Disease, Darwin, and medicine in the third epidemiological transition

Four Thousand Years of Concepts Relating to Rabies in Animals and Humans, Its Prevention and Its Cure

The epitome of the One Health paradigm-and of its shortcomings-rabies has been known to humankind for at least 4000 years. We review the evolution through history of concepts leading to our current understanding of rabies in dogs and humans and its prevention, as transmitted by accessible and surviving written texts. The tools and concepts currently available to control rabies were developed at the end of the 19th Century, including the first live, attenuated vaccine ever developed for humans and the first post-exposure prophylaxis (PEP) regimen. No progress, however, has been made in etiological treatment, leaving clinicians who provide care to animals or patients with symptomatic rabies as powerless today as their colleagues in Mesopotamia, 40 centuries ago. Rabies remains to date the most lethal infectious disease known to humans. Widespread access to timely, effective, and affordable PEP in rural areas of developing countries is urgently needed.

EMERGING AND RE-EMERGING INFECTIOUS DISEASES: The Third Epidemiologic Transition

▪ Abstract  We use an expanded framework of multiple epidemiologic transitions to review the issues of re/emerging infection. The first epidemiologic transition was associated with a rise in infectious diseases that accompanied the Neolithic Revolution. The second epidemiologic transition involved the shift from infectious to chronic disease mortality associated with industrialization. The recent resurgence of infectious disease mortality marks a third epidemiologic transition characterized by newly emerging, re- emerging, and antibiotic resistant pathogens in the context of an accelerated globalization of human disease ecologies. These transitions illustrate recurring sociohistorical and ecological themes in human–disease relationships from the Paleolithic Age to the present day.