Sarah Dolitsky                                                                       Help Received: Previous Artifacts,

Dr. Hinks                                                                              Films, PowerPoints, & Class Notes

BI-245X-01

6 MAY 2019

Word Count: 958

Final Reflective Essay

            Reflecting back on this semester of Epidemics and Society, I have come to realize the immense impact a society has on a disease and vice versa. Growing up I was slightly ignorant when it came to diseases, only knowing that I got vaccines to keep me healthy. The only infectious disease I can recall growing up was the H1N1 “swine flu” that terrified people. Since I was never directly affected by anything of this nature, I never realized the impact these diseases had on our society as a whole.

After taking Epidemics and Society I now know how truly fatal and contagious many of these infectious diseases are. For example, after writing artifact #3 (The Black Death: A Plague with No Mercy)concerning the “Black Plague,” I finally realized how extreme the amount of deaths were and how easily this disease was transmitted. In this artifact I wrote, “In 1346, the second known pandemic, The Black Plague, began and by the time it was through in 1353, 80-100 million people had been victim to it.” In addition to those immense numbers, I also learned the effect this plague had on society at the time. Since the culture in the 1300’s revolved around religion, people believed the plague was a result of impurity, so they began to clean their act up, removing all prostitutes and watching their word choice for cuss words. This shows the direct effect the infectious disease had on a society as a whole.

An example of the alternative relationship, a society’s effect on an infectious disease, artifact #6 (The Killing Potatoes & a Current Attempt to Fight it with Technology), demonstrated how a common cultural tendency lead to an infectious outbreak. Due to a large increase in the Irish population in the 1700’s and 1800’s, food supply became a large problem. The Irish began to depend on potatoes as their primary source of food and nutrients. Therefore, when a blight infected a large majority of the potatoes, the disease rapidly infected the Irish population. Due to their cultural dependency on potatoes, this infectious disease was effectively able to spread amongst many people with ease. Furthermore, I learned through this artifact that some infectious diseases can pave way for other diseases to flourish as well. In this artifact I stated, “Another major consequence of the potato blight aside from starvation and malnutrition, were that those that were already malnourished became more vulnerable to other diseases such as Measles, diarrhea, TB, and Cholera.”

Another strong example of society’s direct effect on the spreading of a disease can be found in artifact #8 (Deadly Cholera: Contaminated Water that Results in Rice Water). In this artifact I wrote, “Dating to before the first pandemic, an endemic of the disease is known to have been associated in India and traced to crowds in the river Ganges. The disease spread from India to other countries when British war ships entering and leaving India spread it elsewhere in 1816. This spread of cholera lead to the first pandemic of it. In addition to British troop spreading cholera elsewhere, trade routes allowed cholera to be transmitted to China, Japan, the Philippines, Persian Gulf, Africa, and Central Asia.” There are many examples of societal influence on cholera in this quoted section. For one, crowded rivers in India were due to the fact that populations were heavy and water resources were not. Another societal factor that is often forgotten is the impact of war and trade. Soldiers, as well as traders, traveling from country to country, makes it easy for them to contract a disease that may be centralized in one area and assist the disease in spreading to wherever they travel next. Furthermore, currently cholera is an issue in Africa because of how impoverished and deficient they are in water resources. Since their culture is so poor, they do not have the proper funds for water sanitation and therefore they’re forced to drink horribly infected water. Through this unfortunate cultural deficiency, the infectious disease of cholera is able to disperse throughout the African population.

On a more optimistic note, a way in which society has successfully taken a stand in attempting to fight these infectious diseases can be seen through the abundance of vaccines. For example, in artifact #4 (Smallpox: Quack Treatments as Well as Effective Treatments), a very successful vaccine was developed eventually. Initially, medical professionals, as well as ordinary citizens, turned to any possible method for a cure such as: bloodlettings, leeches, fasting, laxatives, heat therapy, and cold therapy. Although none of these early remedies were ever proven to work, they paved the way for interest and attempt in stopping the spread of smallpox. Eventually, Edward Jenner discovered a vaccine for smallpox in 1796 and began to administer it to whoever was interested. Socially, the vaccine received backlash from people claiming it to interfere with God’s plan as well as uncertainty regarding its safety. However, people eventually started to see the positive effects it had against the disease and vaccinating became more popular.

