Marsh fever: the geography of malaria in England

Temperate climate malaria in nineteenth century Denmark

Background

Plasmodium vivax was endemic in northern Europe until the early twentieth century. Considering climate change and the recent emergence of other vector borne diseases in Europe, historical insight into the relationship between malaria and environmental factors in northern Europe is needed. This article describes malaria epidemiology in late-nineteenth century Denmark.

Methods

We described the seasonality and spatial patterns of malaria, and the relationship of the disease with environmental factors such as soil types, clay content and elevation for the period 1862–1914. We studied demographic and seasonal patterns and malaria mortality in the high-morbidity period of 1862–1880. Finally, we studied the relationship between malaria seasonality and temperature and precipitation using a Spearman correlation test.

Results

We found that the highest incidence occurred in eastern Denmark. Lolland-Falster medical region experienced the highest incidence (14.5 cases per 1000 pop.) and Bornholm medical region experienced the lowest incidence (0.57 cases per 1000 pop.). Areas with high malaria incidence also had high soil clay content, high agricultural production, and Lolland-Falster furthermore has a low elevation. Malaria incidence typically peaked in May and was associated with high temperatures in July and August of the previous year but not with precipitation. The case fatality rate was 0.17%, and the disease affected both sexes and all age groups except for infants. In 1873, a large epidemic occurred following flooding from a storm surge in November 1872.

Conclusions

Malaria gradually declined in Denmark during our study period and had essentially disappeared by 1900. The high adult and low child morbidity in 1862–1880 indicates that malaria was not highly endemic in this period, as malaria is most frequent among children in highly endemic areas today. The association of high malaria incidence in spring with warmer temperatures in the previous summer suggests that transmission took place in the previous summers. The close geographical connection between malaria and soil types, agricultural production and elevation suggests that these factors are detrimental to sustain endemic malaria. Our findings of a close connection between malaria and environmental factors such as climate and geography provides insights to address potential reintroduction of malaria in temperate climates.

Syndemics and the history of disease: Towards a new engagement

Historians of medicine and disease have yet to think through a syndemic lens. This commentary aims to point out why they should. Although there are several hurdles to overcome, our histories of disease and our understanding of current syndemics both stand to gain should historians begin to explore episodes of cooccurring diseases that share root causes.

The greatest health problem of the Middle Ages? Estimating the burden of disease in medieval England

OBJECTIVE

To identify the major health problems of the Middle Ages. Bubonic plague is often considered the greatest health disaster in medieval history, but this has never been systematically investigated.

MATERIALS

We triangulate upon the problem using (i) modern WHO data on disease in the modern developing world, (ii) historical evidence for England such as post-medieval Bills of Mortality, and (iii) prevalences derived from original and published palaeopathological studies.

METHODS

Systematic analysis of the consequences of these health conditions using Disability Adjusted Life Years (DALYs) according to the Global Burden of Disease methodology.

RESULTS

Infant and child death due to varied causes had the greatest impact upon population and health, followed by a range of chronic/infectious diseases, with tuberculosis probably being the next most significant one.

CONCLUSIONS

Among medieval health problems, we estimate that plague was probably 7th-10th in overall importance. Although lethal and disruptive, it struck only periodically and had less cumulative long-term human consequences than chronically endemic conditions (e.g. bacterial and viral infections causing infant and child death, tuberculosis, and other pathogens).

SIGNIFICANCE

In contrast to modern health regimes, medieval health was above all an ecological struggle against a diverse host of infectious pathogens; social inequality was probably also an important contributing factor.

LIMITATIONS

Methodological assumptions and use of proxy data mean that only approximate modelling of prevalences is possible.

SUGGESTIONS FOR FURTHER RESEARCH

Progress in understanding medieval health really depends upon understanding ancient infectious disease through further development of biomolecular methods.

Exploring the spatiotemporal drivers of malaria elimination in Europe

Background

Europe once had widespread malaria, but today it is free from endemic transmission. Changing land use, agricultural practices, housing quality, urbanization, climate change, and improved healthcare are among the many factors thought to have played a role in the declines of malaria seen, but their effects and relative contributions have rarely been quantified.

Methods

Spatial datasets on changes in climate, wealth, life expectancy, urbanization, and land use trends over the past century were combined with datasets depicting the reduction in malaria transmission across 31 European countries, and the relationships were explored. Moreover, the conditions in current malaria-eliminating countries were compared with those in Europe at the time of declining transmission and elimination to assess similarities.

Results/conclusions

Indicators relating to socio-economic improvements such as wealth, life expectancy and urbanization were strongly correlated with the decline of malaria in Europe, whereas those describing climatic and land use changes showed weaker relationships. Present-day malaria-elimination countries have now arrived at similar socio-economic indicator levels as European countries at the time malaria elimination was achieved, offering hope for achievement of sustainable elimination.

Electronic supplementary material

The online version of this article (doi:10.1186/s12936-016-1175-z) contains supplementary material, which is available to authorized users.

