[Protector Saints Against Plague Epidemics - Analysis of the Examples from the Sacral Patrimonies of the Cites of Rijeka and Osijek]

Plague epidemics have remained in the collective consciousness until nowadays remembered as the deadliest. Therefore, it is not surprising that the answers to them throughout history have been not only medical but also religious. The previously mentioned will be analyzed in this paper through the cults of the protector saints against the plague epidemics that have developed in two Croatian cities of comparable size, Rijeka and Osijek, but with the diametrically opposed geographical positions and, accordingly, quite different historical developments. On the one hand, a more detailed overview of the development of the cults of various saints present in the mentioned cities will be presented. On the other hand, based on their presentation in the sacral heritage of these cities, the broader context of the time and space in which they have developed will be lightened. Particular attention will be paid to their medical connotations.

[HOW HEALTH SERVICES IN ISRAEL COPED WITH THE POLIO EPIDEMIC OF THE 1950'S]

Today, the introduction of a new medicine or vaccine or the clinical trial of some new potion requires the approval of a variety of bodies in accordance with Helsinki Agreement rules, National Health Laws and Health Ministry regulations. The creation of the World Health Organization (WHO) in 1946 added another essential layer to the firm base of principles governing the conduct of clinical trials that exist today. Its main contribution was to create a new reality following The Second World War and the subsequent Nuremberg Trials. The Declaration of Helsinki was only adopted eighteen years later, in 1964. In its first years of independence the infant State of Israel was attacked by a serious outbreak of polio which claimed many victims - mostly children and youngsters. Infantile paralysis - poliomyelitis (polio) was then considered as being untreatable. The disease affected 0.1% of the population of Israel. In 1950, out of a total population of 1.2 million, 1,500 were infected by polio. The epidemic struck over three successive seasons and affected more than 3,000 victims. The mortality rate stood at 10%. Experts, charlatans and fame seekers all presented their inventions to the country - creams, medicines and research projects all designed to bring relief to the sick children. Against all these stood the newly formed Ministry of Health, determined to bring order to the chaos. The only trial conducted by the Health Ministry was unsuccessful, but it was accompanied by the most stringent controls that would not have shamed even today's researchers. The clinical trials of Zibaline were conducted in the early 60's, after the polio vaccine had been introduced and the epidemic had passed. The purpose of this paper is to examine the influence of medical ethics, norms and morals on the way that medical practice dealt with the epidemic at a time when there were no laws or rules.

The epidemiological signature of influenza B virus and its B/Victoria and B/Yamagata lineages in the 21st century

We describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000–2018. We calculated the proportion of cases caused by influenza B and its lineages; determined the timing of influenza A and B epidemics; compared the age distribution of B/Victoria and B/Yamagata cases; and evaluated the frequency of lineage-level mismatch for the trivalent vaccine. The median proportion of influenza cases caused by influenza B virus was 23.4%, with a tendency (borderline statistical significance, p = 0.060) to be higher in tropical vs. temperate countries. Influenza B was the dominant virus type in about one every seven seasons. In temperate countries, influenza B epidemics occurred on average three weeks later than influenza A epidemics; no consistent pattern emerged in the tropics. The two B lineages caused a comparable proportion of influenza B cases globally, however the B/Yamagata was more frequent in temperate countries, and the B/Victoria in the tropics (p = 0.048). B/Yamagata patients were significantly older than B/Victoria patients in almost all countries. A lineage-level vaccine mismatch was observed in over 40% of seasons in temperate countries and in 30% of seasons in the tropics. The type B virus caused a substantial proportion of influenza infections globally in the 21^st century, and its two virus lineages differed in terms of age and geographical distribution of patients. These findings will help inform health policy decisions aiming to reduce disease burden associated with seasonal influenza.