This is relevant in today’s society with vaccines of this nature because there is still some negative backlash against vaccines and uncertainties concerning them, however, medically we know as majority that they are extremely effective against diseases. After taking this course, I now have much further insight into the true effectiveness of vaccines as well as the fatality and societal effect both towards and from infectious diseases. I was able to learn both: how diseases can affect a culture, such as with the black plague causing fear for a society to purify and change how they act; and, how a culture can affect a disease, such as the Irish contracting the potato blight due to their dependence on potatoes.

The Diagnosis and Treatment of Rabies

Sarah M. Dolitsky

Virginia Military Institute

Word Count: 1,389 words

Author Note

Help Received: References

The Diagnosis and Treatment of Rabies

            The virus that causes rabies is known as lyssavirus, named after Lyssa, the Greek Goddess of rage (Evans, 2017). This is fitting considering that later symptoms of the one type of the disease are aggressiveness, hallucinations, seizures, and delirium. Initial symptoms for both types of rabies include discomfort, an itching sensation, anxiety, confusion, fear of water, difficulty swallowing, and agitation (CDC, 2011). Rabies is transmitted when the saliva of an infected animal comes into contact with another animal or human, typically through a bite. Rabies, which can be a fatal disease if left untreated, can be prevented and treated. The current paper will examine the various methods of diagnosing as well as treating the infectious disease known as rabies.

First off, diagnosing rabies is critical since, as previously states, the disease can be fatal. Since rabies, is so rare it is sometimes difficult to treat without conducting tests especially since the infected person may be unaware of a bite mark from an infected animal. This is because the incubation period of rabies typically one to three months but could be as short as a few days or as long as a year. As for diagnosing rabies, there are two clinical forms: encephalitic, known as furious, and paralytic, known as dumb. The former makes up for 80% of cases while the latter makes up the remaining 20% of rabies cases (Jackson, 2009). The symptoms for furious rabies are exactly how it sounds and how many typically stereotype rabies; aggression, madness, hallucinations, and rage. On the other hand, the symptoms for dumb rabies are less known, which are paralysis, coma, multiple organ failure, and eventual death. The laboratory tests should focus on detecting the virus antigen or RNA in tissues or fluids of the human infected. For example, Cerebrospinal fluid or CSF, often shows abnormal results for those infected with rabies. To be more specific, the white blood cell count detected in a CSF sample tends to be less than 100 cells/μL (Jackson, 2009).

Further methods for diagnosing rabies include taking a skin biopsy or a brain biopsy. A skin biopsy can be taken from the nape of the neck which contains hair follicles making it more detectable. This method is more useful than a brain biopsy since a brain biopsy can only be used to assess rabies postmortem or after the infected person has already died. However, the brain biopsy can still be used to give information on the victim’s extent and/or type of rabies. More so, the brain biopsy is specifically useful for its accuracy. Rabies cannot be excluded due to negative tests unless it’s a brain tissue test. This means that if a CSF sample or skin biopsy comes up negative for rabies, the patient could still have rabies, but if a brain biopsy comes up negative, there’s no chance the person had rabies (Jackson, 2009).

Rabies can also be diagnosed through bodily fluids such as saliva and urine, however, similar to CSF samples and skin biopsies, these may not always show up positive on initial testing. This is because the virus is not continuously shed by those infected with it, meaning it’d be a hit or miss whether a sample was collected while the infected person was shedding the virus (Nigg & Walker, 2009). The method for these kinds of bodily fluid tests are known as Direct Fluorescent Antibody Technique (DFA) and they’re applicable for almost all tissue sources in living patients (Yousaf et al., 2012).

Another method that could work for diagnosing rabies is Magnetic Resonance Imaging (MRI) of the brainstem, hippocampus, and/or hypothalamus regions. Abnormal scans can appear in these three regions when a person is infected, but the degree may vary on a wide scale depending on the stage of rabies the infected person currently has. It’s also very important to note that the reason laboratory testing is so necessary for diagnosing rabies is because there are many other medical conditions that have similar symptoms of paralytic rabies. These conditions include “Guillain Barre syndrome, Japanese encephalitis, cerebral malaria, and the West Nile Virus” (Nigg & Walker, 2009). This is important to know because a disease as fatal as rabies should be diagnosed and treated as soon as possible, which could be delayed if a misdiagnosis were to occur. To summarize diagnosing rabies, no one test is sufficient. Multiple tests should be run in congruency in order to accurately diagnose rabies (CDC, 2011).