Mapping hotspots of malaria transmission from pre-existing hydrology, geology and geomorphology data in the pre-elimination context of Zanzibar, United Republic of Tanzania

BACKGROUND

Larval source management strategies can play an important role in malaria elimination programmes, especially for tackling outdoor biting species and for eliminating parasite and vector populations when they are most vulnerable during the dry season. Effective larval source management requires tools for identifying geographic foci of vector proliferation and malaria transmission where these efforts may be concentrated. Previous studies have relied on surface topographic wetness to indicate hydrological potential for vector breeding sites, but this is unsuitable for karst (limestone) landscapes such as Zanzibar where water flow, especially in the dry season, is subterranean and not controlled by surface topography.

METHODS

We examine the relationship between dry and wet season spatial patterns of diagnostic positivity rates of malaria infection amongst patients reporting to health facilities on Unguja, Zanzibar, with the physical geography of the island, including land cover, elevation, slope angle, hydrology, geology and geomorphology in order to identify transmission hot spots using Boosted Regression Trees (BRT) analysis.

RESULTS

The distribution of both wet and dry season malaria infection rates can be predicted using freely available static data, such as elevation and geology. Specifically, high infection rates in the central and southeast regions of the island coincide with outcrops of hard dense limestone which cause locally elevated water tables and the location of dolines (shallow depressions plugged with fine-grained material promoting the persistence of shallow water bodies).

CONCLUSIONS

This analysis provides a tractable tool for the identification of malaria hotspots which incorporates subterranean hydrology, which can be used to target larval source management strategies.

Analysis of the causes of spawning of large-scale, severe malarial epidemics and their rapid total extinction in western Provence, historically a highly endemic region of France (1745-1850)

BACKGROUND

The two main puzzles of this study are the onset and then sudden stopping of severe epidemics in western Provence (a highly malaria-endemic region of Mediterranean France) without any deliberate counter-measures and in the absence of significant population flux.

METHODS

Malaria epidemics during the period from 1745 to 1850 were analysed against temperature and rainfall records and several other potentially relevant factors.

RESULTS

Statistical analyses indicated that relatively high temperatures in early spring and in September/October, rainfall during the previous winter (principally December) and even from November to September and epidemics during the previous year could have played a decisive role in the emergence of these epidemics. Moreover, the epidemics were most likely not driven by other parameters (e.g., social, cultural, agricultural and geographical). Until 1776, very severe malarial epidemics affected large areas, whereas after this date, they were rarer and generally milder for local people and were due to canal digging activities. In the latter period, decreased rainfall in December, and more extreme and variable temperatures were observed. It is known that rainfall anomalies and temperature fluctuations may be detrimental to vector and parasite development.

CONCLUSION

This study showed the particular characteristics of malaria in historical Provence. Contrary to the situation in most other Mediterranean areas, Plasmodium falciparum was most likely not involved (during the years with epidemics, the mean temperature during the months of July and August, among other factors, did not play a role) and the population had no protective mutation. The main parasite species was Plasmodium vivax, which was responsible for very severe diseases, but contrary to in northern Europe, it is likely that transmission occurred only during the period where outdoor sporogony was possible, and P. vivax sporogony was always feasible, even during colder summers. Possible key elements in the understanding of the course of malaria epidemics include changes in the virulence of P. vivax strains, the refractoriness of anophelines and/or the degree or efficiency of acquired immunity. This study could open new lines of investigation into the comprehension of the conditions of disappearance/emergence of severe malaria epidemics in highly endemic areas.

Quinine, mosquitoes and empire: reassembling malaria in British India, 1890-1910

The drug quinine figured as an object of enforced consumption in British India between the late 1890s and the 1910s, when the corresponding diagnostic category malaria itself was redefined as a mosquito-borne fever disease. This article details an overlapping milieu in which quinine, mosquitoes and malaria emerged as intrinsic components of shared and symbiotic histories. It combines insights from new imperial histories, constructivism in the histories of medicine and literature about non-humans in science studies to examine the ways in which histories of insects, drugs, disease and empire interacted and shaped one another. Firstly, it locates the production of historical intimacies between quinine, malaria and mosquitoes within the exigencies and apparatuses of imperial rule. In so doing, it explores the intersections between the worlds of colonial governance, medical knowledge, vernacular markets and pharmaceutical business. Secondly, it outlines ways to narrate characteristics and enabling properties of non-humans (such as quinines and mosquitoes) while retaining a constructivist critique of scientism and empire. Thirdly, it shows how empire itself was reshaped and reinforced while occasioning the proliferation of categories and entities like malaria, quinine and mosquitoes.

