
History
Pandemic s
Influenza: Approximately 20-40% of the entire world’s population became ill from Spanish flu Many died from the disease very quickly –some were well by morning, sick by noon and dead by nightfall people aged 20-40 were its victims rather than the old and weak. This remains a mystery up to this day By 1919, it disappeared almost as fast as it appeared
History
Pandemic s
Influenza: it already killed about 40 million people, more the death toll of World War I which also ended that year Spain, which is not part of World War I and thus have no other things to report but the disease, have published numerous news articles about the pandemic. Influenza is caused by a variant of viruses which is collectively referred as influenza viruses 1958-59: Asian Flu (70,000 U.S. deaths) 1968: Hong Kong Flu (34,000 U.S. deaths)
The Flu (Influenza Virus)
Pandemic s
Influenza or the “Flu” is a disease caused by a virus that attacks the upper respiratory tract Infection usually lasts for about one week characterized by fever, headache, malaise, cough and sore throat
The Flu (Influenza Virus)
Pandemic s
Influenza A: have the potential to be pandemic Influenza B: mild viruses that produce discomfort and no deaths
The Flu (Influenza Virus)
Pandemic s
Influenza A viruses are further divided into subtypes depending on the difference in their two surface proteins: hemagglutinin (H) and neuraminidase (N). Influenza viruses evolve and mutate rather easily their genetic composition changes gradually: antigenic drift A pandemic is possible when an Influenza A virus makes a dramatic change and acquires a new H or H+N. This shift results in a new or “novel” virus to which the general population has no immunity.
The Flu (Influenza Virus)
Pandemic s
The Flu (Influenza Virus)
Past Influenza Pandemics: 1918: Spanish Flu (A/H1N1) 1957: Asian Flu (A/H2N2) 1968: Hong Kong Flu (A/H3N2) 1976: Swine Flu Scare (A/H1N1) 1977: Russian Flu Scare (A/H1N1) 1997: Avian Flu Scare (A/H5N1)
Pandemic s
Pandemic Severity Index
Pandemic s [US] a proposed classification scales for reporting the severity of influenza pandemics was proposed – the Pandemic Severity Index (PSI) Feb 1, 2007 designed to resemble the Saffir-Simpson Hurricane Scale
Pandemic Severity Index
Pandemic s
Case-Fatality Ratio (CFR), the percentage of deaths out of the total reported cases of the disease, is the main criterion used to measure pandemic severity. focuses less on how likely a pandemic is going to get out of control, and more upon how severe the pandemic actually is
Pandemic Severity Index
Pandemic s
CDC Pandemic Severity Index scheme Category
CFR
example(s)
1
less than 0.1%
Seasonal flu
2
0.1% to 0.5%
Asian Flu and Hongkong Flu
3
0.5% to 1%
4
1% to 2%
5
2% or higher
Spanish Flu
Pandemic Severity Index
Pandemic s
The report recommends four primary measures for slowing down a pandemic: Isolation and treatment of people who have suspected or confirmed cases of pandemic influenza Voluntary home quarantine of household contacts of those with suspected or confirmed pandemic influenza Dismissing school classes and closing daycare centers Changing work schedules and canceling large public gatherings
Pandemics Today
Pandemic s
Present Threats:
Ebola virus AIDS (Acquired Immunodeficiency Syndrome) SARS (Severe Acute Respiratory Syndrome) Avian Influenza (more commonly known as Bird flu) antibiotic resistance
Pandemics Today
Pandemic s
Avian Influenza:
Every year, reports on outbreaks of bird flu are reported in different countries It is still bird-to-human transmittable Caused by flu virus strain known as H5N1 H5N1 evolved into a virus strain which infects more species It is the current deadliest flu virus
Pandemics Today
Pandemic s
Avian Influenza:
It may evolve into a strain which is human-tohuman transmittable and will result to a new global pandemic Disease-control centers around the world are making avian flu their top priority today
Pandemics Today
Pandemic s
Prevention: University of Michigan Medical School study (2006): compared the different measures 43 U.S. cities have implemented during the Spanish flu cities that early on adopted "old-fashioned," non-pharmaceutical interventions — such as school closures, social-distancing in the community and workplace and quarantine — and "layered" multiple interventions at once for a long period of time fared better than other cities, with slower rates of infection and lower rates of death
Pandemics Today
Pandemic s
Prevention:
World Health Organization: currently focused in the surveillance of influenza has a network of 112 National Influenza Centres WHO: “Rapid detection of unusual influenza outbreaks, isolation of possible pandemic viruses and immediate alert to the WHO system by national authorities is decisive for mounting a timely and efficient response to pandemics.”
