The Eyam plague revisited: did the village isolation change transmission from fleas to pulmonary?

Differential word expression analyses highlight plague dynamics during the second pandemic

Research on the second plague pandemic that swept over Europe from the fourteenth to nineteenth centuries mainly relies on the exegesis of contemporary texts and is prone to interpretive bias. By leveraging certain bioinformatic tools routinely used in biology, we developed a quantitative lexicography of 32 texts describing two major plague outbreaks, using contemporary plague-unrelated texts as negative controls. Nested, network and category analyses of a 207-word pan-lexicome, comprising overrepresented terms in plague-related texts, indicated that 'buboes' and 'carbuncles' are words that were significantly associated with the plague and signalled an ectoparasite-borne plague. Moreover, plague-related words were associated with the terms 'merchandise', 'movable', 'tatters', 'bed' and 'clothes'. Analysing ancient texts using the method reported in this paper can certify plague-related historical records and indicate the particularities of each plague outbreak, which can inform on the potential sources for the causative Yersinia pestis.

How England first managed a national infection crisis: Implementation of the Plague Orders of 1578 compared with COVID-19 Lockdown March to May 2020

The current COVID-19 pandemic and lockdown in the UK have parallels with the first ever national management of epidemic infection in England, the Plague Orders of 1578. Combining historical research of the Tudor and Stuart periods with information sources and broadcast news as the epidemic in England unfolds in real time during lockdown, the areas of official guidance, epidemiology, social distancing and quarantine, financing measures, the national health service and fake news are compared. Then as now, limits on freedom of movement and congregation, social distancing and quarantine measures were applied for the sake of preserving life, loss of livelihood ameliorated by government loans and inconvenient opinions suppressed, and these suggest a commonality of organised responses to mass infection across times. Increased danger in certain necessary occupations and flight to second homes by the rich have been observed, health inequities uncovered and restrictions on being with the dying and burying the dead enforced. Wholly unprecedented in comparison with the past, when the wealthiest in a parish were taxed to pay for measures against plague, is the quarantining of the whole society and the financial package for workers on furlough to avoid mass unemployment. In the new normal after lockdown, people should be given more credit for sophisticated understanding than was allowed in past centuries, when fear and punishment coerced the majority to conform, and be allowed access to relevant information which will influence decisions about national and community life going forward after lockdown.

COVID-19 and the ethics of quarantine: a lesson from the Eyam plague

The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur's Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place.

The Inclusive Behavioral Immune System

Although living in social groups offers many advantages, it comes at a cost of increased transmissible disease. The behavioral immune system (BIS) is thought to have evolved as a first line of defense against such infections. It acts by minimizing the contact of yet uninfected hosts with potential pathogens. The BIS has been observed in a wide range of animals including insects, amphibians and mammals, but most research has focused on humans where the BIS is guided by complex cognitive and emotional processing. When researchers discuss the evolutionary origin of the BIS, they assess how it raises individual fitness. What would happen though if we shift our attention to the evolutionary unit of selection – the gene? Success would be measured as the change in the gene’s prevalence in the entire population, and additional behaviors would come to our attention – those that benefit relatives, i.e., behaviors that raise inclusive fitness. One widely-recognized example of the inclusive BIS is social immunity, which is prevalent among eusocial organisms such as bees and ants. Their colonies engage in a collaborative protective behavior such as grooming and the removal of infected members from the nest. Another example may be sickness behavior, which includes the behavioral, cognitive and emotional symptoms that accompany infection, such as fatigue, and loss of appetite and social interest. My colleague and I recently suggested that sickness behavior has evolved because it reduces the direct and indirect contact between an infected host and its healthy kin – improving inclusive fitness. These additional behaviors are not carried out by the healthy individuals, but rather by whole communities in the first case, and by already infected individuals in the second. Since they step beyond the classical definition of BIS, it may be useful to broaden the term to the inclusive behavioral immune system.

A Note on the Risk of Infections Invading Unaffected Regions

We present two probabilistic models to estimate the risk of introducing infectious diseases into previously unaffected countries/regions by infective travellers. We analyse two distinct situations, one dealing with a directly transmitted infection (measles in Italy in 2017) and one dealing with a vector-borne infection (Zika virus in Rio de Janeiro, which may happen in the future). To calculate the risk in the first scenario, we used a simple, nonhomogeneous birth process. The second model proposed in this paper provides a way to calculate the probability that local mosquitoes become infected by the arrival of a single infective traveller during his/her infectiousness period. The result of the risk of measles invasion of Italy was of 93% and the result of the risk of Zika virus invasion of Rio de Janeiro was of 22%.

Human ectoparasites and the spread of plague in Europe during the Second Pandemic

Plague, caused by the bacterium Yersinia pestis, can spread through human populations by multiple transmission pathways. Today, most human plague cases are bubonic, caused by spillover of infected fleas from rodent epizootics, or pneumonic, caused by inhalation of infectious droplets. However, little is known about the historical spread of plague in Europe during the Second Pandemic (14-19th centuries), including the Black Death, which led to high mortality and recurrent epidemics for hundreds of years. Several studies have suggested that human ectoparasite vectors, such as human fleas (Pulex irritans) or body lice (Pediculus humanus humanus), caused the rapidly spreading epidemics. Here, we describe a compartmental model for plague transmission by a human ectoparasite vector. Using Bayesian inference, we found that this model fits mortality curves from nine outbreaks in Europe better than models for pneumonic or rodent transmission. Our results support that human ectoparasites were primary vectors for plague during the Second Pandemic, including the Black Death (1346-1353), ultimately challenging the assumption that plague in Europe was predominantly spread by rats.

