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Human Viruses:
Diseases, Treatments
and Vaccines

The New Insights

Shamim I. Ahmad
Editor

123
Human Viruses: Diseases, Treatments and Vaccines
Shamim I. Ahmad
Editor

Human Viruses: Diseases,

Treatments and Vaccines
The New Insights

123
Editor
Shamim I. Ahmad
Wollaton, Nottingham, UK

ISBN 978-3-030-71164-1 ISBN 978-3-030-71165-8 (eBook)

https://doi.org/10.1007/978-3-030-71165-8
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are exempt from
the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
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The editor dedicates this book to his late
father and mother, Abdul Nasir and Anjuman
Ara, who played important roles to bring
him to this stage of academic achievements
with their esteemed love, sound care and
sacrifice. Dedication also goes to his wife,
Riasat Jan, for her patience and persistent
encouragement to produce this book, as well
as to their children, Farhin, Mahrin, Tamsin,
Alisha and Arsalan, especially the latter two
for providing great pleasure with their
innocent interruptions, leading to the energy
of the editor to be revitalized. Next, his best
wishes go to the ailing patients, suffering
from various viral diseases especially
COVID-19, for their recovery from the ailing
diseases and the rest of the life to run
smoothly. Finally, his dedication goes to his
loving and caring Professors, Dr. Fumio
Hanaoka continuing his work in Japan, and
Dr. Robert H. Pritchard and Dr. Abe
Eisenstark, who passed away now.
Acknowledgements

The editor cordially acknowledges the authors of various chapters to contribute

their works, employing their in-depth knowledge, high skills and professional
presentations. Without their input, it would not have been possible to bring out this
book on this highly topical and important subject. He would also like to
acknowledge Melissa Morton, Karthikeyan Durairaj, Ritu Chandwani and Leo
Johnson of Springer publication for their hard work, friendly approach, patience
and highly professional handling of this project. Final acknowledgement goes to
my son-in-law Mir Azam Ali Khan for his valuable assistance with IT that helped to
bring this book to the stage of publication. Without this help, it would have been
extremely difficult to publish this work.

vii
Viral Pandemics: COVID-19 is Only a Trailer—
We Ought Not to Wait for the Whole Film
to Run

An Appeal to World Leaders, Health Officers, Medical Organizations, and,

Corporations, and those trying to manage the fear of pandemics
Past Pandemics and Epidemics
Before November 2019, most people were unaware what a pandemic is or even
what viruses are! But people now, even in the most remote areas of the world, are
aware at least of the terms virus and COVID-19. Also, although they cannot see this
germ, they have been made aware of the consequences of infection, including high
numbers of deaths; and in certain cases, people consider it to be some kind of horror
coming from the sky. The sequel to this horror film is unclear—we neither know
when it will end nor if and when it will come back. Let us look at how the horror
film ran in the past, and what may be expected in any rerun.
Occurrence of pandemics is not new. Indeed, history reports that as far back as
3000 BC, pandemics occurred, but here only those are mentioned which occurred in
the last two millennia: The Black Death: 1346–1353; Cocoliztli epidemics: 1545–
1548; 16th Century American Plague; The Great Plague of London: 1665–1666;
The Great Plague of Marseille: 1720–1723; The Russian Plague: 1770–1772;
Philadelphia Yellow Fever Epidemic of 1793; Russian Flu Pandemic, 1889–1890;
Spanish Flu of 1918–1920; and Asian Flu of 1957–1958.
Pandemics and Epidemics Which Continue Sporadically:
Dengue virus originated 800 years back, Measles virus may have been originated
around eleventh to twelfth century, American Polio epidemic in 1916, H1N1 Swine
flu pandemic in 2009, the Avian Flu in 2018, West African Ebola pandemic in
1976, Chikungunya virus in 2006, Zika virus epidemic of South East Asia in 2015,
Crimean-Congo hemorrhagic fever virus in 2017, AIDS pandemic in 1981, and
SARS and MERS in 2003 and 2012, respectively, and now SARS-CoV-2.

ix
x Viral Pandemics: COVID-19 …

Sporadic human viruses lurking around: Please see Appendix

Zoonotic Viruses and Their Reservoirs:
Zoonotic viruses are those organisms which mostly reside in vertebrate animals,
birds, bats and insects as their reservoirs and then can jump to humans. The diseases
they cause are called zoonoses.
A PubMed search (27 January 2021) for zoonotic viruses showed that there are
8329 research papers on this subject and highlighted the presence of 224 human
viruses and their associated traits. Out of a number of reservoirs of human viruses
reported, the most common primary viral hosts are humans, ducks, geese, and
shorebirds, bats, pigs, dogs, seals, horses and mosquitoes. Other reservoirs
regionally found are bamboo bats, Belgian hedgehogs, rhesus monkey, honey and
bumble bees, dromedary camel (MERS), palm civets, small and big cats, minks and
ferrets.

Current Crises with SARS-CoV-2 and Its Variants:

In early 2021 when the SARS-CoV-2 pandemic was slowly and steadily coming
under control, it was recorded that three significant variants of this virus have
emerged causing additional issues around the control of the pandemic. These
specific variants are more contagious and more virulent than the Wuhan strains.
These variants have emerged due to new mutations in their genomes. Questions
have been raised as to whether the vaccines currently in use can also confer pro-
tection against these variants. It has been seen for some other viral infections that
high rates of mutagenesis, giving rise to a large number of variants, make it difficult
to produce vaccines which can control all the different strains, e.g. avian viruses
of the H1N1 series cause influenza at regular intervals (for details of viral varia-
tions, see chapter “SARS-CoV-2 Mutations: An Insight” of this book).
Consequences of the COVID-19 Pandemic:
It was January 2021 when the final material for this book was going to press and the
world is still going through the global calamity of COVID-19, which started in
December 2019. The whole world is now experiencing very high numbers of
infections and deaths. Turmoil includes economic damage due to a large number of
factories, industries and shops closing, leading to increased unemployment and
reductions in industrial productivity and agriculture. Other human sufferings
include increased depression and mental health issues and increased domestic
violence. More worryingly, it is not known how long this will last and how many
more human lives will perish. The prediction is that even when the current wave of
infections is over, the virus may re-appear either in other mutated forms or by
finding another suitable environment/host.
Soon after the discovery of COVID-19, strenuous searches started to find
effective treatments, and hundreds of antiviral and other putative drugs, including
Chinese herbal medicines, were tested. As far as my searches have found, no
proven effective therapies for this virus currently exist. Some drugs have been used
in clinical trials, but there is no satisfactory data showing that these drugs, either
alone or in combination, are effective. Dexamethasone, which reduces mortality by
Viral Pandemics: COVID-19 … xi

25% in severe cases, has been in use as an anti-inflammatory drug. Other drugs with
limited success may be remdesivir, tocilizumab, chloroquine phosphate, hydroxy-
chloroquine sulphate and monoclonal antibodies. From the start of the pandemic, a
number of companies and universities entered into the race to produce a variety of
vaccines, and today a number of companies in different countries including the
USA, the UK, Germany, France, India, Russia and China have produced and
released vaccines with the hope that they will control infections and the resulting
disease (for further details, please see chapter “Treatment of COVID-19 by
Combination Therapy with 5-fluorouracil, Ribonucleosides and Ribavirin—A
Modified Strategy” of this book).
Reasons for Rapid Global Spread of Pathogenic Viruses:
The present SARS-CoV-2, causing COVID-19, started in Wuhan, China. The
speculation is that in Wuhan, the virus may have spread from bats or other livestock
being sold in market places and infected humans. Subsequently, the virus rapidly
spread to other cities in China and to neighbouring countries such as South Korea
and Japan. Then fairly rapidly, it spread to almost 160 counties in the world.
Spreading of the virus can be imagined to have occurred from infected persons
travelling from China to other countries and within the country by travelling from
one city to another. Spreading of the virus is exponential, which in its simplest form
means one person infecting a second person and the 2 of them to a further 2 making
4 and then 8 making 16 and then 32 and on and on. Imagine when it reaches say
50,000, the next infection is 100,000. It is not difficult to imagine that the infection
of one person after 20 rounds of infection can reach over a million people. In fact,
the natural infection rate for Sars-CoV-2 is around 3, making the spread even faster.
The main reason for the viral spread is physical person-to-person contact: either
within families or via interfamily contacts. It has become apparent that as with other
diseases, transmission can occur through contact between an asymptomatic person
(unknowingly carrying the infection) and a healthy person.
By March 2020, guidance was issued by governments to people to use face
masks, keep a distance of at least 2 meters between individuals, and to wash hands
more regularly and thoroughly especially when entering home from outside trips.
Unfortunately, the guidance has not been taken, by some, as seriously as required,
resulting in a limited downturn in the number of infections. Hence, more stringent
actions have been taken including the closure of non-essentials shops, restaurants
etc. and the requirement that people stay home as much as possible.
Facts About Human Viruses Affecting Our Life, Unknown or Barely Known to
People
Viruses live all around us, in the air, attached to living and non-living things, being
viable out of hosts for short or long times, and can enter living bodies. In the body,
viruses enter cells and produce their progeny and then release them from the cell to
invade other healthy cells. If this process continues especially when the immune
system is compromised, it can be lethal. Another important feature of human
viruses is that almost all are zoonotic; they can live stably inside their reservoir
hosts without causing diseases. But at times, their genomes change by mutation and
xii Viral Pandemics: COVID-19 …

