Some lesser-known facts on the early history of syphilis in Europe

At the end of the 15th century, an epidemic outbreak occurred in Europe for which the cause was previously unknown. Clinical findings included numerous ulcerations and condylomas as well as disorders of the cardiovascular and neurologic systems. The disease, which had many names at the time and killed about 5 million people, is referred to as syphilis in today's medical terminology. The epidemiology of syphilis is complex and represents an important issue, not only historically but also scientifically, in the development of medicine. Several theories emerged about the origin of this disease, including pre-Columbian and Columbian ones. This contribution aims to present the history of the origin of syphilis, with particular emphasis on the first reports of the disease in Poland.

Histories of Medieval Plague in Renaissance Italy

During the sixteenth century, Italian scholars revised their conception of the field of history so that its purposes went beyond providing political and morally edifying narratives. These scholars contended that history must also account for culture and nature in an encyclopedic fashion. In the same years, numerous newly available texts from antiquity, the Byzantine empire, and the Middle Ages provided insight into the character of earlier outbreaks of plague. Italian physicians, embracing new visions of the field of history, the culture of humanism, and an inductivist epistemology, used these texts to argue that there were continuities among ancient, medieval, and Renaissance epidemics. They catalogued plague and formed historical categories based on severity and perceived origins, leading to the rejection of the conclusions of fourteenth-century western Europeans who viewed the plague of 1347-1353 as unprecedented. These erudite physicians saw medieval plague to be one example of the extreme epidemics that have regularly occurred throughout history.

Lest we forget: Odunbaku Oguntona Sapara William (1895-1935) beyond the demystification of deity

Oguntola Odunbaku Sapara Williams (born Alexander Johnson Williams, 1861-1935) was a Fellow of the Royal Institute of Public Health. This paper attempts to highlight the effort of an African doctor to fight disease outbreaks during the African colonial era. His uninterrupted 32 years career as a colonial medical officer in one of the British colonies in West Africa, provided superintendence for the eradication of smallpox as a result of this, he was credited with the demystification of metaphysical involvement in the smallpox epidemic and thus eradication of smallpox in the Lagos colony. He also provided leadership for the control of bubonic plague, and tuberculosis epidemics and pioneered initiatives to reduce maternal and infant mortality by vaccination, enactment of public health law, environmental sanitation, and health education in Southwest Nigeria.

Typhus Disease in Iran during the Qajar Period (1725 to 1925 AD); a Brief Historical Review

Typhus is an acute febrile disease caused by a series of bacteria called Rickettsia that is transmitted by insects such as lice, fleas, and ticks. This disease has appeared several times in Iran and caused many casualties. There were some therapeutic measures taken by European physicians in Tehran and medical graduates of the Dar al-Fonun school or expatriates who had studied medical courses in Western countries, even though the taken steps were not enough. Due to the lack of sanitation and cleaning products after the outbreak of World War I in March 1917 and its synchronization with the swift outbreak of Typhus in 1918, heavy casualties followed. In this study, we first examine the prevalence of Typhus in the Qajar dynasty in Iran, and will then focus on the pathological importance of this disease history in Iran. After that, we will study the role of Typhus prevalence and World War I in the Persian famine, malnutrition, and food poverty. Moreover, we investigated the role that this great war had in strengthening the spread of this disease and its role in the death of many Iranian people.

Open Secrets: Silence, Suppression, and Memory in the History of Canada's 1918-20 Influenza Pandemic

For several decades, the 1918-20 global influenza outbreak has been called "the forgotten pandemic." Although recent scholarly and public interest in the pandemic has complicated the narrative of forgetting, the label has stuck. Highlighting historical evidence of influenza's long-term impact upon survivors, family, and community in Canada, the flu stories presented here, diverse in form and content, verify that a key question in pandemic influenza history is not whether the pandemic was forgotten or remembered, but by whom, and in what ways, it has been suppressed - or foregrounded. By moving beyond the classic epidemic plot line, with beginning, middle, and end, historians can find new methodologies and evidence with which to more fully understand the influenza pandemic's unfolding intersection with colonialism, war, social inequality, and labour struggles in the 20^th century.

Spanish Flu in Tehran from 1918 to 1920

The Spanish flu spread from September 23, 1918 to 1920. This disease was one of the historical catastrophes in Iran, and a large number of people in Tehran were infected. Evidence also shows that 5000-10000 out of the 250000 infected people died in Tehran over three years. Besides, an increase was detected in the prevalence of other diseases such as pericarditis, orchitis, mastoiditis, meningitis, optic neuritis, paralysis of the palate, mania, cholera, and dysentery. Overall, five percent of the city were destroyed, and the population and economic development were severely damaged. This study aims to evaluate the importance of the history of local medicine in Tehran, the spread of Spanish flu, World War I, and presence of Russian, Ottoman, and British troops in Iran during the flu outbreak. The critical role of Britain in artificial famine, malnutrition, and drug embargo was assessed, as well.

