Throughout this course, we have learned about various diseases that caused epidemics in the world. Some of these diseases include the plague, smallpox, tuberculosis, cholera, and the potato blight. I chose to do my emerging diseases paper on general information about anthrax and several cases from the 2001 series in the United States (US).

I learned that many infectious diseases traveled quickly due to lack of knowledge and poor hygiene. Animals also served as vectors, so when people began to live in closer proximity to their animals, more infectious diseases were seen. Since then, people have separated themselves from certain animals. Obviously, we still live with our beloved cats and dogs, but we no longer let our goats sleep next to us.

As for the plague, we have essentially eliminated it from the US. There has not been an epidemic of the plague in the US since 1924. In 2009, the plague became epidemic in Madagascar. This is likely due to poor hygiene, poverty, political upheaval, health clinics closing, lack of clean water, and accumulated trash which attracted rats that were infected. They also kept crops inside. In rats’ eyes, this was food, which brought infected fleas inside homes and closer to people. Many people also unbury the dead to consult with them, thus spreading the plague even more.

While I think everyone wants to get rid of disease, how far can you go to do so? This is an ethical dilemma. In class, we discussed the Tuskegee study as an example of ethics, or a lack of, in research. In this study, government doctors offered treatment for black men infected with syphilis. The subjects were not told that they had syphilis and endured painful spinal taps. The research was done to see the long-term effects of syphilis. This study was unethical because it denied patients treatment, which caused many of them to die. The doctor who oversaw the study was—and still—believed what he was doing was ethical. He rationalized the harm of the subjects with the benefits he thought it would give to society and medicine.

Another example of a study that had a large impact on the guidelines for ethics of infectious diseases is the Guatemala venereal disease study. In this study, researchers infected prisoners in Guatemala with gonorrhea or syphilis. They were not told they were being infected, and again, many of the subjects died because of the study.  The study was also rationalized in the same manner as the Tuskegee study. So how do you overcome these ethical dilemmas? By setting guidelines for research, ethics may still be held at a standard allowing for trust in medical professionals. Although there are always ethical dilemmas occurring in the medical field, these guidelines can keep the medical professionals from veering into the wrong direction that will harm society.

Getting back to diseases, smallpox was deadly, but was eradicated in the 1980s. If you had smallpox when it first appeared, everyone could tell because of the pustules on your skin. In the 17th and 18th centuries, approximately one-third of the population in London was scarred and two-thirds were blind. The variola major type of smallpox had a 30% mortality rate; whereas, the variola minor type of smallpox had a 1% mortality rate. The spread of smallpox was rapid due to wars, movements of populations, trade routes and caravans, and the slave trade. There were many supposed remedies for smallpox, to include, bloodletting, leeches, fasting, laxatives, purgatives, diuretics, heat therapy, and cold therapy. Luckily, smallpox was eradicated using surveillance and containment. When someone was found to have smallpox, they were isolated to contain the disease. Then everyone around them was vaccinated to prevent the disease from spreading. The difficulty with this was finding those infected with smallpox before they transmitted the disease to others.

While the US is on the fad of cutting carbohydrates from their diets to lose weight, Ireland remembers the potato famine that occurred in the 1800s. When three-quarters of potatoes was lost to blight, the Irish began experiencing widespread starvation, diseases, and emigration. Scientists are now genetically editing foods rather than genetically modifying them. Gene-editing is when DNA is essentially cropped—as in part of the DNA are removed. Gene-modification is when new genes are introduced to and grow into DNA. Since nothing is added with gene-editing, I believe people will be more supportive of it in the hopes of not having another potato blight.

Another disease we learned about in this course was Tuberculosis (TB). TB is an infection caused by the bacteria mycobacterium tuberculosis. The infection mainly targets the lungs, but the kidneys, bones, lymph nodes, and brain can also be attacked. Symptoms of TB include evening fever, night sweats, blood spitting, weak pulse, diarrhea, and emaciation. TB becomes a problem when treatments are not carried out properly and it becomes drug resistant. I doubt that the world will ever be eradicated of TB because this would require curing everyone, which would cost a lot of money that uninfected Americans would not be happy to pay.