when they enter into humans, they can cause catastrophic results. It is also con-
sidered that many more viruses have evolved over millions of years, and some may
surface as and when they get the opportunity. Recent examples are Avian influenza,
Ebola, Dengue, AID, Zika and Chikungunya viruses. Viral impact is highly vari-
able in that it can range from asymptomatic up to lethal.
Vaccines are Used Prophylactically to Prevent Disease Rather Than Treat it:
The fact is vaccines are not for use in the treatment of established diseases. They are
given to the general public to safeguard themselves by activating the immune
system: vaccine components acting as antigens. Vaccines are prepared in a number
of different ways: as attenuated whole virus, inactivated virus or engineered viruses.
The third method is prevailing now which involves the use of viral genetic material:
specific sequences of DNA or RNA are used, which drive the production of the
specific protein which acts as the antigen (such as the recent use of the spike protein
of SARS-CoV-2). To protect the sequence from degeneration and provide efficient
packaging, the sequence requires a vehicle. A vehicle developed for this purpose is
the lipid nanoparticle. This nanoformulation enables the safe delivery of the genetic
material, biodistribution, intracellular localization and release. The antigen induces
the immune system, which incapacitates the invading live viruses (for more about
vaccines, please see chapter “Global Polio Eradication: Progress and Challenges” of
this book).
Difficulties in Generating the Antiviral Drugs:
Although a large number of antiviral drugs have either been isolated from natural
sources or synthesized in laboratories, only a handful of them have been found to be
effective on COVID-19. In contrast to antibiotics which are commonly available to
kill bacterial infections, there are only a handful of antiviral agents available which
can be used to treat more than one virus. One reason for this failure is that unlike
other microbial infections, in which the infective agent can live and grow outside
the cells in the body and hence their drugs can find the targets more easily, most
viruses live silently inside host cells. This means that to send drugs to the targets, it
is important that the drugs be produced which can easily enter the cell without
harming it which is not that easy, or only treat the symptoms rather than the cause
of infection.
Viral Pandemics: COVID-19 … xiii

The Appeal
As SARS-CoV-2 may not be the last pandemic, the emergence and re-emergence
of pandemics by SARS coronaviruses, Ebola virus, Zika virus and zoonotic avian
influenza viruses is highly probable. But when and how and to what extent they
will appear and interfere with normal global human life is everybody’s guess.
According to an estimate, 224 types and traits of human viruses are present
globally.
So what is the future of re-emergence of epidemics and pandemics? Are we
ready for the next pandemic? A simple answer is “NO” and so should we not
learn lessons from the present pandemic and prepare to combat future attacks?
Now is the time to prepare and coordinate local, national and global efforts
and determine what should be done in the preparation.

• We should take valuable lessons from the present COVID-19 and use them if
and when a new pandemic emerges.
• A centralized organization either independent or a subsection of WHO should
be established which can take an oversight of epidemics and pandemics strictly
at the global levels.
• More robust and unified policies should be made and introduced by independent
or subsection organizations of WHO to combat them at the global level.
• Countries suspecting the start of a pandemic must send an alarm to the central
organization (mentioned above), as soon as possible.
• More advanced safety measures must be developed to protect doctors, surgeons,
nurses, health workers and caregivers in hospitals, nursing homes and old
people homes, and ambulance men and the police on the street.
• We need an infrastructure to provide rapid testing, which exists and can be
tweaked for each virus. This will be more valuable for travellers.
• More stringent travel restrictions must be imposed at early stages in potential
pandemic events, and travellers should be tested more stringently as soon as
possible.
• Especially for the underdeveloped countries, new techniques must be developed
and used to produce and distribute vaccines to combat viruses causing epi-
demics and pandemics.
• More government funded research must be carried out to develop antiviral
drugs.
• Safe handling and consumption must be imposed on birds, bats and animals
used by viruses as their reservoirs.
xiv Viral Pandemics: COVID-19 …

I sincerely hope that at least the scientific community all over the world will
support my presentation and the proposal to save millions of lives expected to be
at risk in future epidemics and pandemics, with various kinds of viruses expected
to emerge in future.

February 2021 Shamim I. Ahmad

PS: Excerpts from the speech of Mr. Bill Gates “The Next Outbreaks? We are
not ready”—delivered in 2016 and presented on YouTube.
With apology if any part of the presentation improperly understood and
presented.
During the 1918 flu pandemic, 3 million people died and it was predicted that
any further outbreak may be more devastating. Now, we are living in a much more
technologically advanced age and can use all our modern knowledge, facilities and
technology to fight emerging diseases.
When our army goes to war, it uses all the technological advancements,
equipments and facilities at its disposal to win the war. We should follow a similar
approach to fight the pandemic war. For this:
1. Strong health systems must be developed.
2. Medical expertise needs to be pooled.
3. There needs to be a step up in terms of specific diagnostics, medical research
and development.
4. Vaccine must be developed and delivered earlier, especially in support of poor
countries.
5. Germ-game simulations should be developed to practice scenarios in a similar
way to that used in war games.
Editor’s salutation: A big salute to Mr. Bill Gates with my hat down in front of
him. Also I salute all the doctors, surgeons, nurses, health workers and caregivers
both at hospitals, nursing homes and old people homes, ambulance men and the
police for their hard work in the most dangerous COVID-19 environment risking
their lives, and send condolences to those who have lost their loving and caring
relations and friends.
Viral Pandemics: COVID-19 … xv

Appendix
Epidemics and Pandemics by Zoonotic Human Viruses
Avian Influenza Viruses
Influenza A virus (IAV): It is zoonotic and infects various living organisms
including humans. By mutational changes of its genomes or by its reassembling
during co-infection with different IAV strains, it can change its host and properties.
The past recorded influenza virus pandemics, linked to IAV subtypes, are H2
(1889-91), H3 (1990), H1 (1918-20), H2 (1957-58) and H3 (1968). Regarding
pathogenecity, there are the low pathogenic avian influenza viruses (LPAIVs)
which are normally asymptomatic in their natural avian hosts and from this they
become highly pathogenic (HPAIVs) with devastating consequences.
H1N1: This strain appeared during 2018–2019 which marks the centennial
of the Spanish flu which killed approximately 50 million people. This strain can be
considered the parent strain of all the variants of the viruses presented below.
Reasons for the variations and pathogenecity presented are the regular sequential
induction of mutations in their genome, which can evade the vaccines used for their
prevention. Although good achievements have been made for diagnosis, prevention
and treatment, the possibility of a severe pandemic to re-emerge remains possible.
H1N1, also known as the Swine flu virus, causes upper, and potentially, lower
respiratory tract infections in the host it infects.
H2N2: The Asian flu pandemic of 1957 was generated by this virus and cir-
culated among humans from 1957 to 1968 before it was replaced by H3N2 subtype.
H3N2: Then in 1968, there was a 50th A(H3N2) pandemic. Although the
pandemic morbidity and mortality were much lower in 1968 than in 1918, influenza
A (H3N2) virus infection was the leading cause of seasonal influenza illness and
death over the last 50 years. Clinically, influenza is characterized by acute onset
fever, chills, runny nose, cough, sore throat, headache and myalgia. Mostly, illness
lasts for 3–4 days with a resolution in 7–10 days.
H3N3: Limited information about this virus is that it was isolated from migra-
tory birds in South Korea in November 2016 and in Canadian pigs in 2001 and
2002.
H3N8: This virus is universally present in dogs, cats, horses, donkeys and
Bacterian camel in different countries ranging from China (2007, 2014 and 2015) to
Malaysia (2015) and Chile (2018). This virus is included in this appendix for the
possibility of its spillover in future.
H5 avian and human influenza viruses: This virus was first identified in 2013
as low pathogenic avian influenza virus (LPAI) and in 2017, its derivative
LPAIH7N9 became highly pathogenic and existed for two decades.
H5N1: The highly pathogenic virus was first reported in 1997 which had moved
from birds to humans and from Eurasia to Asia to going around the world. Since
then, the outbreaks of this highly pathogenic subtype have affected a wide variety of
mammals in addition to poultry and wild birds.
xvi Viral Pandemics: COVID-19 …

