TERM PAPER ON

EPIDEMIOLOGICAL INFECTIOUS DISEASES

(MEDICAL MICROBIOLOGY)

PREPARED BY:

MARARAC. SHARMAINE B.

BS BIOLOGY 2-4

SUBMITTED TO:

MR. LARRY PADILLA

APRIL 30, 2020

I.INTRODUCTION

Infectious diseases is responsible for the most serious health issues in the world
until the beginning of the 20th century, as this was when chronic degenerative diseases
began to dominate in developed countries instead (Barreto, 2006). Meanwhile, infectious
disease epidemiology is the study of the complex relationships among infectious agents and
their hosts (Payne, 2017). Epidemiologists are then particularly concerned with the specific
mechanisms a disease spreads and is transmitted.

To able to create a model of disease transmission, epidemiologists are faced

with a variety of factors involving both host and microbe that they must take in account,
which include but may not be limited to: (1) prevalence of the agent within the population,
(2) mode of transmission, (3) duration of the infection and the window of transmissibility, (4)
numbers of susceptible and non-susceptible individuals in the population, (5) population
density, (6) patterns of travel or associations, (7) living conditions, and even (8) climate
and/or season (Payne, 2017). These factors affect whether a pathogen may successfully
result into a large-scale infection, and eventually an epidemic, or not.

Because of the effects of globalization, infectious diseases that were previously

localized can now become intercontinental almost as immediately, initiating a continuous
evolution of emerging and reemerging infectious threats to human health from a series of
different pathogens. The first comprehensive list of human pathogen species was not
published until 2001 (Taylor,Latham, & Woolhouse, 2001) , each entry a distinct species
known to be infectious, though since then taxonomies have been revised and the criterion
“disease-causing” may have different interpretations.

This paper is a discussion on few examples of epidemiological infectious diseases

that have been recorded in different parts of the world. It will focus on some of the known
epidemiological infections (and the microbes causing them) that have occurred during the
time from twenty years ago up to date of writing (as reported by WHO), that can either be
reemerging or emerging diseases. The disease it causes, mode of entry, mode of
transmission of the microbe, as well as treatment to and their effect on the human body
along with the epidemiology (incidence, distribution, and possible control) of the disease
shall also be mentioned if not thoroughly discussed.
 Infectious epidemics to be included are chosen in no specific order or criterion
due to restriction on available information, though most are chosen subjectively by the
author as most common examples, in which the general public will be most familiar with.
Only nine are mentioned as the list of epidemics that have occurred worldwide from the last
two decades is extensive and cannot be enumerated altogether.

DISCUSSION
A. SOME OF THE VIRAL EPIDEMIOLOGICAL INFECTIOUS DISEASES AROUND THE WORLD

Yellow fever

Yellow fever is a viral hemorrhagic fever transmitted by mosquitoes and occurs

with high mortality, caused by the prototype member of the genus Flavivirus (family
Flaviviridae), which is estimated to carry approximately 70 positive-strand, single-strand
RNA viruses, the majority of which are transmitted by mosquitoes and ticks (Monath &
Vasconcelos, 2015) Originally occurring as large outbreaks in North America and Europe
from the first occurrences (Barnett, 2007), serving as a major threat to human health from
the 18th to early 20th century (Monath & Vasconcelos, 2015), the disease is now only
recorded in regions in Africa and Central and South America. According to WHO, a total of
57 epidemic events of Yellow fever has taken place from 2011-2017 despite the availability
of vaccines for almost 70 years, causing up to 200,000 cases of yellow fever annually
(Barnett, 2007).

The mode of transmission could either be when humans are bitten by carrier
mosquitoes that have previously fed on a viremic monkey, causing them to be infected, or
when infected humans themselves serve as the viremic host for inter-human transmission
and introduce the virus to the population by Aedes aegypti (Monath & Vasconcelos, 2015)
and mode of entry into humans would be by the mosquito bites. Available vaccines protect
against all yellow fever virus strains and are attenuated live virus vaccines that have been
derived from a virus originally isolated in 1927 (Barnett, 2007).