Standing on the shoulders of giants: two centuries of struggle against meningococcal disease

Meningococcal disease was first clinically characterised by Gaspard Vieusseux in 1805, and its causative agent was identified by Anton Weichselbaum in 1887, who named it Diplococcus intracellularis menigitidis. From the beginning, the disease was dreaded because of its epidemic nature, predilection for previously healthy children and adolescents, and high mortality. In the last decade of the 19th century, the concept of serum therapy for toxin-related bacterial diseases was identified. This concept was applied to meningococcal disease therapy, in an independent way, by Wilhelm Kolle, August von Wasserman, and Georg Jochmann in Germany, and Simon Flexner in the USA, resulting in the first successful approach for the treatment of meningococcal disease. During the first three decades of the 20th century, serum therapy was the standard treatment for meningococcal disease. With the advent of sulphamides first and then antibiotics, serum therapy was abandoned. The great challenges that infectious diseases medicine is facing and the awaiting menaces in the future in terms of increasing antibiotic resistance, emergence of new pathogens, and re-emergence of old ones without effective therapy, make passive immunotherapy a promising tool. Acknowledging the achievements of our predecessors might teach us some lessons to bring light to our future.

The epidemic characteristics and spatial autocorrelation analysis of hand, foot and mouth disease from 2010 to 2015 in Shantou, Guangdong, China

BACKGROUND

Hand, foot and mouth disease (HFMD) is the highest incidence of infectious diseases in China. Shantou is one of the most infected cities. Therefore, it is necessary for us to understand the epidemic characteristics and distribution trend of HFMD in Shantou. The purpose of this study is to investigate the spatial epidemiological characteristics of HFMD and analyse its spatial autocorrelation.

METHOD

We collated and summarised the data of HFMD in Shantou from 2010 to 2015. SaTScan software and Moran's I were used to analyse the spatial correlation of HFMD, and the results were presented in ArcMap.

RESULTS

The distribution of HFMD in Shantou was of a seasonal trend, mainly concentrating during May and June. Children under 5-years-old were the main group of cases of HFMD, accounting for 92.46%. The proportion of infected children, especially those aged zero to 1, was the largest in each year, accounting for 45.62%, meaning that smaller children were more susceptible to HFMD. The number of male patients with HFMD was greater than that of females (1.78:1, male: female). With regard to the potential impact of patients' living style on the incidence rate of HFMD, this study revealed that scattered children were the dominant infected population, accounting for as much 84.49% of cases. The incidence of HFMD was unevenly distributed among streets. The incidence interval of streets was in a range of 13.76/100,000 to 1135.19/100,000. Spatial autocorrelation analysis showed that there was no global spatial correlation in Shantou, except in 2013. The results of local spatial autocorrelation analysis showed that H-H correlation existed in the high incidence local area of Shantou.

CONCLUSIONS

The incidence of HFMD across the various streets in Shantou not only varied widely but also represented local autocorrelation. Attention, as well as prevention and control measures, should be focused on those high-incidence areas, such as the Queshi street, Zhuchi street and Xinjin street.

Childhood health shocks, comparative advantage, and long-term outcomes: Evidence from the last Danish polio epidemic

This paper examines the long-term effects of childhood disability on individuals' educational and occupational choices, late-career labor market participation, and mortality. We merge medical records on children hospitalized with poliomyelitis during the 1952 Danish epidemic to census and administrative data, and exploit quasi-random variation in paralysis incidence in this population. While childhood disability increases the likelihood of early retirement and disability pension receipt at age 50, paralytic polio survivors are more likely to obtain a university degree and to go on to work in white-collar and computer-demanding jobs than their non-paralytic counterparts. Our results are consistent with individuals making educational and occupational choices that reflect a shift in the comparative advantage of cognitive versus physical skills. We also find that paralytic polio patients from low socioeconomic status backgrounds are more likely to die prematurely than their non-paralytic counterparts, whereas there is no effect on mortality among polio survivors from more advantaged backgrounds.