H6: This is the subtype of IAVs, is commonly detected in wild birds and
domestic poultry and can infect humans.
H6N6: In 2010, the H6N6 virus emerged in Southern China, and since then, it
has caused sporadic infections among swine. H6N6 swine IAV (SIV) currently
poses a moderate risk to public health, but its evolution and spread should be
closely monitored.
H7: This variant has its origin from H5 A/goose/Guangdong/1/1996 (GsGd) and
Asian H7N9 viruses and has caused several hundred human infections with high
mortality rates in the Netherlands, Italy, Canada, the United States and the United
Kingdom. Human illness ranges from conjunctivitis to mild upper respiratory ill-
ness and pneumonia. While these viruses have not spread beyond infected indi-
viduals, if they evolve to new strains, they can transmit efficiently from
person-to-person and can initiate a pandemic.
H7N3: This moved from birds to humans in Canada in 2013, and China is
undergoing a recent outbreak of a novel H7N9 avian influenza virus (nH7N9)
infection. Evolutionary analysis shows that human H7N9 influenza viruses origi-
nated from the H9N2, H7N3 and H11N9 avian viruses, and that it is as a novel
reassortment influenza virus.
H7N7: This poultry epidemic pathogenic virus moved from birds to humans in
the Netherlands in 2003 is now thought to be extinct.
H7N9: This caused high mortality. Since its identification as novel reassortant
avian influenza A (H7N9) virus in China in 2013, until 2017, this avian origin as an
Asian virus has caused five epidemic waves leading to a total of 1,552 human
infections, with a fatality rate of about 40%. In the spring of 2017, it re-immerged
with few human infections. It is included in the index in case its variation can cause
the next pandemic.
H9N2: This is a subtype of the influenza A virus that originated in China
through interspecies transmission that started in poultry. Its receptor specificity and
human-to-human transfer was first recorded in 2009 in Finland. This influenza A
virus poses a persistent threat to human health, as shown above with H5N1, H7N9
and (see below) the recent surge of H9N2 infections. Recent increase in human
infection with the H9N2 virus in China highlights the necessity to closely monitor
the interspecies transmission events.
H10N8: This is an avian influenza virus with human infection and mortality;
since 2013, it has caused several influenza-related events; the spread of highly
pathogenic avian influenza of H10N8 and others, H5N6 zoonotic infections, the
ongoing H7N9 infections in China and the continued zoonosis of H5N1 viruses in
parts of Asia and the Middle East remains alarming.
H11N9: Although the pathogenecity of this virus is confined to avians such as
wild birds and domestic ducks, it is important to note that the N9 gene of H7N9,
which has the ability to cause death in humans, originated from an H11N9 influenza
strain. In future surveillances, emphasis should be given on reassortments of
H11N9 viruses affecting public health.
Viral Pandemics: COVID-19 … xvii

Rhinoviruses: These, present ubiquitously as respiratory tract pathogens, have

been neglected in the past because they were perceived as a virus only capable of
causing mild common cold. The virus was first discovered in the 1950s; their
epidemiological studies have shown that these viruses are commonly present in
adults and children with upper or lower respiratory tract infections. The virus can
cause upper respiratory tract illness (“the common cold”) and lower respiratory tract
illness (pneumonia). Other chronic respiratory diseases include asthma and
bronchitis.
Bats and Flying Foxes Viruses
Ebola virus: This virus (EBOV) of the family Filoviridae discovered in 1976 causes
hemorrhagic fever that can lead to death in a few days. The first major outbreak in
West Africa appeared with patients who suffered from chills, myalgia, fever,
diarrhoea, vomiting, and other hemorrhagic complications and failure of multiple
organs. The virus spreads by infected persons passing body fluids such as blood,
saliva, urine, seminal fluid to uninfected person, and also by contact with con-
taminated surfaces. This virus has spawned several epidemics during the past 38
years during this period spread from Africa to other continents, Guinea, Liberia,
Sierra Leone and Nigeria becoming a pandemic (details can be found in chapters
“Ebola Virus: Overview, Genome Analysis and Its Antagonists” and “Global
Outbreaks of Ebola Virus Disease and Its Preventive Strategies” of this book).
Nipah and Hendra viruses: Nipah and Hendra viruses were classified in the new
genus Henipavirus because of their uncommon features among Paramyxoviridae.
These are equine based and were first identified in mid-1990s in Australia and
Malaysia, causing epidemics with high mortality rate in affected animals and
humans. Then in 1994 and in 2010, the hendra virus infection of horses spread from
the viral reservoir in Australian mainland flying foxes, and the transmission
occurred to people by exposure from affected horses. Pteropid bats (flying foxes)
are the natural host of hendra virus causing severe acute respiratory disease,
encephalitis and highly fatal infection in horses and humans.
Marburg viruses (MARV): This is a zoonotic and highly pathogenic and is
associated with severe disease and mortality rates as high as 90%. Outbreaks of
MARV are sporadic and deadly through hemorrhagic fever. Its genus includes two
viruses: MARV and Ravn. The first case of the Marburg virus disease was reported
in 1967, but in 2002 the outbreaks spread to Uganda, Angola, Congo, Kenya and in
the USA. Bats have been considered as one of the most important reservoirs for this
virus.
Middle East respiratory syndrome (MERS) and Severe acute respiratory
syndrome (SARS) viruses: Human coronaviruses (HCoVs) in the past although
considered to be relatively harmless respiratory pathogens, after the outbreak of
SARS and MERS, have received worldwide attention as important pathogens in
respiratory tract infection. SARS-CoV and the MERS-CoV outbreaks started in
China and Saudi Arabia in 2003 and 2012, respectively. Since then they have
caused multiple major public health events that resulted in epidemics. Although
both viruses likely originated in bats, their spike protein (S) is slightly
xviii Viral Pandemics: COVID-19 …

different. MERS is mostly known as a lower respiratory tract (LRT) disease

involving fever, cough, breathing difficulties and pneumonia that may progress to
acute respiratory distress syndrome and multiorgan failure.
SARS-CoV-2/COVID-19: The outbreak in December 2019 has a significant
impact on people’s health and lives. Like SARS and MERS, this virus can cause
viral pneumonia, however, evidence exist that this virus may also affect the central
nervous system. Given the outbreak of COVID-19, it seems necessary to perform
investigations on the possible neurological complications in patients who suffered
from this virus (for further details, see chapter “Treatment of COVID-19 by
Combination Therapy with 5-fluorouracil, Ribonucleosides and Ribavirin—A
Modified Strategy” of this book).
Nipah virus (NIV): This is an emerging bat-borne pathogen, related to the
Hendra virus, first emerged in Malaysia in 1998. Clinically, it can stay asymp-
tomatic but can lead to fatal encephalitis. After its outbreak in Malaysia, subse-
quently, it moved to other parts of South and South East Asia, Bangladesh and
India. It causes severe neurological and respiratory diseases and encephalitis which
is highly lethal.
Other Mammalian Viruses
Rabies virus: This is zoonotic and a member of Lyssavirus, infecting humans with a
high fatality rate. Mostly, it is transmitted via the saliva of an infected animal
especially after dog bites which accounts for >99% of human cases especially
children. Pathologically, the virus first infects peripheral motor neurons, and
symptoms occur after the virus reaches the central nervous system. Once the
clinical disease develops, it is almost certainly fatal. Although rabies has been the
subject of large-scale public health interventions chiefly through vaccination efforts,
the disease continues to take the lives of about 40,000–70,000 people per year;
roughly, 40% of them are children. Most of these deaths occur in poor countries.
Hepatitis A virus: Acute hepatitis due to the hepatitis A virus usually is a short,
benign and self-limited disease causing non-chronic hepatitis. Hepatitis A virus is
one of the most common infectious virus prevailing worldwide. The virus is
transmitted by faecal-orally, resulting in symptoms ranging from asymptomatic
infection to fulminant hepatitis, often causing jaundice and mostly remains
non-lethal.
Hepatitis B virus: This is a human blood-borne virus which infects hepatocytes
and causes significant liver diseases. An estimated 400 million chronic carriers of
HBV exist worldwide. This virus is associated with human delta virus (HDV) and
15 to 20 million having serological evidence of exposure to HDV. High rates of
endemicity are present in Central and Northern Africa, the Amazon Basin, Eastern
Europe and the Mediterranean, the Middle East and parts of Asia.
Hepatitis C virus: This virus, first emerged in 1970, causes hepatitis, liver
cirrhosis and hepatocellular carcinoma. It infects around 170–200 million people
globally, especially in developing countries. Being a blood-borne virus, its preva-
lence progressed by parenteral transmission routes associated with medical treat-
ments, immunization, blood transfusion and by injecting drug use. Suspected
Viral Pandemics: COVID-19 … xix