Bioarchaeological insights into the last plague of Imola (1630-1632)

The plague of 1630-1632 was one of the deadliest plague epidemics to ever hit Northern Italy, and for many of the affected regions, it was also the last. While accounts on plague during the early 1630s in Florence and Milan are frequent, much less is known about the city of Imola. We analyzed the full skeletal assemblage of four mass graves (n = 133 individuals) at the Lazaretto dell'Osservanza, which date back to the outbreak of 1630-1632 in Imola and evaluated our results by integrating new archival sources. The skeletons showed little evidence of physical trauma and were covered by multiple layers of lime, which is characteristic for epidemic mass mortality sites. We screened 15 teeth for Yersinia pestis aDNA and were able to confirm the presence of plague in Imola via metagenomic analysis. Additionally, we studied a contemporaneous register, in which a friar recorded patient outcomes at the lazaretto during the last year of the epidemic. Our multidisciplinary approach combining historical, osteological and genomic data provided a unique opportunity to reconstruct an in-depth picture of the last plague of Imola through the city's main lazaretto.

Historical Investigation of Fowl Adenovirus Outbreaks in South Korea from 2007 to 2021: A Comprehensive Review

Fowl adenoviruses (FAdVs) have long been recognized as critical viral pathogens within the poultry industry, associated with severe economic implications worldwide. This specific group of viruses is responsible for a broad spectrum of diseases in birds, and an increasing occurrence of outbreaks was observed in the last ten years. Since their first discovery forty years ago in South Korea, twelve antigenically distinct serotypes of fowl adenoviruses have been described. This comprehensive review covers the history of fowl adenovirus outbreaks in South Korea and updates the current epidemiological landscape of serotype diversity and replacement as well as challenges in developing effective broadly protective vaccines. In addition, transitions in the prevalence of dominant fowl adenovirus serotypes from 2007 to 2021, alongside the history of intervention strategies, are brought into focus. Finally, future aspects are also discussed.

The enigma of Pacini's Vibrio cholerae discovery

During the 1854 cholera outbreak in Florence, Italy, Filippo Pacini documented that the cause of the infection was a bacterium. This conclusion was also independently reached by John Snow during the 1854 cholera outbreak in London. By using an epidemiological method, Snow found that the infection spread through a polluted water network. Snow identified a water pump as the source of the disease. After removing the infected handle of this pump, the cases of cholera rapidly began to decrease. A microscopic examination of the water showed organic impurities but no bacteria. This discovery was ignored during Snow's lifetime. In contrast, through microscopy during the autopsies of cholera victims, Pacini observed that the disruption of their intestinal mucosa was closely associated with millions of the bacteria that he called Vibrio cholerae. Via histological techniques, Pacini detected that intestinal mucosa reabsorption dysfunction was the cause of debilitating diarrhoea, vomiting, severe dehydration and death. Nevertheless, his discovery of Vibrio cholerae was ignored during Pacini's lifetime. A survey of Pacini's autographic manuscripts suggests that Pacini and Snow may have shared mutual knowledge within their respective seminal papers. This survey also facilitates, for the first time, the creation of maps that illustrate the worldwide distribution of Pacini's cholera papers from 1854 to 1881. The consistent neglect of Pacini's discovery remains a true enigma.

A grim anniversary - 20 years since burning pyres marred our landscape

Georgina Mills reflects on the 2001 foot-and-mouth outbreak and the lessons that have been learned since then.

The 1942 Massive Contamination of Yellow Fever Vaccine: A Public Health Consequence of Scientific Arrogance

In the late 1930s, the 17D vaccine against yellow fever was produced in record time. 17D was and is an excellent vaccine. Its rapid diffusion led, however, to several problems, the most important among them being the 1942 massive contamination of the vaccine distributed to the US Army by the hepatitis B virus. The US part of this story is relatively well-known, but its Brazilian part much less so. In 1940, scientists who were producing the 17D vaccine in Rio de Janeiro found that it was contaminated by an "icterus virus" that originated in normal human serum. They solved this problem through the exclusion of human serum from vaccine production, but failed to persuade their US colleagues to do the same. The Rio experts, aware of the potential pitfalls of a new technology, carefully supervised the consequences of their vaccination campaigns. They were thus able to rapidly spot problems and eliminate them. By contrast, US scientists, persuaded of their technical superiority and distrustful of warnings that originated from a "less developed" country, neglected to implement basic public health rules. A major disaster followed. (Am J Public Health. 2021;111(9): 1654-1660. https://doi.org/10.2105/AJPH.2021.306313).

History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak

BACKGROUND

The aims of this systematic review and meta-analysis are to examine the prevalence of adverse mental health outcomes, both short-term and long-term, among SARS patients, healthcare workers and the general public of SARS-affected regions, and to examine the protective and risk factors associated with these mental health outcomes.

METHODS

We conducted a systematic search of the literature using databases such as Medline, Pubmed, Embase, PsycInfo, Web of Science Core Collection, CNKI, the National Central Library Online Catalog and dissertation databases to identify studies in the English or Chinese language published between January 2003 to May 2020 which reported psychological distress and mental health morbidities among SARS patients, healthcare workers, and the general public in regions with major SARS outbreaks.