The last disease we discussed in depth as a class was Cholera. Cholera is a dangerous disease that can kill you within a day. The symptoms include diarrhea, vomiting, and dehydration. The last pandemic occurred in India in 1961. This disease is not as prevalent because sanitation has increase, along with other factors like better healthcare.

This class taught me a lot about diseases and the effects they can have on various societies. My favorite part of the course was learning about anthrax, which is why I am happy we could choose a topic for our emerging diseases paper. I think future classes should also be able to choose their own topic.

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Cholera is a dangerous disease that can will you within a day. The symptoms include diarrhea, vomiting, and dehydration. There have been seven pandemics of cholera in the last two centuries that have devastated countries around the globe. There are two biotypes of cholera—El Tor and classical. Within each of those biotypes, there are two serotypes—Inaba and Ogawa. The pandemics from the 19^th and early 20^th centuries were caused by the classical biotype. The biotype still wreaking havoc on the world today is the El Tor. The problem with the El Tor biotype is that it shows little to no symptoms, thus making it more likely to be spread because people are unaware that they are infected. Cholera is transmitted via contaminated water; this includes food that has been grown using or washed in contaminated water.

The first pandemic began in Calcutta in 1816 and spread through the Philippines, Persian Gulf, Africa, central Asia, and to the borders of Russia. From the route in which the disease spread, there is a theory that Cholera was following along the slave trade route. This is a good theory since the conditions in which slaves were kept were highly unsanitary. This pandemic ended in 1823. Another pandemic appeared just five years after the first ended. This time the disease began in Russia and traveled throughout Europe, Canada, and port cities in the United States. This pandemic ended in 1851. Just a short year later, the third and most deadly pandemic started. This time the disease spread throughout Africa, U.S., Middle East, Europe, and India. It was during this pandemic that Jon Snow published his work on Cholera. This pandemic ended in 1863.

Jon Snow noticed that less people were dying from Cholera if they received water from Lambeth Company. This company had just began getting water from a less polluted are of the Thames River. After investigating the number of deaths from Cholera based on what company people received water from, he began to believe that his hypothesis was true. Henry Whitehead later began to agree with Snows hypothesis and played a large role in removing the handle of a water pump suspected of infecting may people. Filippo Pacini identified the cholera bacterium around the time that Snow was doing research on the cause of Cholera. However, Pacini’s article was ignored. In 1883, Dr. Robert Koch named the bacteria responsible for Cholera—unaware that Pacini had already discovered it.

Less severe, but nonetheless deadly were the fourth and fifth pandemics beginning in 1863 and 1881. Lethal outbreaks occurred in Naples, Russia, and Spain. In 1899, the sixth pandemic began and killed many in India, Arabia, and those living along the North African coast. This time though, the pandemic did not reach the Americas. This is likely due to the Americas achievements in public health sanitation. However, the United States again joined in the devastation of the Cholera outbreak of 1910. The disease likely traveled to the U.S. by ships of immigrants from Naples. The last pandemic originated from India in 1961. Poor water quality and sanitation, as well as conflicts dealing with public infrastructure and health care access probably caused the easy spread of Cholera.

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Tuberculosis (TB) is an infection caused by the bacteria mycobacterium tuberculosis. The infection mainly targets the lungs, but the kidneys, bones, lymph nodes, and brain can also be attacked. Symptoms of TB include evening fever, night sweats, blood spitting, weak pulse, diarrhea, and emaciation. TB has had several names throughout history, to include: Phthisis (Greek), Tabes (Latin), and Consumption (Latin). High population density and poor sanitation created the perfect environment for TB to thrive in. When John Harvard died of TB, society romanticized the death and erected a statue of Harvard looking sensitive.

Tenements which epitomized poor living conditions fostered TB. Sanatoriums began appearing as a treatment for TB; however, these could only help a small number of people in comparison to the number infected. As it turns out, death rates were the same in sanatoriums and in victims of the disease home. Upon the end of World War II, streptomycin experiments began as a possible treatment for TB. This worked, but toxicity and resistance proved to become problems. However, the following drugs were found to be effective if taken correctly and for the duration of treatment: isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA).

