Author Archives: johnsonac2025

Preventing a Pandemic – How Zika was Stopped

“In the April 2016, we described the rapid spread of Zika virus from East Africa, through Southeast Asia, and into South and Central America. At that time, the virus had not made significant inroads in the United States. Unfortunately, that is no longer the case. Short on funds and with no therapeutics or vaccines in sight, U.S. health officials are scrambling to prepare for a protracted fight with a tenacious foe.”

Chris Fellner, Pharmacy and Therapeutics, December 2016

            Before the current coronavirus pandemic, there was another infectious disease threat to the United States (U.S.) in 2016. Although it had been previously identified decades before, the Zika virus had not been considered a public health concern until it began to spread through the Americas in 2015. Graphic photographs of deformed newborns from infected women flooded the mass media and sparked fears that the United States was facing a devastating pandemic. With little known regarding transmission, prevention, or treatment, public health officials prepared for the worst. Fortunately, due to aggressive public health interventions, the Zika virus pandemic was rapidly extinguished in the United States and the response provides multiple lessons for the study and treatment of communicable diseases.

            Surprisingly, the Zika virus (ZIKV) was first isolated in the Zika Forest in Uganda in 1947. At that time, the virus was strictly enzootic, meaning confined to nonhuman animals, and transmitted via mosquitoes. When the virus migrated to Asia, a new lineage of the virus emerged in a type of mosquito, Aedes aegypti, which was capable of transmitting the virus to humans. Nevertheless, fewer than 20 mild cases had been reported before 2007. Subsequently, there were outbreaks in small Pacific islands in 2007 and 2013. In 2015, a pandemic was identified with cases in Africa, the Caribbean and the Americas. “The ZIKV pandemic was an example of a “perfect storm,” in which a new American subclade (strains isolated in the Americas) emerged from the Asian lineage of the virus and was introduced into a uniformly susceptible population that had not been previously exposed to ZIKV. The pandemic underscores the ability of the virus to be efficiently transmitted in Aedes-infested settings and to spread across regions through human mobility and travel (Musso 2019).”

            In addition to non-vector borne transmission via blood transfusion and maternal-fetal transmission, Zika was found to be unique from other arboviruses in that it may be transmitted through sexual contact. Clinically, 50-80% of infections are asymptomatic. “Maternal–fetal transmission of ZIKV may occur in all trimesters of pregnancy, whether infection in the mother is symptomatic or asymptomatic. Vertical transmission has been estimated to occur in 26% of fetuses of ZIKV-infected mothers in French Guiana, a percentage similar to transmission percentages that have been observed for other congenital infections (Musso 2019).” For symptomatic cases, illnesses are generally mild after a 3 to 14-day incubation period. Symptoms include rash, fever, arthralgia, myalgia, and conjunctivitis. Rarely, illness can be severe and fatal. The more severe manifestations include the following: Guillain-Barre syndrome, an autoimmune polyneuropathy (2-3/10,000 cases); thrombocytopenic purpura, a bleeding disorder with low platelets; and congenital zika, with microcephaly and devastating neurologic damage. As many as 5-14% of newborns born to infected women will be afflicted, with mortality as high as 4-7% in the first week of life. This high risk for often lethal congenital defects mobilized the response to this illness.

            The first step in the response to this pandemic was to develop adequate testing to identify infected individuals. The testing involves paired urine and blood samples which are checked initially for nucleic acid testing early in the illness and then for the presence of antibodies two weeks later. There can be some cross reactivity with other flaviviruses. Because testing may be less reliable during pregnancy, ultrasound can be used to look for the congenital neurologic deformities.  Because no anti-viral treatments have been approved for the illness, clinical care is mainly supportive and makes prevention even more important. Much of the preventative strategies revolve around vector-control strategies already associated with the Aedes mosquito. As per the EPA, in addition to individuals wearing appropriately protective clothing and repellants, the scientifically proven strategy to limit mosquito requires an integrated approach involving removing mosquito habitats, using structural barriers, controlling mosquitoes at the larval stage, and controlling adult mosquitoes (EPA 2020).” Tracing contacts and education were also especially in preventing the sexual transmission of the disease. Currently, clinical trials are underway in the development of a vaccine.