source of this virus remains non-human primates harbouring viruses and is related
to HCV with cross-species transmission of variants. Seven main genotypes have
been identified in humans.
Hepatitis D virus and Hepatitis Delta virus: Hepatitis D causes hepatitis dis-
ease, was first reported in 1977, and now is estimated that 15–20 million people are
infected worldwide. Infection in liver leads to liver cirrhosis and possible liver
cancer. To complete the life cycle in hepatocytes, this RNA virus requires hepatitis
B surface antigen (HBsAg). In industrialized countries, this virus seems to have
diminished since the last two decades. However, it remains a medical issue for
injecting drug users, as well as immigrants travelling from infected area to
non-infected areas.
Hepatitis E virus: This zoonotic virus infection can lead to acute and chronic
hepatitis leading to acute liver failure as well as neurological and renal diseases.
Infections occur through transmission or contaminated blood products. At least 20
million people worldwide suffer from HEV infections, with more than 3 million
symptomatic cases and about 60,000 fatalities. Hepatitis E is generally self-limiting,
with fatality a rate of 0.5–3% in young adults.
Oropouche virus: This zoonotic virus circulates mainly in South and Central
America, and is responsible to induce oropouche fever. During the last 60 years,
more than 30 epidimecs and over half a million clinical cases are attributed to
OROV infection in Brazil, Peru, Panama, and Trinidad and Tobago.
Measles virus: Measles is a highly contagious disease that results from infection
with measles virus, and although vaccines are given, it is estimated that about
100,000 deaths occur every year due to measles. The virus is transmitted by the
respiratory route and illness begins with fever, cough and conjunctivitis followed
by a characteristic rash. Measles virus of genus of Morbillivirus belongs to the
family Paramyxoviridae. Persistent infection of this virus can lead to affect the
central nervous system including developing encephalitis and damage to certain
other inner organs. The infection is self-limiting interacted by virus-specific
immune response and leads to lifelong immunity of the sufferers. The viral genomic
RNA is single-stranded, non-segmented, and encodes six major structural proteins.
Mumps virus: This ia a member of the paramyxoviridae, enveloped,
non-segmented, negative-sense RNA virus mostly infecting children. The disease
symptoms are painful inflammation such as parotitis and orchitis. It is also highly
neurotropic, affecting the central nervous system in approximately half of the cases.
Due to the availability of MMR vaccines, mumps virus infection is now much rarer
at the global level.
Parainfluenza viruses and Respiratory syncytial virus (RSV): Human parain-
fluenza viruses (HPIVs) are single-stranded, enveloped RNA viruses of the
Paramyoviridaie family. Their four serotypes cause respiratory illnesses in adults
and mostly in children causing otitis, pharyngitis, conjunctivitis, croup, tracheo-
bronchitis and pneumonia. Uncommonly, it can cause acute bronchiolitis, mucosal
and sub-mucosal oedema, apnoea, bradycardia, parotitis, and respiratory distress
xx Viral Pandemics: COVID-19 …

syndrome and rarely disseminated infection. Worldwide, the disease is the leading
causes of death of infants of less than 1 year of age, second only to malaria.
Rubella virus: Also known as German measles, its infection and disease are
often mild. Body rash with swollen lymph nodes and fever normally start 2 weeks
after the infection and may last for 3 days. Although its infection causes mild
symptoms or even no symptoms, it can cause serious problems for unborn babies if
the mother is infected during pregnancy.
Mosquito-Borne Viruses
Dengue virus: A mosquito-borne flavivirus and a member of arboviruses, this is
one of the oldest discovered human viruses. Dengue fever disease was first sus-
pected by outbreaks in 1635 in Martinique and Guadeloupe, and in 1699 in
Panama. Viral transmission by Aedes aegypti mosquitoes was recorded in the early
nineteenth century. This virus most likely is responsible for higher morbidity and
mortality than any other Arbovirus illness in humans. Its recorded spread spans
40% of the world’s population, and about 2.5 billion people live in Dengue-infested
areas. According to WHO, around 400 million people are infected annually by any
of the 4 dengue virus serotypes resulting in diverse range of symptoms, from mild
undifferentiated fever to life-threatening hemorrhagic fever and shock (for details,
please see chapters “Dengue Preventive Strategies Through Entomological Control,
Vaccination and Biotechnology”, “Dengue Fever Epidemic in Pakistan and Its
Control Measures: Where Are We Moving?”, “Employing Geographic Information
System and Spatiotemporal Analysis of Dengue Outbreaks in a Metropolitan Area
in Pakistan”, “Identification of Dengue NS2B-NS3 Protease Inhibitors Through
High-Throughput Virtual Screening—Impacts on Drug Development Against the
Dengue Virus” of this book).
West Nile fever virus: This zoonotic arbovirus has been found in birds, mos-
quitoes of Culex genus and horses. Isolated in Uganda first in 1937, it spread
globally up to North America in 1999 and is responsible for a high rate of morbidity
and mortality. Blood transfusion, organ transplantation, and possibly pregnancy and
breastfeeding also can transfer this virus from person to person. Clinical symptoms
range from mild to asymptomatic pathogenesis to neuroinvasion.
Chikungunya virus: A member of arboviruses (CHIKV), this causes crippling
musculoskeletal inflammatory disease in humans characterized by fever, pol-
yarthralgia, myalgia, rash and headache. Aedes aegypti is the most common
reservoir from where through bite the virus is transmitted to humans. Its long-term
progress from infection is yet ill-defined but its prolonged debilitating arthralgia is
well identified. Since 2004, CHIKV has spread on a global scale.
Zika virus: This is another mosquito-borne member of arboviruses and is closely
related to dengue, yellow fever, West Nile, and Japanese encephalitis viruses. From
Africa and Asia, its emergence in Brazil in 2015 peaked the spread throughout the
Americas. Its infections are characterized by subclinical or mild influenza-like ill-
ness, but severe outcomes such as Guillain-Barre syndrome in adults and micro-
cephaly in babies born to infected mothers have been recorded (for further
Viral Pandemics: COVID-19 … xxi

information, see chapters “Zika Virus Disease: Progress and Prospects” and “The
Medicinal Chemistry of Zika Virus” of this book).
Tahyna virus (TAHV): This virus endemic to Europe, Asia and Africa is
responsible for California encephalitis. A mosquito-borne California encephalitis,
viral sera analysed from wild boar, roe deer and red deer collected in Austria,
Hungary and Romania, demonstrate that TAHV transmission to mammals is
widespread in Europe, particularly in the wild boar population, but are no more a
major health problem in Western Europe.
Inkoo and Chatanga viruses: These viruses of the Bunyavirus group, circu-
lating in Finland, are mosquito-borne California serogroup orthobunyaviruses that
have a high sero-prevalence among humans. In Northern Europe, the sero-
prevalence against Inkoo virus (INKV) is high, 41% in Sweden and 51% in
Finland. Studies indicate that INKV infection is mainly asymptomatic, but can
cause mild encephalitis in humans.
Sindbis virus: Sindbis virus (SINV) is another mosquito-borne alphavirus that is
locally amplified in a bird-mosquito enzootic cycle and distributed all over the Old
World and Australia/Oceania. Its disease can range from mild illness to lethal
encephalitis or severe polyarthritis.
Batai virus: Belonging to the Bunyavirus group, this is another
mosquito-transmitted Orthobunyavirus. It was first detected in 2009 in Southwest
Germany in anopheline and culicine mosquitoes. Little is known about its infec-
tivity in humans as almost no systematic surveillance or infection studies have been
carried out to date.
Lednice virus: The Bunyavirus group Lednice virus (LEDV) has been detected
in Culex modestus mosquitoes in several European countries within the last six
decades. Not much information is available about this virus.
Semliki Forest complex virus: Mosquito species, Aedes camptorhynchus, Aedes
vigilax and Culex annulirostris are the prime vectors for this virus. Not much is
known about this virus.
Tick-Borne Viruses
Powassan virus (POWV): This is a flavivirus discovered in Powassan, Ontario in
1958, which causes sporadic but severe cases of encephalitis in humans. Its study
for infectivity in humans showed that each year in the USA it has steadily
increased. The virus is first transmitted by Ixodes scapularis, Ixodes cookei, and
several other Ixodes tick species to small- and medium-sized mammals and then
from there to humans. The Powassan virus is a neurovirulent flavivirus consisting
of two lineages causing meningoencephalitis.
Crimean-Congo hemorrhagic virus: This is a member of the Bunyaviridae
family and Nairovirus genus associated with Hyalomma ticks. Its viral genome
consists of 3 RNA segments of 12 kb (L), 6.8 kb (M) and 3 kb (S). Viral induced
fever is widespread and infection is reported from many regions of Africa, the
Middle East, Southern and Eastern Europe, India and Asia. Transfer of virus by tick
bite or body fluids from an infected individual to another is the most common route.
xxii Viral Pandemics: COVID-19 …

Clinical manifestations include asymptomatic or high fever, headache, malaise,

arthralgia, myalgia, nausea, abdominal pain and non-bloody diarrhoea.
Other Less-Important Zoonotic Viruses
Enteric viral co-infections: This has been reported for a diverse group of etiological
agents, including rotavirus, norovirus, astrovirus, adenovirus and enteroviruses.
These pathogens are causative agents for acute gastroenteritis and diarrheal disease
in immunocompromised individuals of all ages. Some of them have been high-
lighted below.
Human Astrovirus (HAtVs): This is a non-enveloped, positive-sense,
single-stranded RNA virus discovered in 1975. It causes gastrointentinal illness
(e.g. diarrhoea) in children, elderly and immunocompromised people. Astroviruses
were classified into Mamastrovirus and Avastrovirus infecting mammalian and
avian groups.
Rotavirus: Group A rotavirus (RVA) is another gastroenteritis disease and
worldwide, its yearly prevalence is around 180 million, which remains the leading
cause of disease in neonates, children and adults. The virus was first reported in
turkey poults in the USA during 1977 and since then, RVs of group A (RVA), D
(RVD), F (RVF) and G (RVG) have been identified around the globe. The rotavirus
genome is composed of 11 gene segments of double-stranded RNA. This extremely
contagious virus is transmitted by the faecal-oral route, and diarrheal infections
remain the major cause of morbidity and mortality among young children.
Norovirus: This is a non-enveloped, positive-sense, single-stranded RNA viru-
ses, discovered in 1968, which belongs to the Caliciviridae family. This worldwide
prevailing virus remains a cause of acute gastrointestinal illness especially in
children, and disease may remain associated with nausea, vomiting, and diarrhoea
and significant dehydration. Viral transmission occurs by the faecal-oral route,
person-to-person contact, or by the ingestion of contaminated food and water.
About 699 million infections and over 200,000 deaths worldwide each year have
been recorded.
Oncogenic viruses: As most oncogenic viruses are not associated with pan-
demics, only their names are given as reference: Epstein-Barr virus, Hepatitis B and
C Viruses, HIV-1 and HIV-2 (human immunodeficiency virus 1 and 2), Human
papilloma virus, Human T-lymphotropic virus type 1, Human herpesvirus type 8,
and Merkel cell polyomavirus.
Editor’s Worries About the Changing World