TB has since become resistant at different levels to drugs, ranging in lethality. There is normal TB, which is not resistant to drugs. The next is multidrug resistant TB (MDR-TB), which is resistant to isoniazid and rifampin, but not all drugs. MDR-TB can be treated with a combination of drugs and be effective. Lastly, the deadliest is extensively drug resistant TB (XDR-TB), which is resistant to isoniazid, rifampin, any fluoroquinolone, and at least one of three injectable second-line drugs. Treatment options for XDR-TB are much less affective due to its drug resistance. Thus, making XDR-TB the deadliest.

The only way to eradicate the world of TB is to treat and cure everyone. This would need an extensive amount of money to fund all the treatment. This movement would also need a social revolution in America. The individualist culture would not abide by taking money from some and giving it to others that cannot afford to pay for healthcare. A collectivist culture would foster the right environment for this movement to take place because it would do the most good for the society as a whole.

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If one thing is for certain, America currently does not appreciate the potato as much as Ireland did in the 1800s. Even now, many Americans do not consume potatoes because they are worried about eating too many carbohydrates and getting fat. The Irish had a different perception of the potato. They saw it as something that could be mass produced with little labor. This was important for the Irish because their population grew from 3.5 to 8 million in the matter of a century. The potato combined with milk—and sometimes cabbage and salt—provided the Irish with all the essential nutrients to stay healthy. The potato was adapted and largely grown because of its’ ability to grow in cool, moist conditions.

When three-quarters of potatoes was lost to blight, the Irish began experiencing widespread starvation, diseases, and emigration. This killed around one million of the population, and another million emigrated from Ireland—largely to North America. In 1847, the United States responded to the massive wave of Irish immigrants by increasing the cost of passage. The United States also began confiscating ships that were overcrowded. The pathogen that cause this disaster is known as phytophthora infestans. This originated from Mexico by the HERB-1 strain of phytophthora infestans and spread through potatoes carried on ships to North America and Europe.

In March of 2017, scientists created three genetically modified potatoes resistant to potato blight and approved by the FDA and EPA. These genetically modified potatoes contain genes from the Russet Burbank, Ranger Russet and Atlantic potatoes. It should be noted that only potato genes were used to create this new potato. There have been no potential harms found associated to the genetically modified potato. However, some people have found ethical issues in eating something that has been genetically modified.

Scientists are now genetically editing foods rather than genetically modifying them. Gene-editing is when DNA is essentially cropped—as in part of the DNA are removed. Gene-modification is when new genes are introduced to and grow into DNA. I believe people will be more open to the idea of gene-editing compared to gene-modification because nothing is being added. Thus, there is less of a likelihood of genetic disruption because there is more control in where to cut the DNA rather than trying to insert a new gene. These ideas are still being developed and I am excited to see where they go in the future and how society reacts to them.

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Known as one of the most devastating diseases humanity has ever faced, Smallpox killed 300 million people in the 20^th century. The disease is transmissible by face to face contact, infected bodily fluids and scabs, contaminated objects, and airborne. It has been eradicated since 1980, and in the 1970s, routine smallpox vaccination ceased.

If you had smallpox when it first appeared, everyone could tell because of the pustules on your skin. In the 17^th and 18^th centuries, approximately one-third of the population in London was scarred and two-thirds were blind. The variola major type of smallpox had a 30% mortality rate; whereas, the variola minor type of smallpox had a 1% mortality rate. The spread of smallpox was rapid due to wars, movements of populations, trade routes and caravans, and the slave trade. There were many supposed remedies for smallpox, to include, bloodletting, leeches, fasting, laxatives, purgatives, diuretics, heat therapy, and cold therapy.

There was nothing that had any effect on the mortality of smallpox until inoculation was created. Inoculation involved having a sample of smallpox scraped onto the arm—or thigh for some women. This cause a few pustules to appear; however, they did not become infected with smallpox. In 1746, data from the London Smallpox and Inoculation Hospital showed that the mortality rate for smallpox was 20%. If patients had inoculation, their mortality rate was lowered to 1%. In the 1760s, changes were made to inoculation to make it more safe. These changes included smaller incisions, less preparation time, isolation of inoculees, and simultaneous inoculation of groups.