RESULTS

The literature search yielded 6984 titles. Screening resulted in 80 papers for the review, 35 of which were included in the meta-analysis. The prevalence of post-recovery probable or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) among SARS survivors were 19, 20 and 28%, respectively. The prevalence of these outcomes among studies conducted within and beyond 6 months post-discharge was not significantly different. Certain aspects of mental health-related quality of life measures among SARS survivors remained impaired beyond 6 months post-discharge. The prevalence of probable depressive disorder and PTSD among healthcare workers post-SARS were 12 and 11%, respectively. The general public had increased anxiety levels during SARS, but whether there was a clinically significant population-wide mental health impact remained inconclusive. Narrative synthesis revealed occupational exposure to SARS patients and perceived stigmatisation to be risk factors for adverse mental health outcomes among healthcare workers, although causality could not be determined due to the limitations of the studies.

CONCLUSIONS

The chronicity of psychiatric morbidities among SARS survivors should alert us to the potential long-term mental health complications of covid-19 patients. Healthcare workers working in high-risk venues should be given adequate mental health support. Stigmatisation against patients and healthcare workers should be explored and addressed. The significant risk of bias and high degree of heterogeneity among included studies limited the certainty of the body of evidence of the review.

The origins of viral infection sleuth

The events of the past year have underscored the serious and rapid threat that emerging viruses pose to global health. However, much of the rapid progress in understanding and combating SARS-CoV-2 was made possible because of the decades of important groundwork laid from researchers studying other emergent infectious diseases. The 2021 John Dirks Canada Gairdner Global Health award recognizes the contributions of Joseph Sriyal Malik Peiris and Yi Guan toward understanding the origins and options for control of newly emerging infectious disease outbreaks in Asia, notably zoonotic influenza and severe acute respiratory syndrome (SARS). Cell's Nicole Neuman corresponded with Yi Guan about his path to becoming a viral infection sleuth and the challenges of understanding emerging pathogens and their origins. Excerpts of their exchange are included here.

Mortality of the COVID-19 Outbreak in Sweden in Relation to Previous Severe Disease Outbreaks

Influenza viruses have caused disease outbreaks in human societies for a long time. Influenza often has rapid onset and relatively short duration, both in the individual and in the population. The case fatality rate varies for different strains of the virus, as do the effects on total mortality. Outbreaks related to coronavirus infections have recently become a global concern but much less is known about the dynamics of these outbreaks and their effects on mortality. In this work, disease outbreaks in Sweden, in the time period of 1860-2020, are characterized and compared to the currently ongoing COVID-19 outbreak. The focus is on outbreaks with a sharp increase in all-cause mortality. Outbreak onset is defined as the time point when death counts start to increase consistently for a period of at least 10 days. The duration of the outbreak is defined as the time period in which mortality rates are elevated. Excess mortality is estimated by standard methods. In total there were 15 outbreaks detected in the time period, the first 14 were likely caused by influenza virus infections, the last by SARS-CoV-2. The mortality dynamics of the SARS-CoV-2 outbreak is shown to be similar to outbreaks due to influenza virus, and in terms of the number of excess deaths, it is the worst outbreak in Sweden since the "Spanish flu" of 1918-1919.

Development and dissemination of infectious disease dynamic transmission models during the COVID-19 pandemic: what can we learn from other pathogens and how can we move forward?

The current COVID-19 pandemic has resulted in the unprecedented development and integration of infectious disease dynamic transmission models into policy making and public health practice. Models offer a systematic way to investigate transmission dynamics and produce short-term and long-term predictions that explicitly integrate assumptions about biological, behavioural, and epidemiological processes that affect disease transmission, burden, and surveillance. Models have been valuable tools during the COVID-19 pandemic and other infectious disease outbreaks, able to generate possible trajectories of disease burden, evaluate the effectiveness of intervention strategies, and estimate key transmission variables. Particularly given the rapid pace of model development, evaluation, and integration with decision making in emergency situations, it is necessary to understand the benefits and pitfalls of transmission models. We review and highlight key aspects of the history of infectious disease dynamic models, the role of rigorous testing and evaluation, the integration with data, and the successful application of models to guide public health. Rather than being an expansive history of infectious disease models, this Review focuses on how the integration of modelling can continue to be advanced through policy and practice in appropriate and conscientious ways to support the current pandemic response.

Mapping the cryptic spread of the 2015-2016 global Zika virus epidemic

BACKGROUND

Zika virus (ZIKV) emerged as a global epidemic in 2015-2016 from Latin America with its true geographical extent remaining unclear due to widely presumed underreporting. The identification of locations with potential and unknown spread of ZIKV is a key yet understudied component for outbreak preparedness. Here, we aim to identify locations at a high risk of cryptic ZIKV spread during 2015-2016 to further the understanding of the global ZIKV epidemiology, which is critical for the mitigation of the risk of future epidemics.

METHODS

We developed an importation simulation model to estimate the weekly number of ZIKV infections imported in each susceptible spatial unit (i.e. location that did not report any autochthonous Zika cases during 2015-2016), integrating epidemiological, demographic, and travel data as model inputs. Thereafter, a global risk model was applied to estimate the weekly ZIKV transmissibility during 2015-2016 for each location. Finally, we assessed the risk of onward ZIKV spread following importation in each susceptible spatial unit to identify locations with a high potential for cryptic ZIKV spread during 2015-2016.