An ecological and comparative perspective on the control of bovine tuberculosis in Great Britain and the Republic of Ireland

Disease ecology involves a systematic approach to understanding the interactions and evolution of host-pathogen systems at the population level, and is essential for developing a comprehensive understanding of the reasons for disease persistence and the most likely means of control. This systems or ecological approach is being increasingly recognised as a progressive method in disease control and is exploited in diverse fields ranging from obesity management in humans to the prevention of infectious disease in animal populations. In this review we discuss bovine tuberculosis (bTB) in Great Britain (GB) within a disease ecology context, and suggest how a comparative ecological perspective helps to reconcile apparent conflicts with the evidence on the effectiveness of badger culling to assist in the control of bTB in GB and the Republic of Ireland (ROI). Our examination shows that failure of past measures to control bTB and the disparity in outcomes of badger culling experiments are the result of a complex relationship amongst the agent, host and environment, i.e. the episystem, of bTB. Here, we stress the role of distinctive bTB episystems and badger culling trial design in the ambiguity and resulting controversy associated with badger culling in GB and ROI. We argue this episystem perspective on bTB control measures in cattle and badger populations provides a useful and informative perspective on the design and implementation of future bTB management in GB, particularly at a time when both scientific and lay communities are concerned about the ongoing epidemic, the cost of current control measures and the execution of future control procedures.

How human practices have affected vector-borne diseases in the past: a study of malaria transmission in Alpine valleys

Background

Malaria was endemic in the Rhône-Alpes area of eastern France in the 19^th century and life expectancy was particularly shortened in Alpine valleys. This study was designed to determine how the disease affected people in the area and to identify the factors influencing malaria transmission.

Methods

Demographic data of the 19^th century were collected from death registers of eight villages of the flood-plain of the river Isère. Correlations were performed between these demographic data and reconstructed meteorological data. Archive documents from medical practitioners gave information on symptoms of ill people. Engineer reports provided information on the hydraulic project developments in the Isère valley.

Results

Description of fevers was highly suggestive of endemic malaria transmission in the parishes neighbouring the river Isère. The current status of anopheline mosquitoes in the area supports this hypothesis. Mean temperature and precipitation were poorly correlated with demographic data, whereas the chronology of hydrological events correlated with fluctuations in death rates in the parishes.

Conclusion

Nowadays, most of the river development projects involve the creation of wet areas, enabling controlled flooding events. Flood-flow risk and the re-emergence of vector-borne diseases would probably be influenced by the climate change. The message is not to forget that human disturbance of any functioning hydrosystem has often been linked to malaria transmission in the past.

Malaria in Britain: past, present, and future

There has been much recent speculation that global warming may allow the reestablishment of malaria transmission in previously endemic areas such as Europe and the United States. In this report we analyze temporal trends in malaria in Britain between 1840 and 1910, to assess the potential for reemergence of the disease. Our results demonstrate that at least 20% of the drop-off in malaria was due to increasing cattle population and decreasing acreage of marsh wetlands. Although both rainfall and average temperature were associated with year-to-year variability in death rates, there was no evidence for any association with the long-term malaria trend. Model simulations for future scenarios in Britain suggest that the change in temperature projected to occur by 2050 is likely to cause a proportional increase in local malaria transmission of 8-14%. The current risk is negligible, as >52,000 imported cases since 1953 have not led to any secondary cases. The projected increase in proportional risk is clearly insufficient to lead to the reestablishment of endemicity.

Illness and elevated human mortality in Europe coincident with the Laki Fissure eruption

Volcanic eruptions represent a significant source of volatile gases that are harmful to human health. This chapter reviews and develops current understanding of the human health response to volcanogenic pollution and dry fog events; in particular it explores the health impact of the gases from the Laki fissure eruption, and presents data that point to a significant increase in the national death rate in England coincident with the early phases of the eruption. It is noted that many common symptoms of severe exposure to air pollution can be linked to the dry fog of 1783; these included difficulty in breathing, eye and skin irritation, headaches, loss of appetite and tiredness.

Climate change and mosquito-borne disease

Global atmospheric temperatures are presently in a warming phase that began 250--300 years ago. Speculations on the potential impact of continued warming on human health often focus on mosquito-borne diseases. Elementary models suggest that higher global temperatures will enhance their transmission rates and extend their geographic ranges. However, the histories of three such diseases--malaria, yellow fever, and dengue--reveal that climate has rarely been the principal determinant of their prevalence or range; human activities and their impact on local ecology have generally been much more significant. It is therefore inappropriate to use climate-based models to predict future prevalence.

From Shakespeare to Defoe: malaria in England in the Little Ice Age

Present global temperatures are in a warming phase that began 200 to 300 years ago. Some climate models suggest that human activities may have exacerbated this phase by raising the atmospheric concentration of carbon dioxide and other greenhouse gases. Discussions of the potential effects of the weather include predictions that malaria will emerge from the tropics and become established in Europe and North America. The complex ecology and transmission dynamics of the disease, as well as accounts of its early history, refute such predictions. Until the second half of the 20th century, malaria was endemic and widespread in many temperate regions, with major epidemics as far north as the Arctic Circle. From 1564 to the 1730s the coldest period of the Little Ice Age malaria was an important cause of illness and death in several parts of England. Transmission began to decline only in the 19th century, when the present warming trend was well under way. The history of the disease in England underscores the role of factors other than temperature in malaria transmission.