In the 1760s, it was also discovered that chickenpox is not the same as smallpox. In 1796, Edward Jenner discovered the smallpox vaccine. Jenner had heard about milkmaids who had gotten cowpox and then were resistant to smallpox. Jenner tried his first experiment with smallpox vaccination on his son. Jenner inoculated his son with swinepox. His son then was inoculated with smallpox and did not become infected. Jenner made the inference that it must have been the swinepox inoculation that prevented him from getting smallpox. Jenner published his work and word traveled around Europe. The vaccine was passed from arm to arm of orphaned children to keep the vaccine viable.

Although this vaccination could prevent many people from dying of smallpox, it was still not supported by everyone. Reasons for being anti-vaccine included inoculators losing money, idea of reduction in poor population, interference with God’s plan, questions of safety, source of vaccine, and unknown duration of immunity. Even with these objections, data was provided which supported the vaccine as far as prevention. Data was collected from 1919-1928 on incidences of smallpox in areas with compulsory laws, local options, no laws, and laws prohibiting compulsory vaccination. In areas with compulsory laws, there was a 6.6% incidence rate of smallpox. For areas with local options, there was a 51.3% incidence rate of smallpox. In areas with no laws, there was a 66.7% incidence rate of smallpox. Lastly, in areas with laws prohibiting compulsory vaccination, there was a 115.2% incidence rate of smallpox.

Luckily, smallpox was eradicated using surveillance and containment. When someone was found to have smallpox, they were isolated to contain the disease. Then everyone around them was vaccinated to prevent the disease from spreading. The difficulty with this was finding those infected with smallpox before they transmitted the disease to others. WHO declared eradication of smallpox in 1980.

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Ethics in studies have been, and continue to be an issue. Since ethics may differ from person to person, it is hard to generalize to create guidelines for research. Should we be able to isolate people because they might have an infectious disease? Should we be able to require everyone to get a vaccination? These are just a couple of questions that infectious diseases have seen controversy over.

An example of a study that had major implications on the guidelines for ethics of infectious diseases is the Tuskegee syphilis study. In this study, government doctors offered treatment for black men infected with syphilis. The subjects were not told that they had syphilis and endured painful spinal taps. The research was done to see the long-term effects of syphilis. This study was unethical because it denied patients treatment, which caused many of them to die. The doctor who oversaw the study was—and still—believed what he was doing was ethical. He rationalized the harm of the subjects with the benefits he thought it would give to society and medicine.

Another example of a study that had a large impact on the guidelines for ethics of infectious diseases is the Guatemala venereal disease study. In this study, researchers infected prisoners in Guatemala with gonorrhea or syphilis. They were not told they were being infected, and again, many of the subjects died because of the study.  The study was also rationalized in the same manner as the Tuskegee study.

One of the many problems unethical studies create is the distrust for medical professionals. Who would want to go to the doctor thinking you could end up a part of a study where you are infected with a disease or not properly treated? In addition, no one would want to participate in other studies that do not cause harm and would benefit society. If no one trusts the doctors, who is going to treat those that do become ill? A lack of trust in the medical field would probably result in a dramatic increase in illnesses.

So how do you overcome these ethical dilemmas? By setting guidelines for research, ethics may still be held at a standard allowing for trust in medical professionals. Although there are always ethical dilemmas occurring in the medical field, these guidelines can keep the medical professionals from veering into the wrong direction that will harm society.

There have been three waves of plagues: the Justinian plague, the Black Death, and the modern plague. The first epidemic plague was the Justinian plague, which occurred in approximately 542 A.D. The next epidemic plague occurred in 1347 A.D. and was called the Black Death. The third epidemic plague is referred to as the modern plague and began around 1894 A.D. Throughout all of this time, many factors have contributed to the plague and enhanced vulnerability to the epidemic. There have also been different responses from society based on the changes of fear and blame. The effects of the plague have also changed over time. Today, we know more about the transmission of the plague and have established protocols to prevent the transmission.

Factors that contributed to the plague include climate change, lack of sanitation, trade routes, and merchant ships. Trade routes and merchant ships were the main causes for widespread transmission of the disease because they took infected rats into uninfected areas. Society responded out of fear by blaming miraculous events, an imbalance of the elements in the body, evil vapors, and Jews. In an effort to end the plague, people began to pray, hire people from the countryside to bury the dead, and attack Jews’—blaming them for poisoning the village. They also enacted protocols such as a cordon sanitaire—not allowing anyone in or out of the village—which actually spread it by isolating uninfected people with infected people. As a result of the plague, there was a large number of deaths, fear, imitations of Christ’s suffering, witch hunts, and peasants became more wealthy (because they were being paid to bury the dead).