As for treatment, Monath (1987) stated that patients may benefit from intensive
care, but despite the benefit of the modern hospitals of today, the case fatality rate among
patients that had yellow fever (YF) as an adverse effect of the YF vaccine had been 50-100%,
implying that intensive care made little difference, and so currently, there is no approved
antiviral drug against YF (Monath, 2008), but it was said that if it had been developed, it
would be effective if given early in the disease. The severe acute illness is characterized with
the symptoms fever, nausea, vomiting, gastric pain, hepatitis with jaundice, organ failure,
hemorrhage, shock and even death in 20–60% of cases (Monath & Vasconcelos, 2015).

For the epidemiology, Barnett (2007) reported that 90% of the cases annually
happens in Africa, but there is a dramatic reemergence occurring since the 1980s for both
the sub-Saharan Africa and South America. In fact, starting from 1997, intense YF has been
observed in Brazil and then outside the endemic region (Monath & Vasconcelos, 2015). On
the other hand, annual reporting rate in Africa has varied widely, though starting from 2008,
an increased number of cases have been reported from Central African countries such as
the Central African Republic, Congo, and Chad wherein many of these countries have
infrequently reported YF cases in the past (Monath & Vasconcelos, 2015). Due to past
failures to report cases and/or conduct tests, it is unclear if these recent reports in these
countries are due to improved surveillance or simply increased disease activity.

Barnett (2007) added that as vector-control strategies that were once successful
for elimination of yellow fever from many regions have faltered, this has lead to
reemergence of the disease, and that immunization is most crucial in preventing yellow
fever, supplementary with measures to prevent mosquito bites.

Chikungunya

Chikungunya is an arthropod-borne disease transmitted by species of aedes

mosquitoes (Leparc-Goffart et al., 2014) caused by the Chikungunya virus (CHIKV) and
responsible for 95 outbreak events from 2011-2017 (WHO). The enzootic virus is endemic in
tropical and subtropical regions of Africa, Indian Ocean Islands, and in south and Southeast
Asia, causing severe morbidity and, since 2005, fatality (Burt et. al, 2012). According to
Pialoux et. al (2007), Chikungunya is particularly tropical, but it is considered geographically
restricted, while outbreaks are relatively uncommon, though the possible spread of carrier
mosquitoes into Europe and the Americas increases the risk of establishment in new
endemic locations, with the epidemic likely to extend to other Caribbean islands, and even
serve a substantial potential for spreading from this regions to the American mainland,
where A aegypti is endemic (Leparc-Goffart, I et al., 2014). The virus is also known to be able
to replicate in a broad spectrum of vertebrate species as hosts (mice, hamsters, rats,
rabbits, kittens, etc.) (Ligon,2006).

Since the start of 2006, the mosquito-borne disease has shown an emergence in
locations by the Indian Ocean area that by March 7, 2006, 157,000 people had been
infected in these regions, while also appearing in China and European countries (Ligon,
2006). As of 2014, more than 1 million human cases in the Indian Ocean islands, the Indian
subcontinent, southeast Asia, and Africa, and some autochthonous cases in Europe have
been associated with the East Central South African (ECSA) genotype of chikungunya virus
(genus Alphavirus, family Togaviridae) since 2005 (Leparc-Goffart, I et al., 2014), the larger
outbreaks caused by re-emergence in both Africa and Asia that considerably became a
serious public health concern after several decades of absence (Burt, 2012). The reason for
this re-emergence is yet to be defined clearly, though possible explanations should include
increased tourism, virus introduction into a naïve and immuno-compromised population,
and viral mutation (Pialoux et. al, 2007). Recommended strategies for control included
government and health organization efforts to control mosquito numbers by fogging or
spraying, and individual responsibility of minimizing exposure to mosquito bites through use
of anti-mosquito devices, and wearing protective clothes (Ligon, 2006).

Ligon (2006) also reported that transmission of CHIKV occurs from carrier
mosquitoes to bitten humans (human-mosquito-transmission) and mode of entry would be
through the insect bites. The only known and recommended treatments for arthralgia
caused by CHIKV are non-steroidal anti-inflammatory drugs (Burt et. al, 2012) and as there is
currently no vaccine available, treatment is purely symptomatic (Ligon, 2006). The disease is
typically known by several similarities with the infection of dengue-fever (Burt, 2012), but is
primarily characterized by symptoms such as fever, rash, and arthralgia (Pialoux et. al,
2007), while around 3-25% of people can be asymptomatic (Burt et. al, 2012).