            With the World Health Organization officially declaring that Zika was a pandemic, resources were mobilized to quickly identify the causal link with birth defects. Within 3 years, over 6000 scientific publications have led to improved testing, tracking, and future vaccines. “The pandemic is illustrative of the universal failure of vector-control programs in regions where rapid urbanization and interconnectivity promote epidemic spread. However, new vector-control approaches, such as those that involve genetically modified mosquitoes, wolbachia-transfected mosquitoes, and pyriproxyfen-based larvicide, are under evaluation (Musso 2019).” The response allowed the U.S. to rapidly control the disease. According to the CDC, in 2016, there 5,168 symptomatic Zika disease cases in the U.S., the majority of which were from returning travelers. Nevertheless, 224 cases were identified to be due to local mosquito-borne transmission in Florida and Texas. By 2017, the local mosquito and sexually transmitted cases were down to a total of 15 in the U.S. In 2019, there have been no cases reported of transmission in the U.S., and only 19 cases in returning travelers. The combination of testing, reporting, and educating, both the public and providers, stopped the spread of Zika in the United States. Although the novel coronavirus has been more difficulty to stem, the response to the Zika pandemic demonstrated that a focused response, using a well-established scientific approach, may eradicate a public health threat.

Works Cited

“For Healthcare Providers.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Oct. 2018, www.cdc.gov/zika/hc-providers/index.html.

Fellner, Chris. “Zika in America: The Year in Review.” P & T : a peer-reviewed journal for formulary management vol. 41,12 (2016): 778-791.

Musso, Didier, et al. “Zika Virus Infection — After the Pandemic.” New England Journal of Medicine, vol. 381, no. 15, 2019, pp. 1444–1457., doi:10.1056/nejmra1808246.

“Success in Mosquito Control: An Integrated Approach.” EPA, Environmental Protection Agency, 11 Oct. 2016, www.epa.gov/mosquitocontrol/success-mosquito-control-integrated-approach.

             Throughout this semester, the assignments involving the research and discussion of infectious diseases has taught me a great deal regarding the impact of disease on society and the environment. The process has involved not just the study of the medical disease itself, but also the history of how long the disease has been around, ways people tried to combat against the disease too, and how it affected the society throughout the time the disease has been prevalent. The biggest impact on my perspective on these diseases was how they pushed people to create new medicines or new sanitation technology. What might have been one of the most revolutionary inventions was the creation of the vaccine. In artifact #4- The First Vaccination, I looked at how Edward Jenner first created a vaccine, in 1796, that combat smallpox, a disease that had been around since as early as the 3^rd century. This was a huge feat that paved the way for future medicine, and how many vaccines are made today. In 1979, the last of the disease was officially eradicated. This was only achieved with through the efforts of the World Health Organization, with assistance from other smaller groups. Techniques of surveillance and reporting cases of the disease were established, which helped the scientists track down people who contracted the disease. These techniques are still used today, such as in the spread of Ebola in 2014 and with the Covid-19 virus which is happening currently.

            The disease that has had the biggest impact on human history and completely changed society, was the Bubonic plague. With three known pandemics, the Black Death in the mid-1300s was the most severe, killing millions of people across Europe and Asia, in just a couple of years. I looked at this disease more in depth in artifact #3- Yersinia Pestis. This disease showed people that diseases can be spread from person-to-person contact, as was seen at the siege of Caffa. People who had died from the plague, were catapulted over the walls, to try and infect the people on the other side. Whether it was the bodies themselves, or the flies or rats that came in contact with the bodies, this first example of biological warfare changed history. People realized that they could use biological warfare as a means to get an enemy to concede defeat. In addition, society in most places handled their response to the plague poorly and often brought out the worst in humanity. The royals and landholders left the cities to take refuge in the country, away from where the disease could spread to them. Half a city could die in a day, so people who lived in remote villages would come to help bury and burn the bodies. Looters and robbers would take from the sick and dying. A group of radical Christians, who called themselves the Flagellants, proclaimed that they had a cure for the disease. They would flog and harm themselves just like what had happened to Jesus, in order to purge themselves in sin. They also attacked Jews, who were scapegoated and blamed for the disease. One actual positive outcome from the disease was that it did allow for people who were previously poor to obtain land and have better paying jobs.            In my Guinea Worm Essay- Afflictions with Little Dragons, I examined how societies from countries who had means to help, come to together to try and get eliminate a nasty disease that is located only in Africa. By implementing new technology, sanitation techniques, and building health centers to combat the parasite that is plaguing the rural and poor parts of Africa, great success was seen from their efforts.