Anytime a human is bit by any sort of animal, to include: dogs, cats, ferrets, raccoons, or bats, the animal is supposed to be captured and observed for a minimum of ten days. If any signs of rabies are shown while the animal is confined, they are supposed to be killed and beheaded, so the head could be refrigerated and transported for laboratory research examination. Then, the same methods for diagnosing rabies in humans are used to try and diagnose it in the deceased animal’s head. This is to better locate and prevent the spread of any further rabies from a certain area through more of those specific animals (Jackson, 2009).

When it comes to treating humans with rabies, the main focus is the rabies vaccine. Prior to administering the vaccine though, the wound (if found) should be thoroughly cleaned with soap and water (Yousaf et al., 2012). As for how the vaccine is used, it depends if the infected person has had their vaccine in the past two years or not. If the person infected has had their vaccine with in the past two years, they will be treated with 1 ml of the rabies vaccine on days zero and three since being diagnosed. For those infected who have not had a rabies vaccine with in the last two years, it’s recommended that they receive the same 1 ml dose of the rabies vaccine on days zero, three, seven, and fourteen. In addition to the vaccine, these people should also receive doses of human rabies immune globulin (HRIG) on days zero through seven at the dose of 20 IU/kg. The rabies vaccine is considered active immunization and should be injected into the deltoid muscle on the infected individual. The vaccine comes from a rabies strain grown on a human diploid cell culture (Nigg & Walker, 2009).

HRIG is considered passive immunization since it works by passively providing immunization by making viral antibodies neutral. HRIG is administered by injecting it into the muscle nearest the rabies bite on an infected person. The products that make HRIG come from human donors, making them effective but expensive. These should only be used on an infected person who has not had their rabies vaccine within the last two years (Nigg & Walker, 2009).

In conclusion, there are two types of rabies: encephalitic rabies, characterized my rage/madness and paralytic rabies, characterized by paralysis. These types of rabies could be initially diagnosed through their symptoms. However, to fully diagnose an infected person with rabies, multiple laboratory tests must be run congruently. Tests can be run using CSF samples, bodily fluids like saliva or urine, skin biopsies from the nape of the neck, or brain biopsies from specific locations. Since sometimes a rabies infected person’s tests will appear negative, multiple tests must be used and tested multiple times. Once diagnosed, the infected person should thoroughly clean their wound with soap and water. Once that’s been done, there are two different methods of treatment dependent upon how recently the infected person has had their rabies vaccine. If the person has had their vaccine within the last two years, they will be treated with just the active immunization of the rabies vaccine over multiple days. However, if the infected person has not had their rabies vaccine within the last two years, they will be treated with both the active immunization of the vaccine as well as the passive immunization of human rabies immune globulin (HRIG) for multiple days straight. Properly diagnosing and treating rabies is important due to how fatal the infectious disease could be. Aside from just the fatality of it, the symptoms of the infection are extreme and can be detrimental even if the infected person survives. By educating people on proper diagnosis and treatment of it, rabies can be more quickly diagnosed as well as better prevented due to education regarding keeping up to date with vaccines.

References

Evans, K. (2017, April 12). A brief history of rabies. Retrieved April 29, 2019, from https://www.labroots.com/trending/microbiology/5761/brief-history-rabies

Jackson, A.C. (2009). Update on rabies diagnosis and treatment. Current Infectious Disease Reports, 11(4), 296-301.

Nigg, A.J. & Walker, P.L. (2009). Overview, prevention, and treatment of rabies. Pharmacotherapy, 29(10), 1182-1195.

Rabies. (2011, September 20). Retrieved from https://www.cdc.gov/rabies/diagnosis/animals-humans.html

Yousaf, M.Z., Qasim, M., Zia, S., Khan, M.U., Ashfaq, U.A., & Khan, S. (2012). Rabies molecular virology, diagnosis, prevention and treatment. Virology Journal, 9(1), 1-5.

HIV Pandemic in China

            Some societal factors that have contributed to the pandemic of HIV in China are attitudes towards specific groups, fear, stigma, and shame. This is because the most prominent groups who have HIV in China are gay men and people who inject drugs. Since being gay is not widely accepted in China, men who are gay feel the need to live in secrecy and therefore have minimal understanding regarding the infectious nature of the disease since they cannot openly seek information on it. The risk is so high because these men unfortunately remain ignorant of what is considered risky behavior because everything already seems to be risk behavior for them, having secret relations. About a quarter of HIV cases in China come from homosexual men, with about a 9.9% prevalence rate among these men. As for people who inject drugs, they too hold a negative stigma against them in China. Since drug use is already illegal, just like the homosexual men, these drug users are ignorant to risky behaviors that can transmit HIV. In addition to that, even if they are aware, they are addicts and will use any materials for drug use they can get their hands on regardless of if it were previously used or not. Luckily, China has recognized this and began extensive treatment/prevention programs that include harm reduction interventions, methadone maintenance treatment clinics, and clean needle exchange projects. These programs have shown to be marginally helpful so far reducing the rate of people seeking the methadone treatment from 0.13% to 0.12% over the span of a year.