Figure 1. Global distribution of CHIKV. Blue circles designate historical distribution in areas
virus has previously been identified in. Red circles designate global re-emergence within
past decade. In (): Number of cases, if available, and date. Data from ref 13, photo from ref
10.

Human Swine Influenza A (H1N1)

Back in 2009, Influenza A from Genus Influenzavirus A of Family Orthomyxoviridae

has been named one of the greatest pandemic threat to human beings (Gatherer, 2009), as
this virus possess a rapid inter-personal transmission and a widespread and seasonal
disposition compared to other major epidemics (HIV-1, Ebola, SARS, the plague) despite
these other diseases having a higher mortality rate if untreated. Influenza A viruses are
negative RNA viruses with eight segmented RNA components that encode for ten proteins,
of which two facilitate viral attachment as well as release from host cells (Fitzgerald, 2009),
capable of frequent mutations.

Influenza A is dangerous in the way that it could potentially infect 30% of the
world’s population in a matter of months at a considerable mortality rate of 2% (Gatherer,
2009). Originating from Mexico in April 2009, and then to California and Texas shortly after,
a novel strain of the human H1N1 influenza A virus of swine-origin (S-OIV) (Mossad, 2009)
was reported to spread rapidly between April 15 and May 5 2009 (Fitzgerald, 2009). A total
of 12,954 cases had already been recorded in a few weeks’ time climbing to a worldwide
total of 19,723 by June 2009 (Fitzgerald, 2009), and already spreading to 30 countries by
May 11 of the same year (Smith, 2009). By late June, the WHO reported 60,000 cases of the
pandemic influenza has already occurred in 100 counties, which resulted into the pandemic
alert to level 6 of 6 by the World Health Organization (AlMazroa et. al, 2010). Seed virus
provided by the government for vaccine development and availability of applicable anti-viral
agents have been used to control the epidemic, with the US Food and Drug Administration
(FDA) also authorizing use of disposable N95 respiratory masks by the general public
(Mossad, 2009).

Actually, classical swine (H1N1) viruses are known to circulate in pigs from North
America and other regions from as early as 80 years ago (Smith et. al, 2009), but notably
only few influenza viruses have successfully transmitted from birds to humans and then
finally to swine (Mossad, 2009), while co-circulation of the triple-reassortant H3N2 with
determinative swine lineages consequently generated further H1N1 and H1N2 reassortant
swine viruses that initially caused human infections in the United States in 2005 (Smith,
2009), so that eventually the swine flu H1N1 virus that caused the H1N1 Mexico 09 is a
mixture of the RNA of avian, human, and porcine influenza (Fitzgerald, 2009).

According to Fitzgerald (2009), the Influenza is transmitted by spread of

respiratory secretions from a person to another. This could occur when respiratory droplets
of an infected person who coughs or sneezes get inhaled or deposited on the mouth of
another person in close proximity (Fitzgerald, 2009), while mode of entry should
understandably be by the nose, mouth, or breaks in the skin where it could penetrate the
respiratory system. As for treatment, there are anti-viral drugs that can be used, but
patients who are more healthy than not do not require the anti-viral treatment (Mossad,
2009). In fact, majority of people may be cared for by people from home as with the more
common seasonal influenza (Fitzgerald, 2009) as the illness showed to be mild in majority of
the first 15,000 cases and mortality is low but causes high morbidity (AlMazroa et. al, 2010).
In addition, AlMazaroa et. al (2010) also reiterated that symptoms of the 2009 pandemic
influenza in humans are observed to be similar to those of seasonal influenza and other
influenza-like sickness: fever, sore throat, cough, body aches, and fatigue; joined by an
increased number of patients that experienced diarrhea and vomiting.