RESULTS

We have found 24 susceptible spatial units that were likely to have experienced cryptic ZIKV spread during 2015-2016, of which 10 continue to have a high risk estimate within a highly conservative scenario, namely, Luanda in Angola, Banten in Indonesia, Maharashtra in India, Lagos in Nigeria, Taiwan and Guangdong in China, Dakar in Senegal, Maputo in Mozambique, Kinshasa in Congo DRC, and Pool in Congo. Notably, among the 24 susceptible spatial units identified, some have reported their first ZIKV outbreaks since 2017, thus adding to the credibility of our results (derived using 2015-2016 data only).

CONCLUSION

Our study has provided valuable insights into the potentially high-risk locations for cryptic ZIKV circulation during the 2015-2016 pandemic and has also laid a foundation for future studies that attempt to further narrow this key knowledge gap. Our modelling framework can be adapted to identify areas with likely unknown spread of other emerging vector-borne diseases, which has important implications for public health readiness especially in resource-limited settings.

Prevention of re-establishment of malaria: historical perspective and future prospects

Prevention of re-establishment (POR) refers to the prevention of malaria outbreak/epidemic occurrence or preventing re-establishment of indigenous malaria in a malaria-free country. Understanding the effectiveness of the various strategies used for POR is, therefore, of vital importance to countries certified as "malaria-free" or to the countries to be thus certified in the near future. This review is based on extensive review of literature on both the POR strategies and elimination schemes of countries, (i) that have reached malaria-free status (e.g. Armenia, Mauritius, Sri Lanka), (ii) those that are reaching pre-elimination stage (e.g. South Korea), and (iii) countries at the control phase (e.g. India). History has clearly shown that poorly implemented POR programmes can result in deadly consequences (e.g. Sri Lanka); conversely, there are examples of robust POR programmes that have sustained malaria free status that can serve as examples to countries working toward elimination. Countries awaiting malaria elimination status should pre-plan their POR strategies. Malaria-free countries face the risk of resurgence mostly due to imported malaria cases; thus, a robust passenger screening programme and cross border collaborations are crucial in a POR setting. In addition, sustained vigilance, and continued funding for the national anti-malarial campaign programme and for related research is of vital importance for POR. With distinct intrinsic potential for malaria in each country, tailor-made POR programmes are built through continuous and robust epidemiological and entomological surveillance, particularly in countries such as Sri Lanka with increased receptivity and vulnerability for malaria transmission. In summary, across all five countries under scrutiny, common strengths of the POR programmes are (i) a multipronged approach, (ii) strong passive, active, and activated passive case detection, (iii) Indoor residual spraying (IRS), and (iv) health education/awareness programmes.

Climate drivers of plague epidemiology in British India, 1898-1949

Plague, caused by Yersinia pestis infection, continues to threaten low- and middle-income countries throughout the world. The complex interactions between rodents and fleas with their respective environments challenge our understanding of human plague epidemiology. Historical long-term datasets of reported plague cases offer a unique opportunity to elucidate the effects of climate on plague outbreaks in detail. Here, we analyse monthly plague deaths and climate data from 25 provinces in British India from 1898 to 1949 to generate insights into the influence of temperature, rainfall and humidity on the occurrence, severity and timing of plague outbreaks. We find that moderate relative humidity levels of between 60% and 80% were strongly associated with outbreaks. Using wavelet analysis, we determine that the nationwide spread of plague was driven by changes in humidity, where, on average, a one-month delay in the onset of rising humidity translated into a one-month delay in the timing of plague outbreaks. This work can inform modern spatio-temporal predictive models for the disease and aid in the development of early-warning strategies for the deployment of prophylactic treatments and other control measures.

Measles, Malnutrition and Mortality: Puerto Rico, 1917-1918

OBJECTIVE

Recent measles outbreaks in the United States and Europe have highlighted the threat of the disease. We studied the 1917-1918 epidemic in Puerto Rico to better understand the social and place-specific risk factors and severity of such crises.

METHODS

We reviewed medical and government reports, newspapers and private contemporary documents.

RESULTS

The epidemic developed over two years, encompassed the Island, and caused nearly 2,000 deaths among more than 9,000 registered cases (with much underreporting). During the first six months, 59% of fatalities were children under 2 years of age. Officials recognized poor nutrition and living conditions as an important determinant of epidemic severity. Responses came from different social sectors before the central government mobilized to help. In San Juan, Catholic and Protestant churches and philanthropic women from both Spanish and Englishlanguage communities joined to provide free milk to needy children and create a temporary Infants' Hospital. Despite food scarcity and wartime conditions, central and municipal governments established hospitals and milk stations.

CONCLUSION

Studies that examine the impact of reemerging diseases in a time and place-specific context look at disease severity together with the socioeconomic conditions of patients and health care systems. This type of investigation also suggests avenues into the history of pediatrics, the use of epidemiologic methods, the utility of historical statistics, nutritional history, and the history of disaster response. Historical and recent outbreaks show the need for health care professionals and public health systems to be prepared to confront measles epidemics.