The last plague epidemic in the U.S. occurred in 1924 in Los Angeles, CA. It began in October and was controlled with the month. It began with a patient who claimed to find a rotting rat in his home and picked it up to throw it away, which is likely where the plague originated from. Within a week, the man’s family of eight was dead. Luckily, Los Angeles had learned from past plague epidemics and quickly implemented measures to prevent the transmission of the plague in order to control it. These measures included hospitalizing the sick and anyone that had come into contact with them, a neighborhood quarantine, and a large-scale rat eradication. We now know that fleas infected with Yersinia Pestis would infect and live on rats. Once the rat died, they would need a new host, which ended up being humans. Plague bacteria would starve the flea by causing a build-up in a biofilm. In order to try and clear the blockage, fleas would bite a human, then the flea would puke the blood back into the wound, and as a result, chunks of plague bacillus would also get into the wound.

A more recent instance of the plague occurred in Madagascar in the 1990s, and became epidemic around 2009. Poor hygiene, poverty, political upheaval, health clinics closing, lack of clean water, and accumulated trash attracted rats infected with the plague to Madagascar. Another factor that brought rats closer to humans was the fact that they kept crops inside, food for rats, which carried infected fleas. Many people also unbury the dead in order to consult with them, thus spreading the plague.

Despite the knowledge that we now have about the plague and other diseases, they still re-emerge with new adaptations that we must face. Our society will continue to adapt and change to prevent such diseases; however, the diseases will adapt to infect our society at the same time.

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Throughout history, there have always been diseases; however, the widespread transmission of diseases and plagues did not appear until around 8000 BCE. These epidemics likely began to spread because of the change from hunting and gathering, to farming and domesticating animals. This change allowed groups to settle into one area; thus, allowing for population to significantly increase. The birth interval was reduced to just two years for farmers. This makes sense because as hunter-gatherers, they had to carry everything—including children. Hunter-gatherers also had different types of diseases. For instance, they faced intestinal worms, lice, fleas, and microbes from wild animals. However, the entire group was never affected because the means of transmission were not available. Once the change from hunter-gatherer occurred, individuals began living in close proximity to one another, they used human excrement and animal feces for fertilizer, and lived closely with domesticated animals. All of this allowed for diseases to quickly be transmitted from person to person.

These villages were often heaven for rats, mice, ticks, flies, mosquitoes, and other vectors due to the lack of sanitation. Since most villages only grew one crop, individuals also suffered from a lack of nutrition. Domesticated animals typically lived in the house with people, thus further subjecting individuals to vectors. Domesticated animals also brought a lot to the table as far as contributions go. They provided milk, meat, manure for fertilizer, wool for clothes, and a mode of transportation. Although these benefits from animals were great, epidemics evolved from animals, making them the main cause of epidemics in humans. Diseases like smallpox, influenza, TB, malaria, plague, measles, and cholera adapted to humans, then allowed for human to human transmission.

As humans began to create advancements in farming, they also created avenues of transmission. For example, ditches and irrigation systems allowed for better farming by drowning weds that may compete with crops, but it also acted as a breeding pool for vectors. This is how Schistosoma (blood fluke) first appeared in humans. Aquatic snails acted as a vector and penetrated the skin of humans as they swam or waded in the water.

What do plagues look like now? They are much more controlled. We now have vaccinations and ways to treat these illnesses so they do not spread as quickly or as much. We supposedly eliminated measles—a highly contagious illness that can lead to death—in 2004. However, there were over two-hundred and fifty cases of measles in 2014, ten years after we supposedly eliminated the illness. The two-hundred and eighty-eight cases can be attributed to fifteen outbreaks that caused about five cases each. Even though we still have outbreaks for an illness that we supposedly eliminated, we have significantly cut down the number of cases in the last decade or so. We are still doing research and finding new ways to prevent outbreaks, and I have no doubt that we will have even less outbreaks in the years to come.

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References

Measles — United States, January 1–May 23, 2014. (2014, June 06). Retrieved February 09, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6322a4.htm

Sherman, I. W. (2006). The power of plagues. Washington, D.C.: ASM Press.