Ebola Disease

Ebola virus (EBOV) is a filamentous, negative single-stranded RNA virus from the
Filoviridae family (Baseler et al, 2017), causing a severe, often fatal viral hemorrhagic fever
in humans as well as non-human primates (NHPs) in the form of Ebola disease (Choi &
Croyle, 2013). Though the geographic ranges of many animal species (such as bats, squirrels
mice,others) are found to match known outbreak sites, and none of these animals has been
universally considered as an EBOV reservoir, the epidemics have been associated with bat
migrations and infections (Baseler et. al, 2017). And so, we consider that fruit bats likely
carry the Ebola virus, and humans became infected through close contact with their infected
body fluids (Gostin et, al, 2014), while human-to-human transmission could also only
happen by close contact with said infected body fluids and meat of African wild animals.
 Since discovery of the disease in the 1970s, EBOV has been responsible for several
outbreaks in Central Africa (Saéz et.al, 2014). Before the major outbreak started in

December 2013, West Africa had in fact no record of Ebola deaths (Gostin et. al, 2014), but
as of November 2014, there had been a total of 6,069 deaths from the epicenters Liberia,
Sierra Leone, and Guinea (Buseh et. al, 2015) from 17,145 cases that have been identified in
the five recognized affected countries listed as Guinea, Mali, Sierra Leone, Liberia and the
United States; and three previously affected ones being Nigeria, Senegal, and Spain. The
strain from this West Africa outbreak is that of the Zaire species of the Ebola virus disease
(EVD) (Gostin et. al, 2014), its case-fatality rate apparently about 90% (Heymann, 2015).
Public health countermeasures spearheaded by the government as well as CDC should
follow standard responses namely: (1) Isolation and Quarantine, (2) Social Distancing, (3)
Travel Restrictions, (4) Risk Communication and Burial, (5) Improvement of Existing Health
Systems, and (5) Declaration of National Emergency among others (Gostin et. al, 2014).

Figure 2. A map of countries in West Africa during Ebola epidemic. In table, cumulative
cases and deaths recorded. Data from WHO, 2014. Photo from Ref 27.

The route of transmission from the reservoir to humans remains unknown as

there had been no direct evidence of to support any claim (Choi & Croyle, 2013), and in
most outbreaks from the past the source of the human index case had not even been
identified, though some cases were clearly connected to exposure to animal carcasses
(Pourrut et.al, 2005), and some suggested transmission from a fruit bat reservoir may have
been very possible (Leroy et. al, 2005), as fruit bats are hunted for meat in the affected
regions (Saez et. al,2014). While Choi & Croyle (2013) reported that infection generally enter
through direct contact with mucosal surfaces, non-intact skin, or injection of the virus
through a contaminated needle, Baseler et. al (2017) added that viral particles could even
survive days up to weeks on inanimate objects if a proteinaceous material is present,
allowing situations as such be a source of infection.

Multiple antiviral compounds as part of targeted therapies had been administered

to EVD patients during the West African epidemic to help with treatment (Baseler et.al,
2017), though supportive care had been so far the most helpful. It wasn’t until December 19
2019, however, that the FDA has approved its first approved vaccine for the prevention of
EVD. With the most common symptoms of EVD being fever, fatigue, anorexia, vomiting and
nausea, muscle and joint pain (Kapur & Hug, 2015), other initial EVD symptoms included
malaise, and muscle weakness, eventually progressing to asthenia and watery diarrhea
(Baseler et. al, 2017), during the time of which that the patient is highly infectious. The
following week (2nd), organ failure, other organ dysfunction, and/or mortality may then
occur. These unfortunate complications are the reason it’s important that a working vaccine
has now been issued, as this could be start of better health preparedness and response,
especially in significantly poorer countries where these kind of epidemics hit, such that in
West Africa, potentially saving millions of lives.