Mortality and demographic recovery in early post-black death epidemics: Role of recent emigrants in medieval Dijon

Objective and methods

We analyze the influence of population movement on susceptibility to death and resilience during two epidemics occurring in Dijon soon after the Black Death. Using a specific program designed to propose links between entries in annual tax registers, we define tentative heads of household, the elapsed time since their first registration and their ties with other persons within the city.

Results

During the 1400 epidemic heads of household who were registered for 1–3 years die in large numbers, whereas during years without epidemics, their death rate is lower than that of heads of household who were registered longer. Recent registration is an epidemic vulnerability factor only in association with a low taxation status, which, when isolated, does not influence mortality. A lack of familial ties within Dijon is another vulnerability factor among the recently registered. This suggests that poor, recent emigrants are more affected by epidemic mortality. In contrast, the mortality of recently registered heads of household is indistinct during a later epidemic occurring after several years of major famine that may have selected the more resistant emigrants and/or excluded the more miserable of them from our analysis. In contrast to the first one, this second epidemic is followed by rapid demographic recovery. This latter recovery is fully explained by the contribution of poor, newly registered heads of household without ties in Dijon.

Conclusion

Our results outline the interaction between population movement and low socioeconomic status on death susceptibility in historical plagues and show that poor recent emigrants may also be key players in the resilience of the population after an epidemic.

Control of measles in a juvenile custodial setting in the wake of the recent US outbreak

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

Occupational health responses to COVID-19: What lessons can we learn from SARS?

On 31 December 2019, the World Health Organization (WHO) received reports of pneumonia cases of unknown etiology in the city of Wuhan in Hubei Province, China. The agent responsible was subsequently identified as a coronavirus-SARS-CoV-2. The WHO declared this disease as a Public Health Emergency of International Concern at the end of January 2020. This event evoked a sense of déjà vu, as it has many similarities to the outbreak of severe acute respiratory syndrome (SARS) of 2002-2003. Both illnesses were caused by a zoonotic novel coronavirus, both originated during winter in China and both spread rapidly all over the world. However, the case-fatality rate of SARS (9.6%) is higher than that of COVID-19 (<4%). Another zoonotic novel coronavirus, MERS-CoV, was responsible for the Middle East respiratory syndrome, which had a case-fatality rate of 34%. Our experiences in coping with the previous coronavirus outbreaks have better equipped us to face the challenges posed by COVID-19, especially in the health care setting. Among the insights gained from the past outbreaks were: outbreaks caused by viruses are hazardous to healthcare workers; the impact of the disease extends beyond the infection; general principles of prevention and control are effective in containing the disease; the disease poses both a public health as well as an occupational health threat; and emerging infectious diseases pose a continuing threat to the world. Given the perspectives gained and lessons learnt from these past events, we should be better prepared to face the current COVID-19 outbreak.

Zika Virus: A Brief History and Review of Its Pathogenesis Rediscovered

From its discovery in Uganda in 1947, Zika virus (ZIKV) was considered a relatively innocuous viral pathogen with sporadic and infrequent occurrence of human infection. It was during an outbreak in French Polynesia in 2014 when cases of Guillain-Barré syndrome were identified as a serious complication of ZIKV infection in adults. However, in 2015, ZIKV emerged into and swept through South and Central America infecting millions of people. As part of the latter ZIKV outbreak, in Brazil, cases of microcephaly and other serious congenital complications affecting a large fraction of infants born to mothers infected during pregnancy were first identified and linked to ZIKV. This chapter reviews the history and clinical manifestations of ZIKV infection and mechanisms of immunoprotection. It is notable that, while limited, historical monographs identified most, if not all, of the precepts that are considered as newly discovered.

Drought-induced spatio-temporal synchrony of plague outbreak in Europe

Plague synchronously swept across separated regions in Europe throughout history. However, the spatio-temporal synchrony of plague and its driving mechanism have not been thoroughly investigated. In this study, we transformed the historical European plague database spanned 1347-1800 CE into country-level time-series that differentiated large-scale plague outbreak from counted data. We found that there are 74 years in which two or more countries in our study region (UK, France, Germany, Spain, and Italy) experienced large-scale plague outbreak in the same year. Our Multivariate Ripley's K-function results showed that the onset year and the cessation year of large-scale plague outbreak are synchronized at the 0-23-year and 0-20-year windows, respectively. The temporal association between such synchrony and climatic forcing was further investigated using the Superposed Epoch Analysis, and drought was found to be responsible for the synchrony. Integrating our results with a literature survey, we suggested that prior to the peak of plague, the occurrence of drought and the subsequent reintroduced rainfall dampened both the rodent community and human society and boosted the number of fleas that carried plague. Such a synthesis facilitated the outbreak of plague. At the same time, high temperature associated with such drought also confined the geographic diffusion of the plague. Hence, although continental mega-drought could initiate the synchrony of plague outbreak, the synchrony actually consisted of a number of localized plague outbreak events scattering across different regions in Europe. According to the projected rising trend of drought in terms of its magnitude, duration, and geographic extent, the risk of synchrony of rodent-borne diseases in Europe will be significantly elevated, especially in France, Italy, and Spain.