Viral epidemics and pandemics: Most virologists know that there exist more than
two hundred human viruses; some are continuously persisting in the human body
and others infect humans every now and then causing various diseases and death.
Then there are zoonotic viruses present in animal bodies and ready to adapt to infect
human. The fourth group of unknown types is present underneath the soil, where
they stay for many years and when soil surface will get disturbed, they will emerge
and attack humans either directly or through animals. This means the human spe-
cies will always stay susceptible to viral attacks like epidemics or pandemics. We
have to be fully prepared for that in advance as much as possible.
Environmental disturbance and destruction: Environmentalists every now
and then have been making us aware over the last four to five decades that
disturbances and destructions have been going on in our environment in several
different ways: increased pollutions such as the overuse of plastic materials
and disposal of unwanted chemicals and garbage, increased amount of carbon-
associated exhaust fumes from aeroplanes and cars, deforestation and the reduction
of trees, all of which lead to global warming, melting of glaciers, forest fires,
increased number of floods, storms, typhoons and tornadoes; also possible is the
elimination of small islands in future. With this awareness, I understand that the
leaders of the world, although already putting efforts to minimize these damages,
they join more hands, take more targeted, serious and rapid actions to eliminate
them as much as possible.
Extinction of rare animal and plant species: Another important consequence
of environmental damage is the possible elimination of many rare remaining species
of animals and plants. Naturalists are keeping a close eye on this issue and
including charity organizations who are working for it, but we have to support them
as much as possible for the success of their hard work.
Chemical, biological, and nuclear war fares: Although several countries have
been suspected to be hoarding chemical and biological weapons, human destruction
by these agents are known to be not as destructive as the nuclear weapons.
Moreover, it is possible that in future more and more countries will try to develop
them, and hence the question is whether this will act as a deterrent or will it be used

xxiii
xxiv Editor’s Worries About the Changing World

as a retaliation? It remains an open question. Let us try to stop further production of

this weapon of mass destruction.
Continued wealth gap between rich and poor: It is well known that the wealth
gap between the rich and the poor is increasing at a faster rate. A few years back,
the global list issued was about millionaires, then soon the list of billionaires, and
now it is not far that we will see the list of trillionaires. Its direct or indirect effects
are increased urbanization, unemployment and increased migration of people from
poor to developed countries. Also the increase in automation is resulting in the
replacement of human workforce with higher unemployment. What could be done
about it is another important question.
Public demands through demonstrations: The current surge of demonstra-
tions, some peaceful some violent, although occurring mostly at local and some at
national levels, most are due to the introduction of new unacceptable laws,
unhappiness, disappointment, depression and significant reduction in the quality of
life. There are cases where demonstrators are brutally treated with sporadic deaths.
This issue should stay more effectively to be raised at the United Nation Security
Council and dealt with appropriately through international diplomacy.
Appearance of new human diseases and increase in the number of existing
ones: No doubt that a number of human conditions globally is on the rise including
heart attacks, diabetes (the new type-2 diabetes in children which was rare a few
years back), different kinds of cancers and allergic reactions. No doubt some
of them are caused by environmental pollution and quality of food consumed.
Newly appearing diseases are mostly caused by zoonotic viruses which are gen-
erated by certain unusual way of life in certain countries. A combined global effort
is required to control and minimize these.
Biotechnology: Biotechnology has now reached a stage that if used irrespon-
sibly, it can have enormous devastation on human life. Although strict rules and
regulations have been produced and distributed to the academia and researchers, it
may not be ruled out that someone some day can misuse it and then what? It
remains a worrying prospect. We should stay vigilant about it.
Cybercrimes: This is something equivalent to virus pandemics, in that they both
work at the global level; one infects and kills humans while the other infects
computers and make them dysfunctional. This can affect industries like banking,
telecom, health care, etc. where hackers not only can hack very huge amounts of
money from banks but can also steal confidential/sensitive user information and
then threaten and demand ransom from companies. For this reason, computer
experts should continue finding certain kinds of deterrent for this problem.

February 2012 Shamim I. Ahmad

Contents

Introduction to Human Viruses

Human Viruses: Infection, Prevention and Potential Target(s)
for Therapy – A Comprehensive Review . . . . . . . . . . . . . . . . . . . . . . . . 3
Shilpi Gupta, Prabhat Kumar, Ankan Mukherjee Das, D. K. Gupta,
and Bhudev C. Das

Dengue Virus
Dengue Preventive Strategies Through Entomological Control,
Vaccination and Biotechnology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Idris Nasir Abdullahi, Sharafudeen Dahiru Abubakar,
Hafeez Aderinsayo Adekola, Abdurrahman El-fulaty Ahmad,
Mohammed Ibrahim Tahir, Abubakar Umar Anka,
Muhammad Sagir Shehu, and Yahaya Usman
Dengue Fever Epidemic in Pakistan and Its Control Measures:
Where Are We Moving? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Ali Ahmed and Gul Majid Khan
Employing Geographic Information System and Spatiotemporal
Analysis of Dengue Outbreaks in a Metropolitan Area in Pakistan . . . . 81
Shakeel Mahmood and Ahtisham Irshad
Identification of Dengue NS2B-NS3 Protease Inhibitors Through
High-Throughput Virtual Screening—Impacts on Drug Development
Against the Dengue Virus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Sheikh Murtuja, Deepak Shilkar, Biswatrish Sarkar, Barij Nayan Sinha,
and Venkatesan Jayaprakash

xxv
xxvi Contents

Ebola Virus
Ebola Virus: Overview, Genome Analysis and Its Antagonists . . . . . . . . 123
Sahar Qazi, Ayesha Khanam, and Khalid Raza
Global Outbreaks of Ebola Virus Disease and Its Preventive
Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Ameer Khusro and Chirom Aarti

Chikungunya Virus
Chikungunya Disease: A Concise Review and Its Transmission
Model for India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Rajasekhar Mopuri, Satya Ganesh Kakarla, and Srinivasa Rao Mutheneni
Effect of Chikungunya Viral Infection on the Auditory System . . . . . . . 187
Prashanth Prabhu and Shezeen Abdul Gafoor

Epstein-Barr Viruses
Brief Introduction of Epstein-Barr Virus and Lymphoma . . . . . . . . . . . 195
Daniel Esau

Crimean-Congo Hemorrhagic Fever

Diagnosis, Prognosis and Clinical Trial in Crimean-Congo
Hemorrhagic Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Seyit Ali Büyüktuna and Halef Okan Doğan

Zika Virus
Zika Virus Disease: Progress and Prospects . . . . . . . . . . . . . . . . . . . . . . 223
Swatantra Kumar, Rajni Nyodu, Vimal K. Maurya,
and Shailendra K. Saxena
The Medicinal Chemistry of Zika Virus . . . . . . . . . . . . . . . . . . . . . . . . . 233
Érica Erlanny da Silva Rodrigues, Hannah Maus,
Stefan Josef Hammerschmidt, Alessia Ruggieri,
Elane Conceição dos Santos, Ênio José Bassi, Leticia Anderson,
Pedro Gregório Vieira Aquino, João Xavier de Araújo-Júnior,
Fenju Wei, Xinyong Liu, Peng Zhan, Tanja Schirmeister,
and Edeildo Ferreira da Silva-Júnior

Human Papillomavirus
Human Papillomavirus and Its Role in the Development of Cancer . . . . 299
Sevic Ina, Romano Lucia, Cristina Carolina, and Alaniz Laura
Contents xxvii

Hepatitis B Virus
Characterization of Hepatitis B Virus with Complex Structural
Variations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Kei Fujiwara

Enteroviruses
Impact of Genetic Changes in the Enterovirus 71 Genome
on Virulence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Chit Laa Poh, Madiiha Bibi Mandary, and Seng-Kai Ong

Merkel Cell Polyomavirus

Ubiquitous Merkel Cell Polyomavirus: Causative Agent
of the Rare Merkel Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Naveed Shahzad, Usman Shah Gilani, Menahil Mahmood,
Fareeda Tasneem, Muhammad Farhan Ul Haque, and Iqra Hussain