COVID-19 (Coronavirus disease 2019)

The current outbreak of the novel coronavirus SARS-CoV-2 (severe acute

respiratory syndrome coronavirus 2, formerly 2019-nCoV) that started from Wuhan, Hubei
Province of the People’s Republic of China (Velavan & Meyer, 2020) rapidly spread from a
single city to the entire country in just 30 days (Wu & McGoogan, 2020) from when the first
cases were reported in December 2019 (Hui et. al, 2020). Its family of viruses Coronaviridae
comprises a group of large, single, plus-stranded viruses that have been isolated from
several species while being known to cause the common cold and diarrheal ailments
(Benvenuto et. al). And while known respiratory viruses (SARS-CoV, MERS-CoV) were ruled
out for the outbreak of pneumonia with then unknown cause, it was later found that the
novel coronavirus responsible for COVID-19 is with at least 70% similarity in genetic
sequence to SARS-CoV (Hui et. al, 2020). Patients reported to have visited a local fish and
wild animal market in Wuhan in November (Benvenuto et. al, 20220) and so an
epidemiological link to the Huanan Seafood Wholesale Market where sale of live animals
take place has been made (Hui et. al, 2020).
 The outbreak of the SARS-CoV-2 has spread globally (del Rio & Malani, 2020) since
then that in fact, by February 27, 2020, more than 82 000 cases of COVID-19 had already
been determined with 2800 deaths, and had been identified in 49 other countries beside
China (del Rio & Malani, 2020). As of 28 March 2020, there had already been a total of 591
971 cases of COVID-19, including 26 990 deaths (ECDC, 2020). Most case patients were
noted to be 30 to 79 years old, with the overall case-fatality rate (or CFR) of about 2.3%,
with no deaths on age group 9 years and younger, but a higher CFR has been recorded from
70-79 years old, and then even higher on those aged 80 years and above (Wu & McGoogan,
2020). Health authorities carried out appropriate response measures such as active case
finding, retrospective patient investigations, closure of the local seafood market suspected

to be the origin, public risk communication and public awareness improvement, technical
guidance (Hui et. al, 2020) along with immediate isolation of confirmed cases (Wu &
McGoogan, 2020), travel ban guidelines, enhanced community quarantine in respective
countries, and public support during quarantine among others.

Figure 3. Worldwide geographic distribution of cumulative number of reported COVID-19

per 100,000 population. Figure and data from ECDC, 2020 (ref 42).

Transmission likely originated from the bat and then to human from recent
evidence (Benvenuto et. al, 2020), while the virus is transmitted from person-to-person
primarily through large respiratory droplets (when sneezing, coughing or exhaling), close
contact with other infected, and even by an asymptomatic carrier who can also pass it to
others (del Rio & Malani, 2020), though via stool and blood is also potential mode of
transmission. On the other hand, the CDC (2020) reported that contact with a surface or
object that has the virus might also result in a mode of entry through the mouth, nose, or
eyes, but this is not believed to be the main way the virus spreads. In symptomatic patients,
clinical manifestations consist of fever, cough, nasal congestions, abdominal pain, fatigue
and other similar symptoms of upper respiratory tract infections (Velavan & Meyer, 2020),
and then progressing to difficulty in breathing and more commonly, pneumonia in the 2nd
or third week. Current estimates of the incubation period range from 1 to as long as 24 days,
and the virus’ preliminary reproductive number suggest a higher pandemic potential than
SARS (del Rio & Malani, 2020). A combination of the antiretroviral drugs lopinavir and
ritonavir significantly improved clinical conditions manifested by SARS-CoV patiends
(Velavan & Meyer, 2020), though in general treatment would be similar to that of other viral
pneumonias: oxygen supplementation when needed and primarily supportive care (del Rio
& Malani, 2020). No vaccine is currently available.

HIV-1 Infection

Acquired immunodeficiency syndrome (AIDS) of humans, caused mainly by the

retrovirus HIV-1 group M (Sharp, 2010), is said to be the end stage disease of human
immunodeficiency (HIV) infection (Weiss, 1993). Though according to the WHO (2017), the
term AIDS is most applicable as the most advanced stage of HIV infection where any of more
than 20 opportunistic infections and/or HIV-related cancers have occurred. The source of
HIV-1 group M is traced to a virus infecting several chimpanzees’ subspecies (Keele et. al,
2006), while the route of chimpanzee-to-human transmission would have been most likely
through exposure to infected blood and other bodily fluids during butchery of African wild
meat (Hahn et. al, 2000).
 Though HIV-1 infections is not necessarily a new epidemic following its initial
recognition in 1981 (De cock et. al, 2012), global AIDS-related death has since then peaked
at 2.3 M back in 2005, but in 2012 decreased to 1.6 M possibly because of the estimated 9.7
M people in low-income and middle-(Makun et.al, 2016wider coverage, to reduce sexual
transmission of HIV, developmental assistance and recommended mother-to-child
transmission interventions has been helpful in fighting spread of disease (Maartens, Celum
& Lewin, 2014).