Some factors that have helped limit the ability of the HIV organism to spread further in China are the previously mentioned prevention programs, medically preventing mother-to-child transmission, and prevention of infected blood donations & transfusions. By preventing the spread of HIV from mother-to-child, a significant amount of cases are prevented since many people who have HIV choose to still have children. In addition to this, there are a number of pregnant women who don’t even realize that antenatal health services are an option and therefore either choose to have the child regardless or avoid pregnancy altogether. As of 2009, there have been no reported cases of children getting HIV even when born to HIV infected mothers. To prevent the transmission of HIV through infected blood transfusions, more funding has gone into screening for HIV for blood donations. Funding has increased all the way to one billion dollars towards blood donations in China.

One overall effect that the HIV pandemic has had on China’s society is infringing upon human rights of Chinese citizens. Since HIV activism is not as widely shown in China as it is in other countries around the world, the government has been accused of harassing, detaining, and censoring activist groups. Also, many federal laws protecting the rights of those with HIV are commonly undermined by lower authorities such as state police. Unfortunately, this further leads to more negative stigmas and discrimination against those with HIV in the Chinese society.

References (Help Received)

https://www.avert.org/professionals/hiv-around-world/asia-pacific/china

Deadly Cholera: Contaminated Water That Results in Rice Water

            There have already been seven pandemics of cholera that we know of. Dating to before the first pandemic, an endemic of the disease is known to have been associated in India and traced to crowds in the river Ganges. The disease spread from India to other countries when British war ships entering and leaving India spread it elsewhere in 1816. This spread of cholera lead to the first pandemic of it. In addition to British troop spreading cholera elsewhere, trade routes allowed cholera to be transmitted to China, Japan, the Philippines, Persian Gulf, Africa, and Central Asia. Along with trading resources and goods, slave trade made it easy to transmit cholera efficiently. Furthermore, cholera was further spread by Chinese soft-shell turtles which allow the disease to hang on it and develop.

Another pandemic began in 1829, where it started in Russia and quickly made its way across Europe. Furthermore, the disease spread to Canada and New York when Irish immigrants immigrated there. From there the disease spread to the U.S. west coast as well as Mexico and Latin America. Port cities, such as New York, New Orleans, and Philadelphia, tended to get hit hard due to constant trade and immigration flowing through them. Since urbanization and immigration had become common, diseases like cholera flourished. This is because urbanization caused tight spaces with crowds and lower sanitation due to high populations and poverty. If water or food became infected with cholera it was easy to spread if people continuously kept taking from that same location.

A third pandemic occurred between 1852 and 1863 and is thought to have been the deadliest of the cholera pandemics. This pandemic was associated with Africa, the U.S. the Middle East, Europe, and India. During this outbreak, John Snow, with the help of Henry Whitehead, published groundbreaking studies on Cholera. Snow observed that in the Epidemic Soho area of London, water was being taken from polluted areas. This led Snow to believe contaminated water was causing cholera. Once he had knowledge to believe this to be true, the handle on the water pump on Broad Street was removed and deaths from cholera began to decrease. Although Snow hypothesized water causing cholera, he never truly determined the bacterial root cause of it. Around the same time as Snow’s research, a researcher named Filippo Pacini identified the cholera bacterium. Unfortunately, he did not get recognized for this discovery until after his death when Dr. Robert Koch identified the same bacteria in 1883. Once the bacteria was identified, it could be properly prevented and treated in the area’s where it was found such as Calcutta.

As for cholera outbreaks in the 21^stcentury, Africa still has many cases of it. This is mainly due to poor water quality as well as poor sanitation. In these impoverished areas, water is rare to come by so people drink whatever they can find. Since poverty in Africa is so prevalent, many health sanitation systems and hospitals had closed down due to a lack in economics. In 2010, an outbreak began in Haiti following the enormous earthquake they experienced. The earthquake caused fecal matter to contaminate the Artibonite River, one of Haiti’s prime sources for drinking water. As of January 2017, Haiti has been receiving assistance from the U.S. National Institutes of Health in order to provide vaccines. Unfortunately, in October 2016 Hurricane Matthew had hit Haiti, which caused even more people in Haiti in need of homes and health assistance, as well as a further spread of cholera that came with a decrease in available drinking water. As of now, Haiti needs approximately $66 million for water sanitation and hygiene interventions to eliminate the transmission of cholera. However, in the meantime, oral vaccines have been brought in affordable, large amounts to Haiti to fight cholera and public health research remains to occur.