An analysis of deaths in Tuliszków parish caused by a cholera epidemic in 1831

BACKGROUND

Information is presented about cholera as an infectious disease and an epidemic in Polish lands and in Europe in 1831 based on old and modern sources.

OBJECTIVE

To analyze the difference in the percentages of deaths from cholera depending on age, in the Tuliszków parish during the cholera epidemic in 1831.

MATERIAL AND METHODS

A query was carried out in the archives. Information on deaths between 1829 and 1839 was obtained from the parish registry files. The following factors were taken into account: the cause of death, the age of the deceased and the place of residence. For individual age groups, the numbers of people who died of cholera in 1831 and those who died from other causes in the control year 1835 were compared by the Fisher test. The GBL and PubMed database was searched using the keywords: cholera, cholera epidemic, deaths, Tuliszków, the year 1831, Holy Spirit Hospital, Konin.

RESULTS

An outbreak of cholera in Tuliszków parish in 1831 began around the 8th of August and lasted until about the 10th of October. 81 people died of cholera: 74 people in Tuliszków and 7 people in Sarbicko. The number of deaths in infants and children up to 5 years of age was in fact significantly lower than in other age groups (p = 0.0052). The percentage of deaths from cholera compared to deaths from other causes among infants and children under 5 years of age decreased from 52.46% to 28.4%. In the age group of 20 to 40 years old it increased from 13.11% to 23.46% and in the age group over 55 years from 9.84% to 19.75%.

CONCLUSIONS

In Tuliszków parish in 1831, the number of deaths of infants and children under 5 years of age caused by cholera was indeed significantly lower than in other age groups (p = 0.0052).

On Courtroom Dramas and Plot Twists: Typhus in Eighteenth-Century London

This article applies the model developed in Charles Rosenberg's seminal article "What is an Epidemic?" to typhus outbreaks in eighteenth-century London. That framework remains valuable for understanding contagious disease in early modernity by helping to highlight the structure of responses to epidemics. So-called "Jail Fever" outbreaks are especially instructive, in part because the most notorious of these epidemics were small affairs when compared to the larger pandemics that Rosenberg explored. Considering that they accounted for relatively few deaths, historians must answer why they caused such a stir. Whereas the raw body count often drives development of narratives about epidemics, eighteenth-century typhus epidemics often hinged more on who died and where than how many. Typhus ravaged poor and working class communities throughout the period. However, even significant spikes in mortality occurring in poor neighborhoods often failed to trigger proclamations of epidemics. Some deaths mattered more than others in this regard, suggesting that qualitative criteria may have played a greater role than quantitative criteria when it came to identifying which events registered as epidemics in the eighteenth century.

[José Ignacio Bartolache y Díaz de Posada: his contributions to medicine]

During 18^th century in New Spain, the strong link between religion and science hindered scientific growth. Conservatism and scholasticism pervaded educational institutions. Within this restricted context, a scientific community conformed mainly by creoles fulfilled their desire and need to know more as they had access to European books, which allowed erudite leading figures, such as Dr. José Ignacio Bartolache y Díaz de Posada, propel innovative ideas in medicine and pharmacy. Dr. Bartolache was considered sacrilegious and scandalous by the ecclesiastical authorities of that epoch. He favored the performance of human body dissections to improve medical education, as well as the anatomical proposals of Vesalius against Galeno's classical anatomy. He contributed to the dissemination of knowledge as he created the first medical magazine in the American continent: El Mercurio Volante (The Flying Mercury); he also printed medical pamphlets and flyers, some of which were published in Nahuatl and Spanish, as the prescriptions for martial pills, reformulated by himself. Physician ahead of his time, he was characterized by his professional humanism and the comprehensive treatment of patients; he emphasized the rational use of medications, without distinction of social class. His sensitivity allowed him to bring medical knowledge and treatment of illnesses closer to the most vulnerable. Another of his contributions, ahead of his time, was the recognition he gave women for the intelligence and ability they showed, equal to men, when accessing education.

The 'H-Bug' epidemic: lessons from antibiotic-resistant staphylococcal outbreaks in New Zealand hospitals from 1955-1963

Deadly outbreaks of antibiotic-resistant staphylococcal infection occurred in New Zealand from the mid-1950s to early 1960s. The 'H' or 'Hospital-Bug' epidemic was part of a pandemic wave characterised by high numbers of nosocomial staphylococcal infections and the capacity of Staphylococcus aureus to develop resistance to commonly used antibiotics. Surgical patients and childbearing women and babies proved particularly vulnerable to the predominant pathogenic strain, identified as phage type 80/81. The post-war baby boom was at its height in New Zealand, and overcrowded maternity hospitals and outdated nursing techniques increased the risks of infection. The outbreaks challenged the medical profession, which had become reliant on antibiotics for prophylaxis and treatment. The Health Department ascribed responsibility for the indiscriminate use of antibiotics to medical practitioners but had little control over their prescribing habits. Confronted by increasing infection rates and falling public confidence in the maternity services, health officials supported a fundamental change in maternity care to 'rooming-in' of mother and baby, epidemiological research on staphylococcal transmission in hospitals, notification of nosocomial infections, improved barrier nursing and heightened awareness of appropriate aseptic techniques. Phage type 80/81 waned in the early 1960s concurrent with the arrival of methicillin but the emergence of methicillin-resistant S. aureus (MRSA) in the 1980s, vancomycin-resistant S. aureus (VRSA) in the 2000s, and the rapid emergence and spread of multi-drug resistant Gram-negative bacteria over the past decade, highlights the potential for further outbreaks while the use of antimicrobials remains high. Non-pharmacological interventions such as those promoted during the 'H-Bug' epidemic are likely to be central to controlling future waves of resistant nosocomial infection.