Figure 4. Incidence of new HIV infections from 1980-2015. Bars showing mean number of
approximate new infections during a given year, representing 95% uncertainty intervals.
Data and figure from ref 34.

According to the WHO (2017), HIV can be transmitted through unprotected

vaginal and anal sexual intercourse, even oral sex with an infected person; transfused
infected blood; via contaminated needles, syringes, surgical equipment or other sharp
instruments, or even between a mother and her infant during pregnancy, childbirth and
breastfeeding (Maartens, Celum & Lewin, 2014) and can therefore enter through broken or
penetrated skin, linings in the mouth, anus, penis, or vagina unto the bloodstream.
Maartens, Celum, and Lewin (2014) also added that HIV/AIDS primarily works towards
immune dysfunction by progressive depletion of CD4 cells though its reduced production
and increased destruction, making the body more susceptible to other illnesses that the
body won’t be able to fight off because of weakened immunity (CDC, 2019), and HIV-
associated tuberculosis as secondary epidemic had been previously noted (De Cock, Jaffe &
Curran, 2012), suggesting that respiratory ailments is likely to occur. As for treatment, no
available effective cure is existing as of writing, though with proper medical care,
antiretroviral therapy can be successful in suppressing viral replication and 25 licensed drugs
are currently available (Maartens, Celum & Lewin, 2014).

B. SOME OF THE BACTERIAL EPIDEMIOLOGICAL INFECTIOUS DISEASES AROUND THE

WORLD

Cholera

Cholera is a food and water-borne infectious disease caused by the gram-

negative bacterium, Vibrio cholera (Tian & Wang, 2011) characterized by acute diarrheal
illness (Makun et. al, 2016). While safe drinking water and advanced sanitation systems
have made the Global North cholera-free for decades, it is important to note that the same
disease still affect 47 countries across the globe with an estimated 2.86 million cases and
95,000 deaths each year globally (Legros, 2018), despite being considered completely
preventable through proper treatment of sewage and provision of clean drinking water. The
problem lies in the fact that areas where such outbreaks occur are usually faced with
poverty, unsanitary conditions, and poor health systems, causing re-emergence of cholera
(Makun et. al, 2016).

In fact, the last few years have witnessed many cholera outbreaks from
developing countries alone: India (2007), Congo (2008), Iraq (2008), Zimbabwe (2008-2009),
Vietnam (2009), Nigeria (2010), and Haiti (2010) (Tian & Wang, 2011); and Legros (2018)
expressed that the map of cholera outbreaks might as well be the map of global
marginalization and poverty. Every year around the world, approx. 3-5 million cases are
reported along with an estimated 100,000 deaths annually, and the number of cholera cases
only continue to rise (WHO). Untreated patients suffer severe diarrhea and vomiting that
can result to dehydration, and then eventually to death (Tian & Wang, 2011). Meanwhile,
provision of safe water and improved sanitation can prevent fecal-oral transmission of V.
cholera, maybe even eliminating the threat of the disease altogether (Charles & Ryan,
2011), while Makun et.al (2016) added that a well-organized and multisectoral approach
from government and health institutions is required to control cholera outbreaks such as
managing efficient surveillance systems, strengthening laboratories, effective information-
sharing, capacity-building, and vaccination campaigns.

Figure 5. Major cholera outbreaks in 2017 as listed by WHO. Areas of major outbreaks are
noticeably all developing countries. (Source: WHO, 2017).