Bi-logistic model for disease dynamics caused by Mycobacterium tuberculosis in Russia

In this work, we explore epidemiological dynamics by the example of tuberculosis in Russian Federation. It has been shown that the epidemiological dynamics correlates linearly with the virulence of Mycobacterium tuberculosis during the period 1987-2012. To construct an appropriate model, we have analysed (using LogLet decomposition method) epidemiological World Health Organization (WHO) data (period 1980-2014) and obtained, as result of their integration, a curve approximated by a bi-logistic function. This fact allows a subdivision of the whole population into parts, each of them satisfies the Verhulst-like models with different constant virulences introduced into each subsystem separately. Such a subdivision could be interconnected with the heterogeneous structure of mycobacterial population that has a high ability of adaptation to the host and strong mutability.

Epidemiological analysis of the Eyam plague outbreak of 1665-1666

Plague, caused by the bacterium Yersinia pestis, is one of the deadliest infectious diseases in human history, and still causes worrying outbreaks in Africa and South America. Despite the historical and current importance of plague, several questions remain unanswered concerning its transmission routes and infection risk factors. The plague outbreak that started in September 1665 in the Derbyshire village of Eyam claimed 257 lives over 14 months, wiping out entire families. Since previous attempts at modelling the Eyam plague, new data have been unearthed from parish records revealing a much more complete record of the disease. Using a stochastic compartmental model and Bayesian analytical methods, we found that both rodent-to-human and human-to-human transmission played an important role in spreading the infection, and that they accounted, respectively, for a quarter and three-quarters of all infections, with a statistically significant seasonality effect. We also found that the force of infection was stronger for infectious individuals living in the same household compared with the rest of the village. Poverty significantly increased the risk of disease, whereas adulthood decreased the risk. These results on the Eyam outbreak contribute to the current debate on the relative importance of plague transmission routes.

Magnitude and frequency variations of vector-borne infection outbreaks using the Ross-Macdonald model: explaining and predicting outbreaks of dengue fever

The classical Ross-Macdonald model is often utilized to model vector-borne infections; however, this model fails on several fronts. First, using measured (or estimated) parameters, which values are accepted from the literature, the model predicts a much greater number of cases than what is usually observed. Second, the model predicts a single large outbreak that is followed by decades of much smaller outbreaks, which is not consistent with what is observed. Usually towns or cities report a number of recurrences for many years, even when environmental changes cannot explain the disappearance of the infection between the peaks. In this paper, we continue to examine the pitfalls in modelling this class of infections, and explain that, if properly used, the Ross-Macdonald model works and can be used to understand the patterns of epidemics and even, to some extent, be used to make predictions. We model several outbreaks of dengue fever and show that the variable pattern of yearly recurrence (or its absence) can be understood and explained by a simple Ross-Macdonald model modified to take into account human movement across a range of neighbourhoods within a city. In addition, we analyse the effect of seasonal variations in the parameters that determine the number, longevity and biting behaviour of mosquitoes. Based on the size of the first outbreak, we show that it is possible to estimate the proportion of the remaining susceptible individuals and to predict the likelihood and magnitude of the eventual subsequent outbreaks. This approach is described based on actual dengue outbreaks with different recurrence patterns from some Brazilian regions.

Modeling Importations and Exportations of Infectious Diseases via Travelers

This paper is an attempt to estimate the risk of infection importation and exportation by travelers. Two countries are considered: one disease-free country and one visited or source country with a running endemic or epidemic infectious disease. Two models are considered. In the first model (disease importation), susceptible individuals travel from their disease-free home country to the endemic country and come back after some weeks. The risk of infection spreading in their home country is then estimated supposing the visitors are submitted to the same force of infection as the local population but do not contribute to it. In the second model (disease exportation), it is calculated the probability that an individual from the endemic (or epidemic) country travels to a disease-free country in the condition of latent infected and eventually introduces the infection there. The input of both models is the force of infection at the visited/source country, assumed known. The models are deterministic, but a preliminary stochastic formulation is presented as an appendix. The models are exemplified with two distinct real situations: the risk of dengue importation from Thailand to Europe and the risk of Ebola exportation from Liberia to the USA.

Why Do We Feel Sick When Infected--Can Altruism Play a Role?

When we contract an infection, we typically feel sick and behave accordingly. Symptoms of sickness behavior (SB) include anorexia, hypersomnia, depression, and reduced social interactions. SB affects species spanning from arthropods to vertebrates, is triggered nonspecifically by viruses, bacteria, and parasites, and is orchestrated by a complex network of cytokines and neuroendocrine pathways; clearly, it has been naturally selected. Nonetheless, SB seems evolutionarily costly: it promotes starvation and predation and reduces reproductive opportunities. How could SB persist? Former explanations focused on individual fitness, invoking improved resistance to pathogens. Could prevention of disease transmission, propagating in populations through kin selection, also contribute to SB?

Yersinia pestis as a telluric, human ectoparasite-borne organism

The classic epidemiological model of plague is an infection of rodents that is transmitted to human beings by rodent ectoparasites. This model fits with observations of sporadic and limited outbreaks, but hardly explains the persistence of plague foci for millennia or the epidemiological features drawn from the descriptions of historical pandemics. A comprehensive review of the published data, including scientific papers published in France between 1920 and 1940, allows the completion of the epidemiological chain by introducing soil as a reservoir, burrowing rodents as a first link, and human ectoparasites as the main driving force for pandemics. Modern studies are needed to confirm the validity of this controversial model and to assess the relative contribution of each link in the various epidemiological presentations of plague. If confirmed, these data should be taken into account to update public-health policies and bioterrorism risk management, particularly among ectoparasite-infested people.