            As seen today with the Coronavirus and Ebola, we are not always well-equipped to handle emerging diseases, or even fight an established disease, such as tuberculosis that has developed resistance against traditional antibiotics. Our technology and medicine are far superior today and only continue to get better, but at the same time, people often fail to follow basic personal and group hygiene precautions, which allows for rapid transmission of pathogens. Many people just do not wish to follow the rules that would prevent the spread of diseases, which would benefit not just themselves, but everyone around them. There is also not enough medicine to be distributed to everyone if there is a pandemic that requires a specific novel treatment or vaccine. Many countries in Africa are examples of societies that have had difficulty controlling the spread diseases such as guinea worm, and HIV. Many countries are too poor to spend for the resources to protect and educate people on the diseases. In turn, out of ignorance and need, they resort to drinking dirty water containing cholera or eat bushmeat and get Ebola. Many Asian countries have wet markets, which have live animals, with many different species, stacked on top of each other, which allows the transmission of diseases through their defecation and urination. In turn, the sellers and consumers of these livestock are risking development of the infection in humans. Many of these animals can carry zoonotic diseases, which are infectious diseases that animals can transmit to humans. The cause of the coronavirus is thought to come from wet markets, which were shut down temporarily, but are now reopened. These diseases can be reduced to eradicated only when people decide to get serious and follow the guidelines on reducing the risk for contracting infectious diseases.

            In summary, the lessons learned from this class are critical for understanding the foundations of public health and infectious disease. Furthermore, this class was invaluable in helping me prepare for the current global pandemic.

HIV Assignment

HIV is a well-known disease that can be easily prevented. For a long time people did not know how the virus was transmitted and were scared to touch other people until Princess Diana was filmed hugging an AIDS patient, and Michael Jordan dapped up and hugged Magic Johnson. As of today, there are around 1.4 million people living with HIV, and of those people 14% of them do not know that they have the virus. Young people between the ages of 13-24 were the mostly likely age group of being unaware that they had the virus at an estimated 54.6%. Therefore it is recommended that people from the ages of 13-64 should get tested at least once to see if they are living with the virus and do not unknowingly transmit it to other people.  In 2018 38,700 were infected with HIV, with the annual infection rate being around 39,000 since 2013. Between 2010-2016, the main age groups and groups of people who contract the disease declined. Gay and bisexual men are the most prevalent to contracting the disease, especially men who are minorities. 69% of HIV diagnoses come from gay or bisexual men, with the leading group being Black men, then Latino men, then White men. From 2010-2017 only the gay and bisexual White men decreased in HIV diagnoses, while for Black men the rate remained constant, but for Latino men the rate increased by 17%. For heterosexuals, the diagnoses went down 27% from 2010-20717.  In 2018, 37% of the HIV diagnoses were Black, 30% were Latino, and 27% were White. Going to regions of the United States, the South has the highest percentage with 52% of the HIV diagnoses coming from that region. Followed by the west with 19%, then the Northeast with 15%, then the Midwest with 13%. Only 7% of HIV diagnoses in 2018 were due to someone injecting themselves with a dirty needle. Which I would have thought would have been a lot higher after being told throughout my education in health and sex education classes would have been higher, but I am sure the number of people infected with some type of disease overall due to sharing a needle is higher. In 2018, 17,032 people were diagnosed with stage 3 HIV, which is otherwise known as AIDS. In 2017 there were 16,350 deaths among adults and children who were diagnosed with HIV, even though their deaths could have been due to any other cause. Tuberculosis is the leading cause of death for people with AIDS, killing everyone in three people. Globally there are around 37.9 million people living with HIV, with 1.7 million new cases each year. Around 770,000 people died globally who were diagnosed with having HIV. Since 2010 there has been a 16% decrease of cases with a 41% drop in children. As of now, there are no vaccines or treatments for people who have the virus. As of now antiretroviral therapy (ART), which is a combination of HIV medicines, is the main method of treating those who have HIV. These medicines have some serious side effects but have also been shown to keep the virus at a low enough count to be undetectable and therefore making the person have no risk of sexually transmitting the disease. These medicines are enzyme inhibitors and help with keeping the virus reproduction to a minimum. One of the biggest challenges in preventing HIV spread is because most people are not aware that they have the disease. Some people choose not to get tested because they do not want the test to come back positive and then their results get revealed even though everything is confidential, or that the test takes a long time to get the results back even though it only takes a swab and 20 minutes for results. Only 40% of people living with HIV have access to treatment, with 30% actually keeping the virus under control by taking the medication often. Some of this is because people do not have access to health care, people have low socioeconomic status, and some live-in communities where the infection rate is high. There are also limited resources for HIV prevention and medication and many Americans have become complacent when trying to be safe and prevent the disease.