Transmission of cholera occurs by consumption of water and/or food

contaminated with V. cholerae, which is why fecal contamination of drinking water and food
could easily result into epidemics (Makun et.al, 2016). Pathogen ingestion through eating
contaminated raw/undercooked shellfish, or eating food prepared by an individual with
soiled hands is also possible (Tian & Wang, 2011), and will result to the disease. For
treatment, fluid replacement therapy is the most important aspect of treatment
programmes, and so when dehydration is minimal, patients can be treated with oral
rehydration solutions with success (Charles & Ryan, 2011), perhaps even reducing mortality
to less than 1%. Infections may be asymptomatic to mild and severe, though generally
clinical features include watery diarrhea, vomiting, dry mucous membranes, muscle cramps,
and feeling of thirst; in severe cases, renal failure, coma, or even death (Makun et.al, 2016).
Plague

The plague is a murine zoonosis caused by gram-negative bacteria Yersinia

pestis transmitted by fleas, bites, scratches, contaminated food, or even aerosols (Raoult et.
el, 2013), associated with high case-fatality rate and high contagion (Bertherat,2015). The
coccobacillus is a member of the family Enterobacteriaceae (Pechous et. al, 2016) and is
able to cause three forms of the plague (bubonic, pneumonic, and septicemic).

Y. pestis, known to cause disease in humans, rodents, and several other

mammals (Lotfy,2015), has been linked to at least three major pandemics in all of human
history: the Justinian plague in 6 th century AD said to be responsible for at least 50% of
Northern Africa, Europe, central and Southern Asian populations; the ‘Black Death’ that
lasted for more than 130 years and supposedly killed a third of the world’s population, and
the most recently from China in 1855, taking 13 million lives in under 50 years (Pechous et.
al, 2016).

There had been instances of re-emergence noted since the 20 th century, and the
plague continues to occur in many regions globally:in Central Asia, North and sub-Saharan
Africa, North and South America and Far East (Bertherat, 2015). Raoult et. al (2013)
reported that 90% of reported cases from the past few decade occur in the African region,
but in the first decade of the 21 st century, the Democratic Republic of Congo became the top
reporting country with over 10,500 cases of the plague as of 2016, followed by Madagascar
with over 7000 cases and Zambia with a rough estimate of 1300 human plague reports
(Pechous et. al, 2016). Published articles regarding statistics of worldwide Plague cases for
the last twenty years are limited, but WHO reported 3248 plague cases worldwide with 584
deaths from years 2010-2015, while other available data indicates that 402 deaths have
been reported from the Democratic Republic of Congo alone from 2004 to 2009 (Bertherat,
2015). Lotfy (2015) stated that immediate diagnosis of infection, isolation of the patient and
immediate contacts, disinfestation of local area infested by plague, updated geographical
distribution and identification of host species are only among the many control measures
that must be done to reduce casualties.

Plague is transmitted between mammals through various routes such as through

flea bites, animal scratches or inhalation of infected particles, contact with carcasses of
infected animal (Raoult et. al, 2012), as well as cannibalism or contaminated soil (Lotfy,
2015) and enter through the nose, mouth, or penetrated skin. Patients with plague
generally exhibit high fever, low blood pressure, chills with fatigue, a tender
lymphadenopathy, pneumonia, while early introduction of antibiotic treatment
(streptomycin as standard treatment) is essential of efficient prognosis (Raoult et. al, 2012).

Typhoid fever

Typhoid fever is an enteric bacterial infection caused by gram-negative

bacterium Salmonella enterica serovar Typhi or Paratyphi (Butler, 2011) and by 2015 is
considered the leading cause of community-obtained bloodstream infections in many low-
to middle-income countries (Crump et. al, 2015) because of food and/or water
contamination. Also from Crump et. al (2015), typhoidal Salmonella strains are human
host- restricted organisms, infecting only humans when ingested, and then multiplying
intracellularly in phagocytes in Peyer’s patches, spleen, bone marrow, and liver (Butler,
2011), to inflict damage.

As reported by WHO’s list of disease outbreak news in the official website,

typhoid fever outbreaks had been listed on four different instances from the last two
decades by the Islamic Republic of Pakistan in 2018 with 8 188 cases, Uganda in 2015 with
1940 suspected cases, Democratic Republic of Congo in 2004-2005 with 42 564 cases and
214 deaths, and Haiti in 2003 with 200 cases accompanied by 40 deaths; the former two
characterized by high rates of perforated intestines partnered with high case-fatality rates
(Slayton, Date, & Mintz, 2013). Moreover, Butler (2011) reported that the world’s estimated
2 million cases, result to approximately 200 000 deaths every year. Because much amount
of the fatal cases occur in low-income countries that typically have limited access to quality
health care and proper sanitation systems, ideal control measures should focus on
 improving these two aspects, especially the water systems and food safety, as well enabling
wider use of vaccines.