[The uncomfortable history of Mary Mallon and typhoid fever]

Mary Mallon (1869-1938) was an Irish immigrant who worked as a cook for rich families in New York. She was responsible for several outbreaks of typhoid fever since she was an asymptomatic carrier of Salmonella typhi. Because of the danger and fear for new outbreaks, she was held in quarantine for years, against her will. What factors contributed to this decision? Was it necessary to keep her isolated? And what was the role of public opinion and media? The history of Mary Mallon is a sad and tragic chapter in medical history, from which we can still draw important lessons.

Cuban Public Health History: The 19th Century Board of Health in the City of Holguín

INTRODUCTION In 19th century colonial Cuba, Boards of Health (Juntas de Sanidad) were created to administer public health, in tandem with and later replacing the older Royal Protomedicato Court (Real Tribunal de Protomedicato). Development of the Board of Health in the northeastern city of Holguín reflected local historical processes, as well as class relations and social issues characteristic of this period. Among the highlights of the Board's activities were epidemic control during cholera and smallpox outbreaks, monitoring the city's sanitary conditions, and support for charitable work. Studying the history of such epidemiological surveillance activities may benefit design and implementation of related current research and prevention/control campaigns. OBJECTIVE Describe the development of the 19th century Board of Health in the city of Holguín. EVIDENCE ACQUISITION The research was conducted through a critical analysis of primary sources contained in the Historical Archives of (today's) Holguín Province, specifically relevant documents from the regional and city government (Fondo Tenencia de Gobierno y Ayuntamiento) and town council (Cabildo). Cuban and international scientific publications were also consulted. DEVELOPMENT The Board of Health was the main institution conducting health and hygiene control and charitable activities in the city of Holguín during the 19th century. It was created mainly to take preventive measures against diseases affecting the population, an effort it undertook with support from the Urban Health Police. Its efforts to confront smallpox and cholera epidemics greatly helped to reduce the toll of these diseases on the population, albeit not sufficiently to prevent their reccurrence. Beginning in the 1870s, weakened government support eroded the Board's position, and health-related measures were implemented mainly by the Board of Charity, which focused on matters concerning the city's Civil Hospital. CONCLUSIONS Although established in 1820, Holguín's Board of Health carried out preventive actions most actively from 1850 to 1865, with support from the Urban Health Police. Its gradual disappearance from the health policy arena beginning in the 1870s reflects its failure as an institution, in large part due to weak government support. KEYWORDS Board of Health, prevention, epidemics, Cuba.

Crimean-Congo Hemorrhagic Fever, Herat Province, Afghanistan, 2017

We studied the clinical and epidemiologic features of an outbreak of Crimean-Congo hemorrhagic fever in Herat Province, Afghanistan. The study comprised 63 patients hospitalized in 2017. The overall case-fatality rate was 22.2%; fatal outcome was significantly associated with a negative IgM test result, longer prothrombin time, and nausea.

Ancient Yersinia pestis genomes from across Western Europe reveal early diversification during the First Pandemic (541-750)

The first historically documented pandemic caused by Yersinia pestis began as the Justinianic Plague in 541 within the Roman Empire and continued as the so-called First Pandemic until 750. Although paleogenomic studies have previously identified the causative agent as Y. pestis, little is known about the bacterium's spread, diversity, and genetic history over the course of the pandemic. To elucidate the microevolution of the bacterium during this time period, we screened human remains from 21 sites in Austria, Britain, Germany, France, and Spain for Y. pestis DNA and reconstructed eight genomes. We present a methodological approach assessing single-nucleotide polymorphisms (SNPs) in ancient bacterial genomes, facilitating qualitative analyses of low coverage genomes from a metagenomic background. Phylogenetic analysis on the eight reconstructed genomes reveals the existence of previously undocumented Y. pestis diversity during the sixth to eighth centuries, and provides evidence for the presence of multiple distinct Y. pestis strains in Europe. We offer genetic evidence for the presence of the Justinianic Plague in the British Isles, previously only hypothesized from ambiguous documentary accounts, as well as the parallel occurrence of multiple derived strains in central and southern France, Spain, and southern Germany. Four of the reported strains form a polytomy similar to others seen across the Y. pestis phylogeny, associated with the Second and Third Pandemics. We identified a deletion of a 45-kb genomic region in the most recent First Pandemic strains affecting two virulence factors, intriguingly overlapping with a deletion found in 17th- to 18th-century genomes of the Second Pandemic.