References (Help Received)

Sherman, I.W. (2017). The Power of Plagues (2^nded.). Washington, D.C.: ASM Press.

“Eliminating Cholera Transmission in Haiti” article (New England Journal of Medicine)

Cholera PowerPoint

Tuberculosis: A Silent Killer with a Not So Silent History

            Tuberculosis, commonly called “the people’s plague,” was highly romanticized in culture. Ranging from movie characters romantically dying from it to famous musicians like Chopin having it, people saw it as beautiful. The people of the time referred to the disease as “consumption” and believed that TB made faces look sensitive and eyes sparkling. People thought this even though TB at the time meant an absolute death.

Although Tuberculosis or TB dates back further than recorded history, having been found in the spines of Egyptian Mummies, it is well known during the 19^thcentury when immigration to U.S. tenements was causing malnutrition, crowding, and poverty. A big reason for why immigration like this made people susceptible to TB was because of poor working conditions and overcrowding. Since TB is spread through spit and coughs, a crowded area allows TB to spread like wildfire with everyone in range to receive it from nearby coughers with it. In most of the crowded city tenements there were no windows or ventilation, so the disease remained essentially trapped with those inside.

In a more contemporary spotlight, TB is prevalent in more impoverished countries today. For example, in the film Silent Killer, TB is seen throughout families in the South African nation of Swaziland. A big thing to note here is that HIV is also very prevalent in this nation, which makes the immune system very weak and more susceptible to getting a disease such as TB. Similar to HIV, TB in this area also comes with a social stigma where people do not want to go near those infected. As a result of this, many people here try to hide the fact that they have TB which only allows it to spread more. While trying to hide this disease, they often won’t seek treatment for it, which just keeps them sick and contagious, making it difficult to put an end to TB. In addition to HIV, malnutrition and poverty play a similar role as well. Just like the historical example of immigration into overcrowded tenements, the people in Swaziland do not have the best living conditions either. In a specific example from the film, a brother and sister took care of their mother who suffered and died from TB. Shortly after her death, it was found that the little sister had contracted TB from their mother, most likely due to the close contact she had with her mom. Since these areas in South Africa are impoverished, the home the brother and sister live in only has one bedroom, so the sister has to leave to go to a hospital, so her brother does not get the disease from her.

Some factors that have led to Multi-Drug Resistant TB (MDR-TB) and Extremely Drug Resistant TB (XDR-TB), are people either not seeking treatment once sick with TB or people quitting their medication before they’ve completed them. These evolved forms of TB are much more difficult now because they require drug cocktails that may not even work once it’s at the point of XDR-TB. Also, if it weren’t already difficult enough to deal with the side effects of the drugs for regular TB, the concoction of drugs for the evolved forms of it prove even worse. For example, a known side effect for treating MDR-TB is permanent hearing loss.

Overall, there are a few things that must happen to conquer TB. One thing that was more prominent in the 19^thcentury but may still remain alive today due to romantic films, is the romanticizing of TB. That needs to stop in order to get over TB because if people still find the disease beautiful, they will avoid seeking treatment for it and even possibly want it like people did in the 19^thcentury. More applicable today is the notion that people need to straight up seek treatment when they get TB. The social stigma associated with it needs to vanish or be seen past so people don’t need to try and hide that they have it. By hiding it and not getting the treatment they need, the disease is able to spread to more and more people. Lastly, people need to stick with and complete their medication once they begin it, so MDR-TB and XDR-TB become less prominent and stop mutating. Once these evolved forms of TB start to occur, treating TB is very difficult especially in impoverished countries that usually don’t have all the proper medication. It’s important to seek an absolute end to TB because the disease is a miserable one that often proves fatal. In addition, now that it has begun to evolve, it is becoming so much harder to treat and will continue down that path until it is stopped.

References (Help Received)

Sherman, I.W. (2017). The Power of Plagues (2^nded.). Washington, D.C.: ASM Press.