Figure 6. Global distribution of typhoid fever occurrence. Figure from ref 53.

S. enterica is transmitted by the faecal-oral route (Butler, 2011), and so it will

spread primarily by consuming contaminated food and/or water (with human feces), which
is why proper sanitation practices, as well as availability of clean drinking water is important
in keeping the numbers of reported infections low. The disease can also be passed by
transfer of disease from one hand to another’s food during preparation (Butler, 2011).
Symptoms are non-specific and may even be clinically non-distinguishable and be initially
misdiagnosed as malaria (Slayton et. al, 2013), though the illness is characterized by
prolonged fever, nausea, loss of appetite, constipation (WHO). An oral live-attenuated
vaccine and an injectable Vi capsular polysaccharide vaccine are currently deemed safe as
well as efficient and they are currently recommended to be available for wider use
(Slayton,Date, & Mintz,, 2013).

CONCLUSION

In this paper, different examples of epidemiological infectious diseases were

enumerated and discussed briefly. For such infectious diseases, it is important that we
define the time between acquisition of an infection and the onset of illness as the
incubation period, and that it is different from the latent period, which is the time between
catching of infection and ability to transmit the causative agent (Payne, 2017).
Asymptomatic patients might be able to carry the pathogen and pass it unto another person
without knowing they are already infected, and by knowing lengths of incubation periods,
the potential carriers of infection might be more cautious in spreading the potential disease.

With viruses, different modes of transmission is possible: through respiratory

droplets (as with the Influenza A, COVID-19); insect bites (as with Yellow fever,
Chikungunya); contact with infected bodily fluids as in HIV/AIDS (sexually, from mother-to-
child, broken skin) and EBOLA (with blood,feces, vomit, breast milk, urine, and semen). No
mentioned virus in this paper is airborne, though large respiratory droplets of SARS-CoV-2
may remain for up to three hours in the air. On the other hand, we saw how some virus like
Yellow fever, Human Swine Influenza, Ebola, COVID-19, HIV-1 Infection came to be from
across species to human beings: from viremic monkeys carried by mosquitoes; combination
of avian, porcine and human strains; exposure to infected body fluids of fruit bat origin;
exposure to infected bodily fluids of bat origin in a live animal market; and exposure to
infected chimpanzee carcass (most likely), respectively. And although antiviral therapy had
been useful in treating cases of Human Swine Influenza, Ebola, HIV-1; retroviral therapy for
COVID-19; and non-steroidal and inflammatory drugs for Chikungunya, only vaccine for the
human swine flu is currently available. As for yellow fever, such vaccination exists but there
is no approved antiviral medication. It is also important to note that the two mosquito-to-
human transmitted diseases are more commonly found in African and South American
regions, the other in African and Asia, as the species of carrier mosquitoes are endemic to
these areas. On the other hand, HIV-1 and Ebola that can both be traced to African origins
and a likely transmission from nonhuman animal to human by close contact with infected
carcasses give us an insight to how cultural and economic differences can instigate such viral
activity.

With bacterial infections, it is notable that both cholera and typhoid fever is food
and/or waterborne where ingestion of pathogen will most likely result into the disease.
Though cholera is characterized mainly by diarrheal symptoms and typhoid fever with
malaria-like symptoms, both continue to appear in small to large outbreaks in several low-
to middle-income countries and take thousands of lives for the last two decades (and even
more before that) despite being easily preventable if only safe drinking water is available
and food safety is enhanced. Again, this shows how poverty-stricken countries are most
vulnerable to such preventable infections as they do not have the resources to protect
themselves, provide quality health care, establish a proper waste management, or even
access to clean water. Lastly, the plague has been around for centuries and even though
outbreaks are less frequent in the 21st century that they had ever been, countries like
Democratic Republic of Congo, Madagascar, and Zambia from the African region still face it
every few years, killing thousands in the process. For cholera, treatment would be fluid
replacement therapy, and for plague and typhoid fever, antibiotic therapy, along with
supportive care.
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