Epidemiological state-building in interwar Poland: discourses and paper technologies

ArgumentThe paper argues that epidemic surveillance and state-building were closely interconnected in interwar Poland. Starting from the paper technology of weekly epidemiological reporting it discusses how the reporting scheme of Polish epidemics came into being in the context of a typhus epidemic in 1919-20. It then shows how the statistics regarding nation-wide epidemics was put into practice. It is only when we take into account these practices that we can understand the epidemiological order the statistics produced. The preprinted weekly report form registered Jews and Christians separately. Yet, the imagined national epidemiological space that emerged from it hardly took notice of this separation. Rather, the category that differentiated Polish epidemiological space in medical discourse was the capacity of contributing to the state-making practices of epidemic surveillance. This category divided Poland into two regions: a civilized and modern western region and a backward and peripheral eastern region.

Cotton Mather's medicine, with particular reference to measles

While the vocation of Cotton Mather (1663-1728) was his ministry in Boston, he made important contributions to medicine, most famously in helping to introduce variolation to New England in 1721-22 and in writing The Angel of Bethesda (1724), the first medical treatise produced in Colonial North America. This article, however, focuses on an earlier initiative, Mather's efforts to quell the epidemic of measles that struck Boston in 1713, killing among many others his wife and three children. Historians have devoted little attention to this episode or to measles in general, even though the disease was highly mortal during the colonial period. To help victims, Mather published a 'letter' on treating measles. Such a specific discussion of treatment would have been rare in Europe and it was unprecedented in America. The therapy that Mather proposed not only reflected popular medicine but also incorporated newer practices, notably those associated with Thomas Sydenham. In contrast to heroic therapies for measles, which were often dangerous but became more popular across the eighteenth century, Mather's recommendations were moderate.

[Encephalitis lethargica. The epidemic at the dawn of neurology]

Lethargic encephalitis is a neurological illness that shows a wide range of symptoms and signs, including neurological and psychiatric spectrum. It presented in an epidemic way, following influaenza relapses. The last relapse started at the beginning of 20th century and it was deeply described by Constantin von Economo. The illness described first in Europe and North America, was described in many others countries including Chile. There were beautiful descriptions by Chilean physicians like Lea-Plaza, Tello, Iturra and Cienfuegos. Their works showed the complexity of the illness like European physicians did too. The etiology is still unknown; however growing evidence about autoinmune aetiology is gaining force with the use of actual medical technology. In this work, we show encephalitis lethargica, focusing in clinical picture, the beauty of medical descriptions that physicians did at this date.

[Prophylactic representations, discourses and practices during the cholera epidemic (1886-1887, Mendoza, Argentina)]

The article takes a look into the disciplinary projects approved by the authorities in the province of Mendoza (Argentina) during the cholera epidemic that took place during the summer of 1886-1887. Although the projects were intended to ameliorate the sanitary conditions of the whole of the population, these were focused and applied more intensively on the underprivileged sectors and their areas of inhabitance. This follows the ideas and representations created by the State regarding the illness and its death during this period.

Edward Ballard and the Practice of Epidemiology in the 19th-Century United Kingdom

This article recovers the history of Victorian epidemiology through the career of British physician Edward Ballard (1820-1897). Ballard's career provides a useful window into the practices of epidemiology in the 19th century because he held notable public health posts as medical officer of health for Islington and inspector at the Medical Department of the Local Government Board. By the time of his death, in 1897, he typified the transition toward professional epidemiology. In exploring some of the most important environmental and health-related problems in preventive medicine in the 19th century, Ballard was part of a group of influential epidemiologists who studied infectious disease. In particular, he was noted for his research into typhoid fever and industrial health. Yet Ballard's career has largely been forgotten. In this article, I explore Ballard's work as a window into the everyday practices of Victorian epidemiology and suggest that the process of professionalizing epidemiology in the 20th century was about forgetting epidemiology's Victorian past as much as it was about championing it.