Silent Killer film

Tuberculosis PowerPoint

The Killing Potatoes & A Current Attempt to Fight it with Technology

            With an increase from 3.5 to 8 million, the Irish population more than doubled between 1700 and 1840. With increases this big, housing and food resources often become a large problem. That being said, the Irish depended on the potato as a main source of food due to its high calories with nutrients and its easy labor. However, between 1845 and 1852, their potatoes became ruined by blight. The pathogen associated with this blight was a fungus calledPhytophthora infestans. Some factors in society that lead to this blight infestation were the changes in migration since the strain of infestans were thought to have made its way to Ireland after cruising on ships from Mexico, North America, and Europe. A huge consequence of this blight was the large increase in starvation and therefore a direct decrease in the Irish population. Another major consequence of the potato blight aside from starvation and malnutrition, were that those that were already malnourished became more vulnerable to other diseases such as Measles, diarrhea, TB, and Cholera. As for Diarrheal diseases, these came as a result of the subpar hygiene, poor sanitation and alteration in diets (lack of potato’s nutrients).

With technology increasing constantly, plant/animal modification has become a large controversy. Although it has many benefits, people are still skeptical about altering life. Some benefits of these modifications include creating crops that cannot be harmed by pathogens such a blight as we saw between 1845 and 1852. This is obviously important because crops can be protected from many different fungi that can harm humans. In addition to this, these genetically modified potatoes have been approved by the FDA deeming them safe. Another positive of these newly approved genetically modified potatoes, is that they reduce the use of fungicide in half. Even though these GMO potatoes have been deemed safe, many people consider their use unethical since nature is being altered. Certain food establishments refuse to use them including McDonalds. Another positive for genome editing crops is a rapid increase in food production. However, with this comes a negative of taking away jobs that farmers currently hold. If their crops rapidly increase, their value will decrease, and the farmers could be driven out of work. Another negative of genome editing is the lack of knowledge we still have on connecting genotypes and phenotypes. As a result of this lack of knowledge, many of these genome-edited crops have in the past and currently struggled with being regulated by the government, FDA, and publicly accepted. Personally, my view on GMOs and genome-edited crops is a positive one. I believe in a quick paced economy and life like the one we live in, efficiency is important. In addition to more rapid production, many of these GMOs, such as the potatoes, have been created to actually be safer and help us avoid bacteria and fungi. However, I do agree that these GMOs should have to be approved by the FDA before they’re accepted but once approved I believe they are safe.

Help Received

Irish Potato Famine PowerPoint

Irish Potato Blight PDF (supplementary reading)

Irish Potato Blight films

FDA approved genetically engineered potatoes (supplementary reading)

Genome editors take on crops (supplementary reading)

Tuskegee Syphilis Study: When Research Goes Too Far

When it comes to ethical issues, there are some that surround infectious disease and the treatment/research involved with them. Sometimes the best way to keep an infectious disease from spreading is to keep the infected person in quarantine, or isolated from the rest of society. This is a difficult area, ethically, because sometimes the infected person does not consent to being isolated. Ethical issues also come into play with vaccinations. For example, with the smallpox vaccine, certain countries began to make the vaccine lawfully mandatory. Some people felt this was unethical and against their rights. Therefore, this method of required vaccines drifted away with smallpox at the time.

As for the Tuskegee Syphilis Study, there were many ethical issues involved. For one, only one race and gender of people were used in the study, African men. This clearly shows discrimination of subjects. However, even worse was the fact that these men were all poor and could not afford health care, so a study like this appeared to be a good opportunity for them to get health care even if it were experimental. Once the study began, the researchers lied to the participants telling them that the spinal tap was a treatment they were lucky to be getting. This made the painful spinal tap, seem like a privilege to the poor men involved. The arguably most unethical part of the study, however, was the fact that treatment for syphilis had been found but the study’s participants were withheld from using it, so they could further be studied. The study was rationalized originally for learning more about syphilis and a cure. Then it was said to be studied because the researchers believed that African Americans responded to syphilis differently. Lastly, the researchers attempted to justify their study as being ethical because they were researching the effects of syphilis over time on untreated participants.

The potential consequences for unethical studies such as the one mentioned above, is a lack of trust in future research studies. For example, since the Tuskegee Syphilis Study contained only African Americans, there’s a high possibility African Americans will no longer consent to participate in future studies on anything. This is because they may have lost trust in this kind of research just because of one horribly unethical study. Even further, they might not even trust medical professionals at health centers and hospitals due to the research done on the African American men in Tuskegee.