Hantavirus
Hantaviruses—A Concise Review of a Neglected Virus . . . . . . . . . . . . . 387
María Victoria Vadell

Flaviviruses
Introduction to Flaviviruses and Their Global Prevalence . . . . . . . . . . . 411
Mansi Verma, Rajendra Phartyal, and Amit Bhatt

HIV-HBV Viruses
HIV-HBV Co-infection, Clinical Concerns . . . . . . . . . . . . . . . . . . . . . . . 443
Ryan D. Heath, Ali Syed, Suha Abu Khalaf, and Veysel Tahan

Rabies Virus
Catalysis of mRNA Capping with GDP Polyribonucleotidyltransferase
Activity of Rabies Virus L Protein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
Tomoaki Ogino and Todd J. Green

Monkeypox Virus
Unveiling the Arcane of an Elusive Virus from the Heart
of the African Continent: The Monkeypox . . . . . . . . . . . . . . . . . . . . . . . 477
Bien-Aimé M. Mandja and Jean-Paul Gonzalez
xxviii Contents

Measles Virus
Brief Introduction of Measles Virus and Its Therapeutic Strategies . . . . 503
Igor José dos Santos Nascimento, Paulo Fernando da Silva Santos-Júnior,
and Edeildo Ferreira da Silva-Júnior

Corona Virus and SARS-CoV-2

Lethal Human Coronavirus Infections and the Role of Vaccines
in Their Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 533
Jeremy Baldwin and Nikolai Petrovsky
SARS-CoV-2 Mutations: An Insight . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
Rajendra Phartyal and Mansi Verma
A Brief Introduction to Coronavirus Disease 2019 (COVID-19)
and the Roles of Zoonotic Spillover . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565
D. Katterine Bonilla-Aldana and Alfonso J. Rodriguez-Morales
Treatment of COVID-19 by Combination Therapy
with 5-fluorouracil, Ribonucleosides and Ribavirin—A
Modified Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571
Shamim I. Ahmad

Antiviral Agents
HIV-1 and HBV RNase H as Metal-Chelating Inhibitors: Discovery
and Medicinal Chemistry Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
Fenju Wei, Edeildo Ferreira da Silva-Júnior, Xinyong Liu, and Peng Zhan

Viral Vaccines
Vaccines for Emerging Viruses—A Comprehensive Update . . . . . . . . . . 605
Roger Hewson
Global Polio Eradication: Progress and Challenges . . . . . . . . . . . . . . . . 629
Ananda Sankar Bandyopadhyay and Grace Ruth Macklin
Passive Immunization to Pandemic Viruses Through Herd Parties . . . . 651
Nitish Aggarwal and Pushkar Aggarwal

General Virology
Phage Therapy of Human Bacterial Infections: A Systematic
Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 663
Shamim I. Ahmad
Contents xxix

Oligomerization of Fusion Proteins: A Common Symptom

for Class I Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 693
Geetanjali Meher and Hirak Chakraborty
Fluorescence Imaging Approaches in Flavivirus Research . . . . . . . . . . . 713
Jorge L. Arias-Arias and Rodrigo Mora-Rodríguez
The Genetics of Post-polio Syndrome—An Overview . . . . . . . . . . . . . . . 731
Radha Saraswathy

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 739
Editor and Contributors

About the Editor

Shamim I. Ahmad after obtaining his Master’s degree

in Botany from Patna University, India, and his Ph.D.
in Molecular Genetics from Leicester University,
England, in 1972 he joined Nottingham Trent
University as a grade-1 lecturer and was subsequently
promoted to a Senior Lecturer post. Here, after serving
for 35 years, he took an early retirement although yet
delivering certain lectures. His research interest culmi-
nated in collaboration with the University of Missouri,
Columbia, USA; University of Osaka, Japan;
University of Copenhagen, Denmark; Institute of
Genetics and Industrial Microorganisms, Moscow,
Russia; Academic Institute of Photographic Chemistry,
Beijing, China; University of Leiden, Holland; Imperial
Chemical Industry, Bellingham, UK; CNRS (Centre
National de la Recherche Scientifique) Gif-Sur-Yvette,
France; and PHLS (Public Health Laboratory Services),
Salisbury, England. These exclude a number of uni-
versities and organizations where he was invited to give
lectures and courses. His active research expanded for
over three decades and carried out in different areas of
molecular biology/genetics including thymineless death
in bacteria, genetic control of nucleotide catabolism,
development of anti-AIDs drug, control of microbial
infection of burns, phages of thermophilic bacteria, and
microbial flora of Chernobyl after the accident at its
nuclear power station. His all along research activities
remained on DNA damage, repair and mutagenesis and

xxxi
xxxii Editor and Contributors

UV photoreaction of biological and non-biological

compounds producing reactive oxygen species: impli-
cations on human health. His latest valued publication
is “5-fluorouracil in combination with deoxyribonu-
cleosides and deoxyribose as possible therapeutic
options for the coronavirus, COVID-19 infection”. He
is a strong believer that the phage therapy remains as an
alternative to the future treatment of bacterial infec-
tions, especially those developing resistant to multiple
antibiotics.
In 2003 he received a prestigious “Asian Jewel
Award” in the UK for “Excellence in Education”. His
long-time ambition to produce medical books started in
2007 and since then, he has published a number of
books including Molecular Mechanisms of Fanconi
Anemia; Molecular Mechanisms of Xeroderma
Pigmentosum; Molecular Mechanisms of Cockayne
Syndrome; Molecular Mechanisms of Ataxia
Telangiectasia; Diseases of DNA Repair;
Neurodegenerative diseases; Diabetes: An Old
Disease A New Insight; Obesity: A Practical Guide;
Thyroid: Basic Science and Clinical Practice;
Ultraviolet Light in Human Health, Diseases and
Environment; Diabetes: A Comprehensive Treatise for
Patients and Caregivers; Reactive Oxygen Species in
Biology and Human Health; Aging: Exploring a
Complex Phenomenon; and Handbook of
Mitochondrial Dysfunction. Springer Publication,
Taylor and Francis, and CRC Press have published
most books.

Contributors

Chirom Aarti Research Department of Plant Biology and Biotechnology, Loyola

College, Chennai, TN, India
Idris Nasir Abdullahi Department of Medical Laboratory Science, Faculty of
Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University,
Zaria, Nigeria
Sharafudeen Dahiru Abubakar Department of Medical Laboratory Science,
Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello
University, Zaria, Nigeria
Editor and Contributors xxxiii

Hafeez Aderinsayo Adekola Department of Microbiology, Olabisi Onabanjo

University, Ogun State, Nigeria
Nitish Aggarwal Yale New Haven Hospital, New Haven, CT, USA
Pushkar Aggarwal University of Cincinnati College of Medicine, Cincinnati,
OH, USA
Abdurrahman El-fulaty Ahmad Department of Medical Laboratory Science,
Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello
University, Zaria, Nigeria
Shamim I. Ahmad Former Senior Lecturer, School of Science and Technology,
Nottingham Trent University, Nottingham, England
Ali Ahmed School of Pharmacy, Monash University, Bandar Sunway, Malaysia
Leticia Anderson CESMAC University Center, Maceió, Brazil
Abubakar Umar Anka Department of Medical Laboratory Science, Faculty of
Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University,
Zaria, Nigeria
Pedro Gregório Vieira Aquino Environment Laboratory, Federal University of
Agreste From Pernambuco, Garanhuns, Brazil
Jorge L. Arias-Arias Facultad de Microbiología, Centro de Investigación en
Enfermedades Tropicales, Universidad de Costa Rica, San José, Costa Rica
Jeremy Baldwin Vaxine Pty Ltd, Warradale, Australia
Ananda Sankar Bandyopadhyay Bill and Melinda Gates Foundation, Seattle,
WA, USA
Ênio José Bassi IMUNOREG – Immunoregulation Research Group, Laboratory
of Research in Virology and Immunology, Institute of Biological Sciences and
Health, Federal University of Alagoas, Campus A.C. Simões, Maceió, Brazil
Amit Bhatt Department of Zoology, Sri Venkateswara College, University of
Delhi (South Campus), New Delhi, India
D. Katterine Bonilla-Aldana Semillero de Investigacion en Zoonosis (SIZOO),
Biodiversity and Ecosystem Conservation Research Group (BIOECOS), Fundación
Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia;
Latin American Network of COVID-19 Research, LANCOVID, Pereira, Risaralda,
Colombia
Seyit Ali Büyüktuna Department of Infectious Disease, School of Medicine,
Cumhuriyet University, Sivas, Turkey
xxxiv Editor and Contributors