Changing of the Genomic Pattern of Salmonella Enteritidis Strains Isolated in Brazil Over a 48 year-period revealed by Whole Genome SNP Analyses

Salmonella Enteritidis became the main serovar isolated from gastroenteritis cases in Brazil after the 90's. In this study we used whole genome sequence analysis to determine the phylogenetic relationships among a collection of strains isolated in Brazil to identify possible genomic differences between the strains isolated in the pre and post-epidemic period. Also, we compared our data from strains isolated in Brazil to strains available in the public domain from other South American countries. Illumina technology was used to sequence the genome of 256 Salmonella Enteritidis strains isolated over a 48 year-period in Brazil, comprising the pre- and post-epidemic period. Phylogenetic analyses revealed distinct lineages for strains isolated before and after 1994. Moreover, the phage region SE20 that may be related to the emergence of Salmonella Enteritidis worldwide was present only in strains of the post-epidemic cluster. In conclusion, our results showed that the genomic profile of Salmonella Enteritidis strains isolated in Brazil shifted after 1994, replaced by a global epidemic group of strains. It may be hypothesized that the presence of the prophage SE20 might have conferred to these strains a better ability to colonize chicken and consequently to infect and cause disease in humans, which might better explain the increase in the number of S. Enteritidis cases in Brazil and other South American countries. However, to verify this hypothesis further studies are needed.

Cordons Sanitaires and the Rationalisation Process in Southern Europe (Nineteenth-Century Majorca)

Never before the nineteenth century had Europeans, especially in the south, adopted cordons sanitaires in such great numbers or at such a fast rate. This article aims to analyse the process of the rationalisation and militarisation of the cordons sanitaires imposed in the fight against epidemics during the nineteenth century on the Mediterranean island of Majorca (Spain). These cordons should be understood as a declaration of war by the authorities on emerging epidemics. Epidemics could generate sudden and intolerably high rises in mortality that the new liberal citizenship found unacceptable. Toleration of this type of measure was the result of a general consensus, with hardly any opposition, which not only obtained the support of scientists (especially in the field of medicine) but also of most of the local and provincial political elite, and even of the population at large.

Coimbra's response to the 1918-1919 influenza epidemic, seen from the viewpoint of a local newspaper

This article investigates the 1918-1919 influenza epidemic in Coimbra using information found in the pages of a local newspaper. Rigorous and systematic analysis of the Gazeta de Coimbra reveals the urban bourgeoisie's perception of this health disaster, considered the most severe in the twentieth century. Guided by the newspaper's editor though an unofficial view of the facts, the reader can glimpse reactions to the first news of the epidemic, particularly the population's fears related to this information, but also the response from authorities and civil society. The newspaper is critical in many aspects, openly censuring inaction by several institutions of the city such as the city council, the medical school at the University of Coimbra, and the Misericórdia charitable institution.

Fumigating the Hygienic Model City: Bubonic Plague and the Sulfurozador in Early-Twentieth-Century Buenos Aires

The 1899/1900 arrival of bubonic plague in Argentina had thrown the model status of Buenos Aires as a hygienic city into crisis. Where the idea of foreign threats and imported epidemics had dominated the thinking of Argentina's sanitarians at that time, plague renewed concerns about hidden threats within the fabric of the capital's dense environment; concerns that led to new sanitary measures and unprecedented rat-campaigns supported by the large-scale application of sulphur dioxide. The article tells the story of early twentieth-century urban sanitation in Buenos Aires through the lens of a new industrial disinfection apparatus. The Aparato Marot, also known as Sulfurozador was acquired and integrated in the capital's sanitary administration by the epidemiologist José Penna in 1906 to materialise two key lessons learned from plague. First, the machine was supposed to translate the successful disinfection practices of global maritime sanitation into urban epidemic control in Argentina. Second, the machine's design enabled public health authorities to reinvigorate a traditional hygienic concern for the entirety of the city's terrain. While the Sulfurozador offered effective destruction of rats, it promised also a comprehensive - and utopian - disinfection of the whole city, freeing it from all imaginable pathogens, insects as well as rodents. In 1910, the successful introduction of the Sulfurozador encouraged Argentina's medico-political elite to introduce a new principle of 'general prophylaxis'. This article places the apparatus as a technological modernisation of traditional sanitary practices in the bacteriological age, which preserved the urban environment - 'el terreno' - as a principal site of intervention. Thus, the Sulfurozador allowed the 'higienistas' to sustain a long-standing utopian vision of all-encompassing social, bodily and political hygiene into the twentieth century.