References/Help Received

• Tuskegee Syphilis Film
• Canvas Page Syphilis

Prompt 2:Smallpox: Quack Treatments as Well as Effective Treatments

            As smallpox progressed and killed many, people started turning to any remedy or treatment possible. Examples of early, but futile, remedies were bloodletting, leeches, fasting, laxatives, purgatives, diuretics, heat/sweat therapy, and cold therapy. Similar to the black plague, many of these remedies were used because medicine was not very advanced, but people believed them to be effective. In addition to these treatments, ceremonies to appease the Goddess of Smallpox was publicly held since many turned to religion for answers. More so, many Gods and Goddesses were worshipped as a means to try and end the spread of the disease. For example, in Hindu culture, the Goddess Shitala was worshipped and in Japanese culture Red Treatment was used through wall hangings/art. Red treatment was the idea that heat therapy worked so anything red like fire would get rid of smallpox (red clothes, red walls, open fire). This treatment started in Japan and continued to be used in Europe. Another practice of defense against smallpox was inoculation which meant “giving eyes.” This was punctures put in areas of the skin and believed to cure smallpox since some random cases of it had worked. This practice was furthered continued by Sutton who made modifications for them to be further accepted in England (1760’s). His modifications included smaller incisions, less preparation time, insolation of inoculees, and simultaneous inoculation of groups.

A truly effective treatment was introduced in 1796 when Edward Jenner discovered a smallpox vaccine. Jenner had been inoculated at age 8 and was studying to become a surgeon. As for his vaccination, he had collected milkmaids who had cowpox and were resistance to the smallpox inoculation. The responses Jenner got for his vaccine were positive and grateful, referring to it as a precious discovery. Even though most were positive responses, some objections still remained, including: that smallpox reduces the poor population, that the vaccine interferes with God’s plan, and uncertainty about its safety. Another problem with the vaccination that remained was the chance of other bloods diseases being spread by use of the arm-to-arm method. In countries that had compulsory vaccine laws, lower mortalities were seen, however, many countries still protested these laws. Many people believed it was considered cruel and inhumane to have a law requiring vaccines since many believed them to be unsafe.

In order to officially eradicate smallpox, many surveillance and containment efforts were used by medical professionals and scientists. For one, propaganda posters were enforced in many areas to influence people to willingly get the vaccination. These scientists and medical professionals kept an eye on where in the world outbreaks were still occurring once people began obeying the need to get vaccinated. For example, Canada was recorded to become smallpox free in 1944 while small outbreaks still remained in the U.S. due to imports. Luckily, the few outbreaks scared much of the nation into pursuing vaccination to avoid the disease, therefore containing it to small outbreaks that eventually died down. More so, potent vaccinations were being used for tropical climates in the 1950’s to contain the disease. Selective control methods were further implicated as the disease dwindled down rather than mass vaccination. This meant scientists were finding specific cases of people and then vaccinating all those they had contact with. Eventually easy to use needles known as Bifurcated Needles, came out, making it much more practical and simpler for anyone to inject the vaccine anywhere. This helped to further contain the disease since people desiring the vaccine, did not have to go out of their way to find it. Finally, with the last case of smallpox appearing in Jenner’s homeland due to its escape from a research facility, smallpox became eradicated. However, the U.S. still has enough vaccination for each citizen in case of an emergency outbreak.

References

Sherman, I.W. (2017). The Power of Plagues (2^nded.). Washington, D.C.: ASM Press.

PowerPoint: Smallpox- The Speckled Monster

In class handouts

The Black Death: A Plague with No Mercy

            Many have heard of the great plague or black death; however, most do not know the true horror that surrounded it at the time. In 1346, the second known pandemic, The Black Plague, began and by the time it was through in 1353, 80-100 million people had been victim to it. In this paper, societal factors as well as responses and effects will be examined. In addition to the historical aspects, the effects of the Black Death will be examined and applied in today’s light.

As for societal factors that contributed to the epidemic, war and famine contributed to its spread. Since agriculture could not keep up with an increase in population as well as cold winters and rainy summers. As a result, poverty and famine occurred and people living in filthy overcrowded cities were perfect catalysts for the spread of a pandemic. As for war, since rats were carrying the plague, soldiers traveling on rat infested ships from country to country were becoming infected and spreading it wherever they went.