Works cited:

https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics

https://www.cdc.gov/hiv/statistics/overview/ataglance.html

https://www.unaids.org/en/resources/fact-sheet

https://www.hiv.gov/hiv-basics/hiv-prevention/potential-future-options/hiv-vaccines

https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/challenges-508.pdf

Artifact #9

Human immunodeficiency virus (HIV) has been traced back to Central Africa, where it was first though to come from chimpanzees to humans sometime in the 1800s. Chimpanzees have a similar disease called simian immunodeficiency virus (SIV), which humans came into contact with the chimp’s infected blood when they were hunting the animal for meat. The virus has been in the United States since at least the 1970s. HIV is transmitted from person to person through certain body fluids such as blood, semen, vaginal discharge, and breast milk. Ways you cannot get the virus are through sweat, saliva, tears, and urine. Once inside the body, the virus attacks your CD4 cells, or T cells. This cell is a type of white blood cell which plays a key role in your immune system. The cell also helps with your adaptive immunity and helps your body fight against pathogens. The virus not only causes the T cells to be less effective, but also uses them to make more of the virus. After the virus uses the T cell to replicate, the cell then bursts and dies. If a persons’ white blood cell count level drops below a certain level, then the person develops AIDS, which stands for acquired immunodeficiency syndrome. This condition results from when the virus reaches a certain stage, and has done extensive damage to the immune system, to where it cannot fight pathogens off effectively. The person then develops what are known as opportunistic infections, such as tuberculosis and pneumonia. Types of cancer can also form due the immune system being weakened and not formed properly. Not always does a person progress to stage three of HIV and develop AIDS. There are three stages in total of the disease. Stage one is called Acute HIV infection. This a person develops flu-like symptoms two to four weeks after contracting the virus, which can last for weeks. This happens because it is the body’s response to fighting off the virus. Not everyone becomes sick if they contract the virus, either an antigen/antibody test or nucleic acid test (NAT) can tell if you have the virus or not. Stage 2 is called Clinical latency (HIV dormancy).  This is when the person produces the virus at low rates, and may not feel any symptoms for years, decades or longer, and with medication the stage can be lengthened even further. This person can still transmit the disease though.  At the end of the stage, the viral load goes up more rapidly, and the T cell count decreases. Stage three is last stage and is called acquired immunodeficiency syndrome. This is when the opportunistic illnesses start to arise due to the white blood cell count being below 200 while according to medicinenet.com the average persons’ count should be anywhere from 4,300 and 10,800 white blood cells. Other symptoms of AIDS include; chills, fever, weight loss, swollen lymph glands, and weakness. As of now, there is no cure for HIV, but the main medication being prescribed is called antiretroviral therapy (ART), which was first introduced in the 1990s, and before this medication, people could develop AIDS after the first few years of contracting HIV. There are many medications that must be taken in combination for this therapy to work, many of which are enzyme inhibitors so that the virus cannot make more of itself. This therapy has worked to the point of someone with HIV has such low levels of it, the person becomes undetectable. These treatments do have side effects, some which are easy to manage, some, such as kidney, liver, and nerve damage, depression and heart disease are some of the long-term effects and harder to manage. I am not trying to have this sound like a commercial, but I am trying to show that this treatment can effectively reduce the virus but can come with some serious side effects. In 2018, there were around 37.9 million people with HIV and of those people 23.3 million had access to ART, which is an increase of 1.6 million people from the year before. This is helping AIDS related deaths slow down, but the virus is still a pandemic.