Pandemics Today
Pandemic s
Prevention: World Health Organization: WHO: “A major component of pandemic preparedness is to strengthen the capacity to respond to yearly epidemics of influenza.” developing specific contingency plans, stockpiling of antivirals, strengthening risk communications, investing in pandemic vaccine research and promoting domestic production of influenza vaccines
Pandemics Today
Pandemic s
Prevention:
Philippine Pandemic Preparedness Plan: Stage 1 - Avian influenza-free Philippines Stage 2 - Avian influenza in domestic fowl in the Philippines. Stage 3 - Confirmation of avian influenza from poultry to humans in the Philippines. Stage 4 - Avian influenza with human-to-human transmission of pandemic influenza causing outbreaks in the country
Environmental Science 1 WFR 1st Semester, AY 2008 – 2009
Outline What are Pandemics? Past Pandemics Pandemics of the 20th Century Pandemic Severity Index Being Ready for Pandemics
Pandemic s
Definition
Pandemic s
Wikipedia: Pandemic is an epidemic of infectious disease that spreads through human populations across a large region, for example a continent, or even worldwide. Merriam-Webster Online: [Pandemic is a disease] occurring over a wide geographic area and affecting an exceptionally high proportion of the population.
Definition
Pandemic s
Common Definition: Pandemic is an epidemic that becomes very widespread and affects a whole region, a continent, or the world. What is an epidemic? An epidemic affects more than the expected number of cases of disease occurring in a community or region during a given period of time.
Definition
Pandemic s
According to the World Health Organization (WHO), a pandemic can start when three conditions have been met: the emergence of a disease new to the population. the agent infects humans, causing serious illness. the agent spreads easily and sustainably among humans.
Pandemic s How they Start and How they Spread
A pandemic usually start whenever a new or “novel” virus to which the general population has no immunity appears. result of mutation or and antigen shift in presently available viruses the novel virus also must spread easily from person to person for a pandemic to occur
Pandemic s How they Start and How they Spread
It’s most likely that no one will have immunity, or antibodies to protect people against the new virus anyone who is exposed to the virus —young or old, healthy or weak— could get sick if the new virus is related to some virus that circulated long ago, older people might have some level of immunity
Their Potential Impact
Pandemic s
how virulent the virus is how fast it spreads across the population how effective the efforts for pandemic prevention and response turn out A pandemic’s impact shouldn’t be measured only by the amount of deaths that it will produce.
History
Pandemic s
Plague during Peloponnesian War: war between Athens and Sparta in 430 BC Thucydides (Greek Historian): "People in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath."
History
Pandemic s
Plague during Peloponnesian War: killed 40% of Athens’ population killed the leaders of Athens and many of its army The word pandemic is derived from: Greek word pan meaning all, and demos meaning people In January 2006, researchers from the University of Athens analyzed teeth recovered from a mass grave underneath the city, and confirmed the presence of bacteria responsible for typhoid.
History
Pandemic s
Antonine Plague:
spread throughout Europe The disease was said to have been carried by Roman soldiers returning from their campaigns from the eastern portion of the Roman Empire back in AD165. It killed 5 million people, 25% of those who were infected by the disease.
History
Pandemic s
Antonine Plague:
It killed Marcus Aurelius Antoninus, a Roman emperor, of whom the plague was named after Antoninus: “Weep not for me; think rather of the pestilence and the deaths of so many others.”
History
Pandemic s
Antonine Plague:
Symptoms: fever, diarrhea, and inflammation of the pharynx, along with dry or pustular eruptions of the skin after nine days. (account by Greek physician and writer Galen) Scholars that the disease is likely to be smallpox. A second outbreak occurred between AD251 and 266, and at its height some 5,000 people were said to be dying in Rome every day.