Responses to the initial spread of the black death were similar to how they tend to be today. At first people thought nothing of it and considered themselves safe. However, as soon as people realized the true severity of it, responses ranged all over the place. Since the time period was the 1300s and people were very religious, people assumed it was a big sin to blame for the pandemic. As a response, people started becoming as pure as possible and cleaning things up (no prostitutes, no swearing, etc.). More so, people would whip and murder themselves and each other to try and imitate Christ’s suffering as a sacrifice for an end to this big sin, or the plague. Outside of religion, some turned to men of medicine, which, in retrospect, was completely unsuccessful. As the film showed, even the most “successful” doctors of the time had no idea what he was dealing with. Doctors alike turned to obscene methods such as bloodletting with leaches as well as strange oils and clothes to cure the infected. People soon realized this was of no use. One final method used as a reaction to the plague was quarantine. In reality, had quarantine been used successfully, it would have worked. However, there was never true quarantine since many people still entered and exited areas once infected, continuing to spread the plague.

The overall effects of the black plague were an obscene decrease in the population at the time. Aside from that, the impact it had on society was a huge amount of fear, and in turn discrimination. Since many people turned to religion and medicine, both which produced no results, they were becoming fearful. Due to this fear, they began to blame the plague on certain groups of people such as the Jews or Christians. Depending on the location of the plague and therefore the cultural minority, one or the other would be blamed.

Relating the black plague to today, we now have a better idea on plague transmission. Knowing that the Bubonic plague was transmitted through a zoonotic source (rats) we can expect that today in other animals as well. More so, knowing that the pneumonic plague was transmitted through bloody spit, we can now better prepare for diseases spreading from the immune system. Knowing both these transmitters, we can prepare accordingly in our society to both sources.

Many people don’t know the plague re-emerged in Madagascar in the 1900’s and reached epidemic levels after 2009. Social factors that were involved in this re-emergence were rural houses being infected with many contagious rodents like prairie dogs, squirrels, mice, and rats. In addition to these vectors, domesticated animals such as dogs and cats, can also be to blame for spreading this. In Madagascar, they experienced a fatality rate of 23% for the pneumonic plague.

References

Sherman, I.W. (2017). The Power of Plagues (2^nded.). Washington, D.C.: ASM Press.

PowerPoint: The Price of Being Sedentary

In class handouts

The Emergence and Re-emergence of Diseases: Are We Ready for More?

            Emerging diseases are obviously significant because the human population has never been exposed to them, and therefore has no knowledge on how to counter them. However, re-emerging diseases are equally as threatening because they come back in adjusted strains that are more powerful against our body’s immune system. Since we are able to create vaccines to fight against them, the strains adjust in a way to trick our body’s and spread more effectively. For example, Ebola was first discovered in 1976 but kept under control in remote areas. However, in the 21^stcentury it re-emerged as an adjusted strain that tricked the human body into letting the virus in and making billions of copies of itself. As for zoonotic sources, these are dangerous because it is more difficult for us to pinpoint exactly which animal is carrying the disease. It is also more difficult to contain the disease when its carried in a zoonotic source, or animal, rather than a human. An example of zoonotic source is mosquitos carrying Zika.

One huge cultural problem associated with major outbreaks is containing it when it is found. As we saw in the film about Zika, Ebola, and Nipah; a lot of the places where these diseases originate are impoverish and culturally different than our Western Civilization. In one instance, Ebola was being spread because people would take care of their diseased love one and catch it. This is because medical centers and sanitation isn’t a huge part of their culture. Furthermore, these cultures often eat food with their hands which can also spread the diseases more easily than in our culture where we use utensils.

As for human responses to epidemics, humans seem to be a bit delayed. When a disease first emerges or re-emerges, people do not take it seriously. This concept is known as “outbreak culture.” They take everything for granted and go about their daily life. An example of this is the man who contracted Ebola and was told he was very sick and needed to stay in the hospital where he was visiting. He did not take the nurses serious and then flew by plane to another area in Africa, potentially spreading it to all passengers on his plane. Then he was finally hospitalized and kept attempting to remove himself from the hospital. He would unplug himself and constantly try to leave but the hospital staff fought hard against him. In the end he died and spread the disease to numerous members of the hospital staff.

Personally, I do not believe we are truly prepared for the next pandemic. I honestly think outbreak culture will continue to be a think and hinder our ability to control whatever disease begins to spread. Also, we were informed by Dr.Hinks, that from the beginning of an outbreak, it typically takes about 6 months to develop a vaccine to control the disease. Knowing this and the fact that people will not take the initial spread of the disease serious, I am worried for whatever comes next. If we want to be effective as a society against the next pandemic, I believe people need to be actively educated on just how dangerous it could be. Leading up to that time I think everyone should have a general knowledge about past pandemics and their severity, just as we are in this class. By knowing how fatal and severe they are, can actually scare people in to caring and reporting symptoms sooner than they would normally would.

Help Received: Film and handouts