Works cited:

https://www.cdc.gov/hiv/basics/whatishiv.html

 https://familydoctor.org/occupational-exposure-to-hiv-advice-for-health-care-workers/

https://www.healthline.com/health/hiv-aids/hiv-vs-aids#hiv-without-aids

https://www.medicinenet.com/script/main/art.asp?articlekey=9983

https://www.medicalnewstoday.com/articles/324013#types

https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics

Guinea worm disease

The Guinea worm disease is caused by a parasitic roundworm that is currently found in African countries. The worm is mainly found in countries with few and little water supplies, and where the water is unsafe, and the same source is used for a variety of activities, such as drinking and cleaning yourself or clothes. The person if infected with the worm once they drink water that is infected with the larva of the worm or the vector which carries the larva. The stomach acid then hatches the eggs, to which the worm then travels to the intestine where they mate and the male dies. The female then grows inside the human, up to two to three feet long, and when the female decides to come out, a blister is created, and immense pain follows. Some of the other symptoms of the disease are fever, diarrhea, nausea and vomiting, shortness of breath, and burning and itching where the worm is buried. The only way to get the pain to be soothed, is by stepping into the water, where the ulcer then breaks. The ulcer releases thousands of larvae into the water, where the cycle begins anew. There is no medicine or vaccine for this parasite, and the only way to get rid of the worm, is up tying the worm to a stick, then pulling the worm from the person. In the bible, it talks about a serpent and putting it on a pole where it will eventually die, and the people who are bitten will live. Pundits today think the serpent that is mentioned in the bible were the roundworms we see today. Our treatment, like they did thousands of years ago are still the same, but we now have better prevention methods to make sure it does not happen anymore. Starting in 1980, a campaign started to end that roundworm that causes the disease. In 1986 the Guinea Worm Eradication Program was started, and this was headed by the Carter Foundation, started by former president Jimmy Carter, along with many other organizations. This program has created preventative measures against the parasite as well as treatment centers. The program has created containment centers, which treat people for the disease as well on educating them about the disease, since many thought it was witchcraft that was the disease. Warning signs to not enter the water have been created as well as books for children. Larvicides have been given to put in the water to kill them before they are ingested. Pipe filters have been given to people, so they can drink the water without intaking any larva or their vectors.  New wells and boreholes have also been built to give people new sources of clean water. This disease is only in Africa still, and when program started, there were 3.5 million cases spanning twenty different countries in Africa, now there are only a little over 10,000 cases in only nine countries in Africa. Sudan is one of the countries that has been cleared as worm free, but Chad, which at one point was reporting no new cases, recently had a spike in cases. This was found that dogs now were able to get the virus from drinking the water as well as eating infected fish and frogs. Other than no outright vaccine or treatment for the parasite, there are a few challenges that people face when trying to eradicate the disease. One being the new finding that domesticated dogs are able to carry and spread a genetically similar worm that humans also get. The other being that cases are not reported in a timely manner, especially in Mali and South Sudan because those countries are facing civil unrest. Other challenges for the program include: getting reports through surveillance of other people and aggressively detecting the disease, investigating the reported cases and finding the source of the infection, and lastly notifying the correct health authorities as to what is happening.

Works cited:

Powerpoint

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Artifact #8

Cholera has been around for centuries, but it was not until the 19^th century, when India had a large and lethal outbreak of the disease, did people really start taking the disease seriously. This pandemic lasted for six years and started from contaminated rice. This rice spread throughout India, due to the trade routes the English had established. The disease spread throughout the Pacific, China, and Japan. The disease then made its way eventually to the Middle East, where is eventually stopped and died out due to a usually cold winter, which killed many bacteria in the water supply. Between 1852-1859 there was another large outbreak of the disease, this time, a physician named John Snow, mapped all of the cases of cholera and was able to trace the source of the outbreak back to a public well pump. For this he is considered the father of epidemiology.   Some of the earliest recordings of a cholera like disease date back to the 4^th and 5^th century. While in the 16^th century, there was a recording of such a bad outbreak in the Ganges Delta, that people were having trouble trying to bury the dead because they could die in as quickly as eight hours after showing symptoms of the disease. This is the same area as the outbreak that happened a few hundred years later in the 19^th century. According to the World Health Organization (WHO), that 1.3 to 4 million people a year get infected with cholera, and of those cases around 21,000- 143,000 are fatal and result in death. The bacteria responsible for cholera is called Vibrio cholerae. The bacteria thrive in warm, salty waters, such as waters along the coast. There are hundreds of different strains of this bacteria Vibrio though, but only two can cause major outbreaks. The bacteria are then ingested by drinking the water, or through eating food that is contaminated with it. Such food such as shellfish, crab and shrimp all can carry cholera. The bacteria can also be ingested by eating raw fruits and vegetables or grains. The bacteria will attach itself to the hard chitin protective shell of the animal, who then carries the bacteria wherever the animal goes. In most developing countries, this bacterium has been eliminated due to modern day sewage, and water treatment of wastewater. Other ways to avoid being infected with cholera are avoiding sushi and eating vegetables that you can peel. But in parts of Asia, Africa, and Haiti, this disease can be found. This is due to the poverty of those countries, and that they do not have the technology to get rid of their wastewater properly. According to mayoclinic.org, a time when being infected cholera is highest, is after a natural disaster, and everyone is living closely and crowded together. An example of this in the United States, is after Hurricane Katrina. Where 22 cases of it were reported and of those, five resulted in death. Houses were destroyed, there was not running water, and many people were lively in closely to one another. What the bacteria actually does to the body is simple, yet effective if untreated. The bacteria release a toxin causes the cells in the intestines to release an increased amount of water, and electrolytes/salt from the body. According to the National Institute of Allergy and Infectious Diseases, one time of having diarrhea due to cholera, can cause a million- fold increase of cholera bacterium in the water. Cholera can result in a variety of symptoms, mainly occurring in diarrhea, vomiting, and leg cramps. This is due to all the water and electrolytes being lost from the intestines. These symptoms can develop into septic shock and then lead to death. 80% of people who become infected with cholera do not show any symptoms and recover on their own. While it is the other 20% that show symptoms and need to be treated. Cholera is quite easy to treat, mainly the use of oral rehydration salts (ORS) are used, along with antibiotics, zine supplements, and intravenous fluids.

Works cited:

https://www.history.com/topics/inventions/history-of-cholera

https://en.wikipedia.org/wiki/Vibrio_cholerae

https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287

https://www.aafp.org/afp/2005/1115/p2132.html

Artifact #7

Tuberculosis gets its name from the “tubercles” that from on the lymph nodes in humans and animals. In March of 1882, Dr. Robert Koch announced that he had finally isolated the bacteria that caused tuberculosis, otherwise known as TB. Before Dr. Koch discovered the bacteria, it was thought that TB was hereditary, and that the person who died from TB would come back as a vampire. At the time, TB killed one out of every seven people in the United States and Europe. TB has been around for an estimated three million years, and throughout the ages, the disease has been nicknamed many times over. In ancient Rome it was called tabes, in the 1700s “the white plague”, and in the 1800s “the consumption,” just to name a few. TB has been traced in humans remains that dated back to 9,000 years ago, and written records to over 3,000 years ago. In the Europe, for a 200-year span, it was estimated that TB was accounted for 25% of the of all deaths. TB is spread through the air and cannot be spread through food or water. A form of TB, called Bovine Tuberculosis can spread among mammals and also be passed to humans either via infected droplets from coughing or ingesting infected milk from a cow. This disease can still be found mainly in Africa, but also in parts of Asia and the Americas. According to unitednationfoundation.org, TB is right the now the world’s leading infectious disease, and kills someone every 18 seconds, with ten million people a year contracting the disease. In the 1940s, doctors first came up with a microbial treatment for TB, and though this helped cure some cases, it also led to drug resistant TB. In the 1960s, better and more effective medications were made, and this led to a decrease in TB infection rates, which led to health agencies not making the disease as much as a priority. Fast forward 30 years to the 90s, more medications and poor usage, caused for painful side and permanent side effects. Between 2005 and 2015 an estimated 49 million people were successfully treated for TB, but at the same time, a global spread of mutli-drug resistant TB was seen. Recently, another form of TB has been observed, known as XDR TB, or extensively-drug resistant TB. This left for fewer options for treating TB, and those that were available were expensive. This new strain also gave patients more complications and a higher rate of death. The average cost to treat a drug susceptible TB, is around $17,000 while the XDR TB can cost $554,000. The XDR TB has a mortality rate of 9%, with a large number of patients that experience side effects. Since 1993 until 2018, in the U.S., the number of cases has gone down from 25,000 cases in one year to around 15,000 in 2018. Of those cases reported in 2018, 70% of those were said to foreign born people. The deaths contributing to TB have also gone down during that time as well. The number of drug resistant cases have remained consistent though over the last 20 years.