History
Pandemic s
Plague of Justinian:
swiped Europe in 6th century AD (500s) named after Byzantine Emperor Justinian I killed about 40% of Constantinople’s population (Istanbul today) found out to be caused by fleas carried in the backs of ship-borne rats
History
Pandemic s
Plague of Justinian: killed 10,000 people in the city every day (account by Byzantine historian Procopius) world’s first encounter with a bubonic plague Bubonic plague is a bacterial disease plague caused by the bacteria Yersinia pestis famous symptom of bubonic plague is swollen lymph nodes, called buboes An infected person would not live by 24 hours
History
Pandemic s
Black Death:
In 1300s, the bubonic plague returned to Europe Name derived from the blackening of the skin which victims suffered through hemorrhaging under the skin
History
Pandemic s
Black Death:
killed a total of 25 million people, 25% of Europe’s population reached Middle East and Asia, making it the very first recorded plague to be labeled as a global pandemic has been described as the deadliest pandemic in human history
History
Pandemic s
Black Death:
some of the iconic images that can be remembered during the Black Death are the plague doctors Bubonic plague outbreaks occurred repeatedly in Europe, reportedly gathering strength with each generation, until the 1700s worldwide death toll for the bubonic plague had reached a dizzying 137 million
History
Pandemic s
Cholera:
Endemic to India, the disease spread along trade routes all over the world except Antarctica It had affected urban areas worse, where poor sanitation provided a perfect breeding ground for Vibrio cholerae, the bacteria causing the disease Symptoms: acute diarrhea, rapid dehydration, rapid pulse, dry skin, tiredness, abdominal cramps, nausea, and vomiting
History
Pandemic s
Cholera: The First Pandemic began in 1816 in Bengal, India and it spread across India, China and Caspian Sea until 1826 The Second Pandemic affected Europe and Northern America from 1821-1851 The Third Pandemic primarily affected Russia during 1852-1860 (about 1 million deaths were recorded) The Fourth Pandemic affected Europe and Africa from 1863-1875 and in 1866, it spread to North America
History
Pandemic s
Cholera: The Fifth Pandemic killed 8,600 in 1892 after the water supply of Hamburg, Germany was contaminated The Sixth Pandemic badly affected Russia during 1899 to 1923. The pandemic could have spread in Europe but improving public health systems are believed to have helped preventing it from spreading The Seventh Pandemic, the last of cholera pandemics, began in Indonesia in 1961. It reached Bangladesh, India and Russia before it stopped in 1966
History
Pandemic s
Influenza:
16th century: some outbreaks in Africa and Europe 19th century: Asiatic flu 1918: Spanish Flu It started in three far-flung locations in 1918: Brest, in France; Boston in the US; and Freetown in Sierra Leone. It moved across the globe with breathtaking speed, killing 25 million people in the course of six months; a fifth of the world's population was infected
History
Pandemic s
Influenza: Approximately 20-40% of the entire world’s population became ill from Spanish flu Many died from the disease very quickly –some were well by morning, sick by noon and dead by nightfall people aged 20-40 were its victims rather than the old and weak. This remains a mystery up to this day By 1919, it disappeared almost as fast as it appeared
History
Pandemic s
Influenza: it already killed about 40 million people, more the death toll of World War I which also ended that year Spain, which is not part of World War I and thus have no other things to report but the disease, have published numerous news articles about the pandemic. Influenza is caused by a variant of viruses which is collectively referred as influenza viruses 1958-59: Asian Flu (70,000 U.S. deaths) 1968: Hong Kong Flu (34,000 U.S. deaths)
The Flu (Influenza Virus)
Pandemic s
Influenza or the “Flu” is a disease caused by a virus that attacks the upper respiratory tract Infection usually lasts for about one week characterized by fever, headache, malaise, cough and sore throat
The Flu (Influenza Virus)
Pandemic s
Influenza A: have the potential to be pandemic Influenza B: mild viruses that produce discomfort and no deaths
The Flu (Influenza Virus)
Pandemic s
Influenza A viruses are further divided into subtypes depending on the difference in their two surface proteins: hemagglutinin (H) and neuraminidase (N). Influenza viruses evolve and mutate rather easily their genetic composition changes gradually: antigenic drift A pandemic is possible when an Influenza A virus makes a dramatic change and acquires a new H or H+N. This shift results in a new or “novel” virus to which the general population has no immunity.