History of Mosquitoborne Diseases in the United States and Implications for New Pathogens

The introduction and spread of West Nile virus and the recent introduction of chikungunya and Zika viruses into the Americas have raised concern about the potential for various tropical pathogens to become established in North America. A historical analysis of yellow fever and malaria incidences in the United States suggests that it is not merely a temperate climate that keeps these pathogens from becoming established. Instead, socioeconomic changes are the most likely explanation for why these pathogens essentially disappeared from the United States yet remain a problem in tropical areas. In contrast to these anthroponotic pathogens that require humans in their transmission cycle, zoonotic pathogens are only slightly affected by socioeconomic factors, which is why West Nile virus became established in North America. In light of increasing globalization, we need to be concerned about the introduction of pathogens such as Rift Valley fever, Japanese encephalitis, and Venezuelan equine encephalitis viruses.

The Emergence of Antimicrobial Resistance as a Public Matter of Concern: A Swedish History of a "Transformative Event"

ArgumentThis article examines how antimicrobial resistance (AMR) came to be constituted as a matter of public concern in Sweden in conjunction with the development of an inter-professional organization called Strama, founded to promote rational prescription of antibiotics. An outbreak of penicillin-resistant pneumococci in the mid-1990s was crucial for this development, because it brought attention to AMR as an urgent public threat. This outbreak fuelled the constitution of AMR as caused by consumption of antibiotics and as a matter of disease control. As a consequence, Strama was able to mobilize the Swedish health officers responsible for disease control. The outbreak is conceptualized as a "transformative event" - an event that makes an issue and its associated risks concrete and urgent. Transformative events play the crucial role of expediting the transformation of issues into matters of public concern.

Dengue outbreaks in Hawai'i After WWII - A Review of Public Health Response and Scientific Literature

The four serotypes of dengue virus (DENV) cause the most important and common arthropod-borne viral diseases in humans. There have been three major dengue outbreaks in Hawai'i since 1946. The most recent and largest outbreak occurred on Hawai'i Island in 2015-2016. This article reviews the public health response to dengue outbreaks over the period 2001-2016, as well as scientific literature on dengue outbreaks in Hawai'i. As summarized in the assessment by the Centers for Disease Control and Prevention in 2015, Hawaii's response to the dengue outbreak was timely, appropriate, and well-coordinated. All facets of a public health response to the outbreak were adequately addressed, but communications and medical entomologic capacities could be improved. The observations of Aedes aegypti on Hawai'i Island and of its co-localization with confirmed human cases highlight the importance of continuous vector surveillance and entomologic research. In-depth studies on the molecular epidemiology, entomology, and epidemiological investigation would provide new insights into the latest outbreak and into strategies to combat DENV and other arboviruses in the future.

The Saint George Quarantine Station of Piraeus, Greece (1865-1947)

For centuries, the marine quarantine system was the major protection of the public health against serious infectious diseases around the world. The present study reconstructs the history of the Quarantine Station of Piraeus, one of the largest Mediterranean ports, known as the "Lazaretto of Saint George", as a vital element in the maritime sanitary protection of Greece. Our research will investigate the impact left by this institution on public health, as well as on the economic life of the port of Piraeus and the adjacent capital city of Athens. With regard to the first issue, we will seek to evaluate its role in relation to major outbreaks in the capital, as well as the arrival of 1.3 million Greek refugees after the Greco-Turkish War of 1922. The opening of Suez Canal (1865) was a great challenge and the institution was problematic at administrative and sanitary levels. During 20th century, the station complied with the national public health legislation and the international sanitary conventions. Until the Second World War, the Lazaretto of Saint George played a key role in both the protection of public health in general, but also in the economic and industrial progress of Piraeus and Athens.

Lead pollution recorded in Greenland ice indicates European emissions tracked plagues, wars, and imperial expansion during antiquity

Lead pollution in Arctic ice reflects midlatitude emissions from ancient lead-silver mining and smelting. The few reported measurements have been extrapolated to infer the performance of ancient economies, including comparisons of economic productivity and growth during the Roman Republican and Imperial periods. These studies were based on sparse sampling and inaccurate dating, limiting understanding of trends and specific linkages. Here we show, using a precisely dated record of estimated lead emissions between 1100 BCE and 800 CE derived from subannually resolved measurements in Greenland ice and detailed atmospheric transport modeling, that annual European lead emissions closely varied with historical events, including imperial expansion, wars, and major plagues. Emissions rose coeval with Phoenician expansion, accelerated during expanded Carthaginian and Roman mining primarily in the Iberian Peninsula, and reached a maximum under the Roman Empire. Emissions fluctuated synchronously with wars and political instability particularly during the Roman Republic, and plunged coincident with two major plagues in the second and third centuries, remaining low for >500 years. Bullion in silver coinage declined in parallel, reflecting the importance of lead-silver mining in ancient economies. Our results indicate sustained economic growth during the first two centuries of the Roman Empire, terminated by the second-century Antonine plague.