Works cited

https://www.cdc.gov/tb/worldtbday/history.htm

https://www.oie.int/fileadmin/Home/eng/Media_Center/docs/pdf/Disease_cards/BOVINE-TB-EN.pdf

https://unfoundation.org/blog/post/tuberculosis-then-now/

https://www.cdc.gov/nchhstp/newsroom/2014/world-tb-day.html

https://www.cdc.gov/tb/publications/factsheets/statistics/tbtrends.htm

Artifact #6

In 1845, what was known as the Potato Blight spread across Ireland. This ruined all the potato crop in the area, which killed many people due to the fact that they had nothing else to eat. Due to many people dying, there had to be another name for that, which was called the Great Irish Famine and lasted for about five years. Many people depended on the potato in Ireland because the plant is easy to grow, especially in poor soils. So, more and more people started to grow potatoes, which would mean that the food would be a staple in many people’s meals. According to medicalnewstoday.com, the potato can help with your blood pressure, bone health, inflammation, heart health, and more. So, I would assume that not only did the farmers like the plant because it was easy to grow, but also because they felt like they were the healthiest that they had ever been. There are two reasons why the blight occurred. One was because in 1845, Ireland experienced unusually cool, moist weather. Also, because a type of algae, called Phytophthora,infectans came over to Ireland from North America. The name comes from the Greek word meaning destruction, due to all the damage the algae can do to other plants. This alga grew like a tumor on the nodes, killing most of the crop that year. The next couple of years resulted in poor crop yields as well. An estimated one million people died to starvation, typhus, and other infectious disease. This caused the Irish government to import more food from Europe and North America. This caused for the landowners to pay for the food that was incoming. And since there was little to sell, many farmers then became tenant farmers or laborers to the bigger landowners. Britain tried to help by funding soup kitchens, and public works jobs, but this just made the Irish people resent Britain more because of their reliance on the poorly nutritional imported meals.  While another two million were estimated to have emigrated from Ireland. This decline continued for decades afterwards, and by the early 20^th century, Ireland’s population was half of what it had been in the 1840s. Due to so many people either dying or leaving, This lead to more grazing land for sheep and cattle, which led to more animal food export to Britain.

Works Cited:

http://www.askaboutireland.ie/learning-zone/primary-students/3rd-+-4th-class/history/the-history-of-food-and-f/early-irish-diet/the-potato-in-ireland/

https://www.medicalnewstoday.com/articles/280579#10_possible_health_benefits

https://www.britannica.com/event/Great-Famine-Irish-history

https://en.wikipedia.org/wiki/Phytophthora

Artifact #5

Syphilis is seen, stereotypically to be spread by woman to man. And because of this, early depictions or posters, warning of the dangers of syphilis, show a woman, or feminine symbols telling males to be careful. That a beautiful woman might have the nasty disease. One of the nicknames for syphilis is the “The Great Imitator,” because the symptoms of the disease were symptoms for many other ailments. This is one of the reasons why it showed the woman looking healthy, because they may carry the disease without showing any signs of it, and if they do show signs, they could be mild, and you may not know. While it was thought that if a guy had the disease, the signs would be prevalent. Congenital syphilis can also happen though, and another reason why women were thought to be the blame for the spread. For if a woman has the untreated disease and becomes pregnant, the child could also contract syphilis. This is caused numerous deformities, such as hearing and vision problems, anemia, and paralyzed limbs to name a few. Before syphilis was the term commonly used by everyone, countries which were not on friendly terms with other nations, would name the disease after that nation. Such as Russia naming it the “Polish disease” or Italy naming it the “French disease” when French soldiers besieging the town of Naples, Italy contracted the disease. It was thought that the sailors and travelers from the other nations would come into town and get the disease from the prostitutes in that town. This would have probably caused xenophobia of the opposing nations, making the citizens see that other country’s people being unclean and unwanted. In the Tuskegee Syphilis study, the experiment was first brought up, because people thought the black men could not contract the disease, and when researchers found out that they in fact could, they pushed to get the experiment to be extended from its original eight-month trial. This experiment also went against Nuremberg Code of ethics, which was made after what the world uncovered what the Nazis had been doing during the war to their prisoners of war. These men were also never told that they were being injected with syphilis and were told that they had “bad blood” and these doctors from the government had come down to treat them. At no point were they given any sort of treatment or go to another clinic to get test or treated. The people conducting the experiment also were able to get these men prevented from being drafted. Because if they did get drafted, then they would have gotten treated for the disease. As part of the experiment, a painful spinal tap without any sort of numbing medication was done on the men. From the experiment, 28 men died due to having the disease. 40 of the men’s wives also contracted syphilis and 19 of the children born during the time of the experiment, were born with congenital syphilis. Because of this experiment, emotional and physical pain was inflicted on the men. The experimenters, sent to the men, when the men were thinking about backing out or stopping, a letter titled “Last Chance for a Special Free Treatment.” Like most men, especially those in a poor rural town in Alabama, trusted the government, and allowed the doctors to do whatever, in hopes that they would be cured of their bad blood. The study ended in 1972, but because of the study, many long-term effects came because of this. There became a general distrust in the government and health care officials, mainly in black men, where a survey in 1999 showed that 32% of black women did not trust healthcare officials, compared to 4% in white women. Even though 80% of women thought that going to a healthcare professional benefited them. In the end, there was much more that was lost to the experiment than any knowledge could have ever been gained form the experiment.