The Flu (Influenza Virus)
Pandemic s
The Flu (Influenza Virus)
Past Influenza Pandemics: 1918: Spanish Flu (A/H1N1) 1957: Asian Flu (A/H2N2) 1968: Hong Kong Flu (A/H3N2) 1976: Swine Flu Scare (A/H1N1) 1977: Russian Flu Scare (A/H1N1) 1997: Avian Flu Scare (A/H5N1)
Pandemic s
Pandemic Severity Index
Pandemic s [US] a proposed classification scales for reporting the severity of influenza pandemics was proposed – the Pandemic Severity Index (PSI) Feb 1, 2007 designed to resemble the Saffir-Simpson Hurricane Scale
Pandemic Severity Index
Pandemic s
Case-Fatality Ratio (CFR), the percentage of deaths out of the total reported cases of the disease, is the main criterion used to measure pandemic severity. focuses less on how likely a pandemic is going to get out of control, and more upon how severe the pandemic actually is
Pandemic Severity Index
Pandemic s
CDC Pandemic Severity Index scheme Category
CFR
example(s)
1
less than 0.1%
Seasonal flu
2
0.1% to 0.5%
Asian Flu and Hongkong Flu
3
0.5% to 1%
4
1% to 2%
5
2% or higher
Spanish Flu
Pandemic Severity Index
Pandemic s
The report recommends four primary measures for slowing down a pandemic: Isolation and treatment of people who have suspected or confirmed cases of pandemic influenza Voluntary home quarantine of household contacts of those with suspected or confirmed pandemic influenza Dismissing school classes and closing daycare centers Changing work schedules and canceling large public gatherings
Pandemics Today
Pandemic s
Present Threats:
Ebola virus AIDS (Acquired Immunodeficiency Syndrome) SARS (Severe Acute Respiratory Syndrome) Avian Influenza (more commonly known as Bird flu) antibiotic resistance
Pandemics Today
Pandemic s
Avian Influenza:
Every year, reports on outbreaks of bird flu are reported in different countries It is still bird-to-human transmittable Caused by flu virus strain known as H5N1 H5N1 evolved into a virus strain which infects more species It is the current deadliest flu virus
Pandemics Today
Pandemic s
Avian Influenza:
It may evolve into a strain which is human-tohuman transmittable and will result to a new global pandemic Disease-control centers around the world are making avian flu their top priority today
Pandemics Today
Pandemic s
Prevention: University of Michigan Medical School study (2006): compared the different measures 43 U.S. cities have implemented during the Spanish flu cities that early on adopted "old-fashioned," non-pharmaceutical interventions — such as school closures, social-distancing in the community and workplace and quarantine — and "layered" multiple interventions at once for a long period of time fared better than other cities, with slower rates of infection and lower rates of death
Pandemics Today
Pandemic s
Prevention:
World Health Organization: currently focused in the surveillance of influenza has a network of 112 National Influenza Centres WHO: “Rapid detection of unusual influenza outbreaks, isolation of possible pandemic viruses and immediate alert to the WHO system by national authorities is decisive for mounting a timely and efficient response to pandemics.”
Pandemics Today
Pandemic s
Prevention: World Health Organization: WHO: “A major component of pandemic preparedness is to strengthen the capacity to respond to yearly epidemics of influenza.” developing specific contingency plans, stockpiling of antivirals, strengthening risk communications, investing in pandemic vaccine research and promoting domestic production of influenza vaccines
Pandemics Today
Pandemic s
Prevention:
Philippine Pandemic Preparedness Plan: Stage 1 - Avian influenza-free Philippines Stage 2 - Avian influenza in domestic fowl in the Philippines. Stage 3 - Confirmation of avian influenza from poultry to humans in the Philippines. Stage 4 - Avian influenza with human-to-human transmission of pandemic influenza causing outbreaks in the country
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