History and Emergence of Zika Virus

Zika virus was discovered in East Africa in 1947 by the Rockefeller Foundation during investigations on the ecology of yellow fever. Although it was subsequently shown to have widespread distribution in Africa and Asia, it was not known to cause epidemics until 2007. This paper describes the history of the virus discovery, emergence and evolution as an epidemic virus, and the its evolving clinical spectrum.

Devastating epidemics in recent ages Greek populations

In the recent Greek ages the most devastating epidemics were plague, smallpox, leprosy and cholera. In 1816 plague struck the Ionian and Aegean Islands, mainland Greece, Constantinople and Smyrna. The Venetians ruling the Ionian Islands effectively combated plague in contrast to the Ottomans ruling all other regions. In 1922, plague appeared in Patras refugees who were expelled by the Turks from Smyrna and Asia Minor. Inoculation against smallpox was first performed in Thessaly by the Greek women, and the Greek doctors Emmanouel Timonis (1713, Oxford) and Jakovos Pylarinos (1715, Venice) made relevant scientific publications. The first leper colony opened in Chios Island. In Crete, Spinalonga was transformed into a leper island, which following the Independence War against Turkish occupation and the unification of Crete with Greece in 1913, was classified as an International Leper Hospital. Cholera struck Greece in 1853-1854 brought by the French troops during the Crimean War, and again during the Balkan Wars (1912-13) when the Bulgarian troops brought cholera to northern Greece. Due to successive wars, medical assistance was not always available, so desperate people turned many times to religion through processions in honor of local saints, for their salvation in epidemics.

The importance of thinking beyond the water-supply in cholera epidemics: A historical urban case-study

BACKGROUND

Planning interventions to respond to cholera epidemics requires an understanding of the major transmission routes. Interrupting short-cycle (household, foodborne) transmission may require different approaches as compared long-cycle (environmentally-mediated/waterborne) transmission. However, differentiating the relative contribution of short- and long-cycle routes has remained difficult, and most cholera outbreak control efforts focus on interrupting long-cycle transmission. Here we use high-resolution epidemiological and municipal infrastructure data from a cholera outbreak in 1853 Copenhagen to explore the relative contribution of short- and long-cycle transmission routes during a major urban epidemic.

METHODOLOGY/PRINCIPAL FINDINGS

We fit a spatially explicit time-series meta-population model to 6,552 physician-reported cholera cases from Copenhagen in 1853. We estimated the contribution of long-cycle waterborne transmission between neighborhoods using historical municipal water infrastructure data, fitting the force of infection from hydraulic flow, then comparing model performance. We found the epidemic was characterized by considerable transmission heterogeneity. Some neighborhoods acted as localized transmission hotspots, while other neighborhoods were less affected or important in driving the epidemic. We found little evidence to support long-cycle transmission between hydrologically-connected neighborhoods. Collectively, these findings suggest short-cycle transmission was significant.

CONCLUSIONS/SIGNIFICANCE

Spatially targeted cholera interventions, such as reactive vaccination or sanitation/hygiene campaigns in hotspot neighborhoods, would likely have been more effective in this epidemic than control measures aimed at interrupting long-cycle transmission, such as improving municipal water quality. We recommend public health planners consider programs aimed at interrupting short-cycle transmission as essential tools in the cholera control arsenal.

On Social and Political Effects of Plant Pest and Disease Epidemics

Selected historical pest and disease outbreaks in the Old World are discussed in view of their social and political consequences. Large-scale epidemics always caused social unrest, and often hunger, pestilence, and death. When coming on top of deeply rooted and widely spread social unrest such epidemics contributed to political change. Examples are the revolts following epidemics in 1789 and 1846. Epidemics, regardless of causal and target organisms, have elements in common. The notion of a common concept grew into a firmly established discipline: epidemiology.