Works Cited

https://en.wikipedia.org/wiki/Syphilis

https://www.marchofdimes.org/complications/congenital-syphilis.aspx#

https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment

https://daily.jstor.org/the-lasting-fallout-of-the-tuskegee-syphilis-study/

Artifact #4 (prompt #2)

Smallpox can first be seen on mummies from Egypt in dating back to the 3^rd century, and there have been descriptions of the disease dating back to the 4^th century, found in China. Over the two millennia since having been aware of the disease, smallpox has claimed over 300 million lives, until its eradication in 1980. Some of the early cures that people tried to get rid of the disease was; bloodletting, red therapy, leeches, laxatives, cold therapy, and heat therapy. Later, people started to use variolation, otherwise known as inoculation, to try and become immune to the disease. This would involve taking fluid or powder from the scab from someone who had smallpox, then putting that into a superficial wound into someone who had not contracted the disease yet. People would not develop as severe symptoms as if they had contracted the disease naturally and after a couple of weeks, the symptoms would subside. This technique was first used in the Middle East and China. Another early method was insufflation, which was the same as variolation in principle. The crust of the scab would be scraped off of someone who had smallpox, to which someone else would inhale the powder. The person would get sick, but with less severe symptoms. In 1796, Edward Jenner tested his theory on the eight-year-old next-door neighbor. There was a wife’s tale that milk maids who contracted cowpox at some point in their lives, a disease that is much milder than smallpox. After years of research, Jenner tested his theory by taking fluid from a cowpox sore and rubbing it on a superficial wound on the boy. The child became ill with cowpox, but then quickly recovered. Jenner then put the deadly smallpox on the superficial cut, and after a period of time, the boy showed no effects. From this the world had its first vaccination, vacca coming from the Latin word meaning cow, due to the cowpox being the reason for smallpox immunity. At first, he was met with much opposition and ridiculed greatly for his findings. This was due to the fact that he had no true explanation as to how his vaccine worked, as well as some thought it was nasty that you would use a diseased animal to inoculate yourself. It was more after his death did people start to widely accept his vaccination method and it became commonplace while banning the variolation method. Some of the pros to compulsory, or mandatory, vaccinations are that it protects many people from the disease, extreme reactions are rare, it saves children’s lives, and they protect future generations. Some of the cons are that it infringes upon our rights, like religious freedom, and that the government should not be telling us what to do. Also, it has the potential to be fatal or you having a more adverse reaction to the vaccine. In 1979, the last person who naturally contracted variola major was treated in Bangladesh. And in 1977 the last person who naturally contracted variola minor was treated in Somalia. Both of these accomplishments took a huge effort and a lot of manpower. This was because these areas were poor and did not have a good enough infrastructure to track everyone down who had the disease or who may have the disease and then give those people the vaccination. Due to the vigilant efforts of thousands of people, they were able to track everyone down who had the disease and cure them of it, eventually eradicating it from the world.

Works cited

https://en.wikipedia.org/wiki/Smallpox_vaccine

https://www.history.com/this-day-in-history/jenner-tests-smallpox-vaccine

http://broughttolife.sciencemuseum.org.uk/broughttolife/people/edwardjenner

https://vaccines.procon.org/