Cristina Carolina Laboratorio de Fisiopatología de La Hipófisis, Centro de

Investigaciones Básicas Y Aplicadas (CIBA), CIT NOBA, Universidad Nacional
del Noroeste de La Pcia. de Bs. As. Consejo Nacional de Investigaciones
Científicas Y Técnicas (UNNOBA-CONICET), Junín, Argentina
Hirak Chakraborty School of Chemistry, Sambalpur University, Burla, Odisha,
India
Bhudev C. Das Stem Cell and Cancer Research Lab, Amity Institute of Molecular
Medicine & Stem Cell Research (AIMMSCR), Amity University Uttar Pradesh,
Noida, India
Edeildo Ferreira da Silva-Júnior Institute of Chemistry and Biotechnology,
Federal University of Alagoas, Campus A.C. Simões, Maceió, Brazil;
Laboratory of Medicinal Chemistry, Pharmaceutical Sciences Institute, Federal
University of Alagoas, Maceió, AL, Brazil
João Xavier de Araújo-Júnior Institute of Chemistry and Biotechnology, Federal
University of Alagoas, Campus A.C. Simões, Maceió, Brazil
Elane Conceição dos Santos IMUNOREG – Immunoregulation Research Group,
Laboratory of Research in Virology and Immunology, Institute of Biological
Sciences and Health, Federal University of Alagoas, Campus A.C. Simões, Maceió,
Brazil
Halef Okan Doğan Department of Biochemistry, School of Medicine,
Cumhuriyet University, Sivas, Turkey
Daniel Esau Department of Medicine, The University of British Columbia,
Vancouver, BC, Canada;
Royal Jubilee Hospital, Victoria, BC, Canada
Kei Fujiwara Department of Gastroenterology and Metabolism, Nagoya City
University Graduate School of Medical Sciences, Nagoya, Mizuho, MizuhoAichi,
Japan
Shezeen Abdul Gafoor Department of Audiology, All India Institute of Speech
and Hearing, Manasagangothri, Naimisham Campus, Mysore, Karnataka, India
Usman Shah Gilani School of Biological Sciences, University of the Punjab,
Lahore, Pakistan
Jean-Paul Gonzalez Department of Microbiology & Immunology, Division of
Biomedical Graduate Research Organization, Georgetown University, School of
Medicine, Washington, DC, USA;
Advisory Board, Centaurus Biotech LLC, Vienna, VA, USA
Todd J. Green Department of Microbiology, School of Medicine, University of
Alabama at Birmingham, Birmingham, AL, USA
Editor and Contributors xxxv

D. K. Gupta Felix Hospital, Noida, India

Shilpi Gupta Stem Cell and Cancer Research Lab, Amity Institute of Molecular
Medicine & Stem Cell Research (AIMMSCR), Amity University Uttar Pradesh,
Noida, India;
Molecular Genetics Laboratory, National Institute of Cancer Prevention and
Research (ICMR), Noida, India;
Felix Hospital, Noida, India
Stefan Josef Hammerschmidt Institute of Pharmaceutical and Biomedical
Science, Johannes Gutenberg-University Mainz, Mainz, Germany
Muhammad Farhan Ul Haque School of Biological Sciences, University of the
Punjab, Lahore, Pakistan
Ryan D. Heath Fellow, Division of Gastroenterology and Hepatology,
Department of Internal Medicine, University of Missouri, Columbia, MO, USA
Roger Hewson Department of Infection Biology, London School of Hygiene and
Tropical Medicine, London, UK
Iqra Hussain School of Biological Sciences, University of the Punjab, Lahore,
Pakistan
Sevic Ina Laboratorio de Microambiente Tumoral, Centro de Investigaciones
Básicas Y Aplicadas (CIBA), CIT NOBA, Universidad Nacional del Noroeste de
La Pcia. de Bs. As. Consejo Nacional de Investigaciones Científicas Y Técnicas
(UNNOBA-CONICET), Junín, Argentina
Ahtisham Irshad Department of Geography, GC University Lahore, Lahore,
Pakistan
Venkatesan Jayaprakash Department of Pharmaceutical Sciences &
Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
Satya Ganesh Kakarla ENVIS Resource Partner on Climate Change & Public
Health, Applied Biology Division, CSIR-Indian Institute of Chemical Technology
(CSIR-IICT), Tarnaka, Hyderabad, Telangana, India;
Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh,
India
Suha Abu Khalaf Department of Internal Medicine, University of
Missouri-Columbia, Columbia, MO, USA
Gul Majid Khan Department of Pharmacy, Quaid I Azam University Islamabad,
Islamabad, Pakistan
Ayesha Khanam Department of Computer Science, Jamia Millia Islamia, New
Delhi, India
xxxvi Editor and Contributors

Ameer Khusro Research Department of Plant Biology and Biotechnology, Loyola

College, Chennai, TN, India
Prabhat Kumar Stem Cell and Cancer Research Lab, Amity Institute of
Molecular Medicine & Stem Cell Research (AIMMSCR), Amity University Uttar
Pradesh, Noida, India
Swatantra Kumar Centre for Advanced Research (CFAR), Faculty of Medicine,
King George’s Medical University (KGMU), Lucknow, India
Alaniz Laura Laboratorio de Microambiente Tumoral, Centro de Investigaciones
Básicas Y Aplicadas (CIBA), CIT NOBA, Universidad Nacional del Noroeste de
La Pcia. de Bs. As. Consejo Nacional de Investigaciones Científicas Y Técnicas
(UNNOBA-CONICET), Junín, Argentina
Xinyong Liu Department of Medicinal Chemistry, Key Laboratory of Chemical
Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong
University, Ji’nan, China;
Institute of Chemistry and Biotechnology, Federal University of Alagoas, Maceió,
Brazil
Romano Lucia Laboratorio de Fisiopatología de La Hipófisis, Centro de
Investigaciones Básicas Y Aplicadas (CIBA), CIT NOBA, Universidad Nacional
del Noroeste de La Pcia. de Bs. As. Consejo Nacional de Investigaciones
Científicas Y Técnicas (UNNOBA-CONICET), Junín, Argentina
Grace Ruth Macklin World Health Organization, Genève, Switzerland;
London School of Hygiene and Tropical Medicine, London, UK
Menahil Mahmood School of Biological Sciences, University of the Punjab,
Lahore, Pakistan
Shakeel Mahmood Department of Geography, GC University Lahore, Lahore,
Pakistan
Madiiha Bibi Mandary Centre for Virus and Vaccine Research, School of
Medical and Life Sciences, Sunway University, Kuala Lumpur, Selangor, Malaysia
Bien-Aimé M. Mandja Faculty of Medicine, Microbiology Department, Kinshasa
University, Kinshasa, Democratic Republic of Congo;
Chrono-Environment Laboratory, UMR 6249 CNRS, Bourgogne Franche-Comté,
University Besançon, Besançon, France
Vimal K. Maurya Centre for Advanced Research (CFAR), Faculty of Medicine,
King George’s Medical University (KGMU), Lucknow, India
Hannah Maus Institute of Pharmaceutical and Biomedical Science, Johannes
Gutenberg-University Mainz, Mainz, Germany
Geetanjali Meher School of Chemistry, Sambalpur University, Burla, Odisha,
India
Editor and Contributors xxxvii

Rajasekhar Mopuri ENVIS Resource Partner on Climate Change & Public

Health, Applied Biology Division, CSIR-Indian Institute of Chemical Technology
(CSIR-IICT), Tarnaka, Hyderabad, Telangana, India;
Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh,
India
Rodrigo Mora-Rodríguez Facultad de Microbiología, Centro de Investigación en
Enfermedades Tropicales, Universidad de Costa Rica, San José, Costa Rica
Ankan Mukherjee Das Laboratory of Disease Dynamics and Molecular
Epidemiology, Amity Institute of Public Health, Amity University Uttar Pradesh,
Noida, India
Sheikh Murtuja Department of Pharmaceutical Sciences & Technology, Birla
Institute of Technology, Mesra, Ranchi, Jharkhand, India
Srinivasa Rao Mutheneni ENVIS Resource Partner on Climate Change & Public
Health, Applied Biology Division, CSIR-Indian Institute of Chemical Technology
(CSIR-IICT), Tarnaka, Hyderabad, Telangana, India;
Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh,
India
Igor José dos Santos Nascimento Chemistry and Biotechnology Institute, Federal
University of Alagoas, Maceió, AL, Brazil
Rajni Nyodu Centre for Advanced Research (CFAR), Faculty of Medicine, King
George’s Medical University (KGMU), Lucknow, India
Tomoaki Ogino Department of Medical Microbiology and Immunology, College
of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
Seng-Kai Ong Department of Biological Sciences, School of Medical and Life
Sciences, Sunway University, Kuala Lumpur, Selangor, Malaysia
Nikolai Petrovsky Vaxine Pty Ltd, Warradale, Australia;
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Rajendra Phartyal Department of Zoology, Sri Venkateswara College,
University of Delhi (South Campus), New Delhi, India
Chit Laa Poh Centre for Virus and Vaccine Research, School of Medical and Life
Sciences, Sunway University, Kuala Lumpur, Selangor, Malaysia
Prashanth Prabhu Department of Audiology, All India Institute of Speech and
Hearing, Manasagangothri, Naimisham Campus, Mysore, Karnataka, India
Sahar Qazi Department of Computer Science, Jamia Millia Islamia, New Delhi,
India
Khalid Raza Department of Computer Science, Jamia Millia Islamia, New Delhi,
India
xxxviii Editor and Contributors

Érica Erlanny da Silva Rodrigues Institute of Chemistry and Biotechnology,

Federal University of Alagoas, Campus A.C. Simões, Maceió, Brazil
Alfonso J. Rodriguez-Morales Latin American Network of COVID-19 Research,
LANCOVID, Pereira, Risaralda, Colombia;
Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria
Autónoma de las Américas, Pereira, Risaralda, Colombia
Alessia Ruggieri Department of Infectious Diseases, Molecular Virology, Center
for Integrative Infectious Disease Research, University of Heidelberg, Heidelberg,
Germany
Paulo Fernando da Silva Santos-Júnior Chemistry and Biotechnology Institute,
Federal University of Alagoas, Maceió, AL, Brazil
Radha Saraswathy 120TT Biomedical Genetics Research Lab (BMGRL),
Department of Biomedical Sciences, School of Biosciences & Technology, VIT
University, Vellore, Tamil Nadu, India
Biswatrish Sarkar Department of Pharmaceutical Sciences & Technology, Birla
Institute of Technology, Mesra, Ranchi, Jharkhand, India
Shailendra K. Saxena Centre for Advanced Research (CFAR), Faculty of
Medicine, King George’s Medical University (KGMU), Lucknow, India
Tanja Schirmeister Institute of Pharmaceutical and Biomedical Science,
Johannes Gutenberg-University Mainz, Mainz, Germany
Naveed Shahzad School of Biological Sciences, University of the Punjab, Lahore,
Pakistan
Muhammad Sagir Shehu College of Health Technology, Ningi, Bauchi State,
Nigeria
Deepak Shilkar Department of Pharmaceutical Sciences & Technology, Birla
Institute of Technology, Mesra, Ranchi, Jharkhand, India
Barij Nayan Sinha Department of Pharmaceutical Sciences & Technology, Birla
Institute of Technology, Mesra, Ranchi, Jharkhand, India
Ali Syed Department of Internal Medicine, University of Missouri-Columbia,
Columbia, MO, USA
Veysel Tahan Associate Professor of Clinical Medicine, Division of
Gastroenterology and Hepatology, Department of Internal Medicine, University of
Missouri, Columbia, MO, USA
Mohammed Ibrahim Tahir Department of Medical Laboratory Science, Faculty
of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University,
Zaria, Nigeria
Editor and Contributors xxxix

Fareeda Tasneem Department of Biology, Virtual University of Pakistan, Lahore,

Pakistan
Yahaya Usman Department of Medical Laboratory Science, Faculty of Allied
Health Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria,
Nigeria
María Victoria Vadell CONICET (Consejo Nacional de Investigaciones
Científicas y Técnicas, Argentina), Instituto Nacional de Medicina Tropical - ANLIS
“Dr. Carlos G. Malbrán”, Puerto Iguazú, Misiones, Argentina
Mansi Verma Department of Zoology, Sri Venkateswara College, University of
Delhi (South Campus), New Delhi, India
Fenju Wei Department of Medicinal Chemistry, Key Laboratory of Chemical
Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong
University, Ji’nan, China
Peng Zhan Department of Medicinal Chemistry, Key Laboratory of Chemical
Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong
University, Ji’nan, China
Introduction to Human Viruses
Human Viruses: Infection, Prevention
and Potential Target(s) for Therapy – A
Comprehensive Review

Shilpi Gupta, Prabhat Kumar, Ankan Mukherjee Das, D. K. Gupta,

and Bhudev C. Das

Abstract It is well known that most pathogenic viruses cause acute, chronic and
co-infections that lead to pathogenesis and progression and manifestated as various
human diseases. Viral diseases mainly AIDS, Zika, Ebola, severe acute respiratory
syndrome (SARS), Middle east respiratory syndrome (MERS), influenza and
pneumonia of various forms are the biggest cause of mortality and disability in both
developed and developing countries. Also certain infectious viruses have the
potential to cause cancers in humans. Taken together, the known, unknown and
novel viral diseases associated with cancers represent a major global public health
challange for social well-being, economic stability, quality human health, produc-
tivity and progress. The threats posed by viral diseases mainly depend on the
continued emergence, re-emergence of new and novel pathogenic viruses with
varied pathogenecity and severity. Chronic infections contribute to as high as 26%
of cancer cases in developing countries, only about 11 out of millions of microbes
and chemical agents around us have been declared as human carcinogens. In the
past few years, several new and highly pathogenic viral infections, that affect
humans, have emerged and majority are of zoonotic origin. Thus, monitoring these
zoonoses and other novel viruses with unidentified origins required, advanced
efforts for increased awarness and the efficient global research co-ordination for

Shilpi Gupta and Prabhat Kumar contributed equally to first authorship.

S. Gupta
P. Kumar
B. C. Das (&)

Stem Cell and Cancer Research Lab, Amity Institute of Molecular Medicine & Stem Cell
Research (AIMMSCR), Amity University Uttar Pradesh, Sector-125, Noida 201313, India
e-mail: bcdas@amity.edu
S. Gupta
Molecular Genetics Laboratory, National Institute of Cancer Prevention and Research
(ICMR), I-7, Sector-39, Noida 201301, India
A. Mukherjee Das
Laboratory of Disease Dynamics and Molecular Epidemiology, Amity Institute of Public
Health, Amity University Uttar Pradesh, Sector-125, Noida 201313, India
S. Gupta
D. K. Gupta
Felix Hospital, Sector 137, Noida 201305, India

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2021 3

S. I. Ahmad (ed.), Human Viruses: Diseases, Treatments
and Vaccines, https://doi.org/10.1007/978-3-030-71165-8_1
4 S. Gupta et al.

pursuance of effective approaches for prevention and the control of diseases

remains crucial. This chapter presents an update on emerging and re-emerging
viruses and viral diseases, highlights their role in causing human diseases including
cancer as well as their potential targets for development of new therapeutics and
vaccines.

Keywords Infection DNA virus RNA virus HPV HIV Influenza







Coronavirus Covid-19 Community transmission Human diseases SARS






MERS Pathogenesis Carcinogenesis Therapy and vaccine

Abbreviations
AIDS Acquired immune deficiency syndrome
AP-1 Activator protein 1
ACE2 Angiotensin-converting enzyme 2
ARDS Acute respiratory distress syndrome
CaCx Cervical cancer
COVID-19 Coronavirus disease
CRISPR Clustered regularly interspaced short palindromic repeats
CAS9 CRISPR associated protein 9
CDC Centres for disease control and prevention
CDK Cyclin-dependent kinases
CD Cluster of differentiation
CYD-TDV CYD-tétravalent dengue vaccine
CFR Case fatality rate
CT Computed tomography
CMV Cytomegalovirus
DENV Dengue virus
dsDNA Double-strand DNA
EBV Epstein-Barr virus
ER Endoplasmicreticulum
ELISA Enzyme-linked immunosorbent assay
FDA Food and drug administration
HIV Human immunodeficiency virus
HPV Human papillomavirus
HR-HPV High-risk human papillomavirus
HPyV Human polyomaviruses
HSV Herpes simplex virus
HBV Hepatitis B virus
HCV Hepatitis C virus
HCQ Hydroxychloroquine
HCC Hepatocellular carcinoma
HTLV-1 Human T-cell lymphotropic virus type 1
IFN Interferon
IL-12 Inter lukin-12
Human Viruses: Infection, Prevention and Potential … 5

IARC International agency for research on cancer

ICTV International committee on taxonomy of viruses
JNK c-Jun N-terminal kinases
KHSV Kaposi sarcoma-associated herpesvirus
LR-HPV Low-risk human papillomavirus
LMIC Low-middle-income country
MERS-CoV Middle east respiratory syndrome coronavirus
MCC Merkel cell carcinomas
MCpyV Merkel cell polyomavirus
mTOR Mammalian target of rapamycin
NAAT Nucleic acid amplification testing
NS1 Non-structural protein 1
NF-kB Nuclear factor kappa-light-chain-enhancer of activated B cells
ORF Open reading frame
PML Progressive multifocal leukoencephalopathy
PIKFYVE FYVE finger-containing phosphoinositide kinase
PCR Polymerase chain reaction
R0 Reproductive number
RT-PCR Real-time reverse transcription PCR
RSV Rous sarcoma virus
SARS Severe acute respiratory syndrome
SARS-CoV-1 Severe acute respiratory syndrome conronavirus-1
SARS-CoV-2 Severe acute respiratory syndrome conronavirus-2
SiRNA Small interfering RNA
STI Sexually transmitted infection
STV Sexually transmitted virus
STD Sexually transmitted disease
ssDNA Single-strand DNA
sgRNA Single guide RNA
STAT3 Signal transducer and activator of transcription 3
TMPRSS2 Transmembrane protease, serine 2
VEGF Vascular endothelial growth factor
VIA Visual inspections with acetic acid
WHO World health organization

1 Introduction

If we think we have greater knowledge of the infectious agents that occupy our
planet and affect our health, nature reminds us that our understanding about
infectious pathogens is too limited. In the last few decades, several kinds of
pathogenic microbes had been discovered to cause various types of human diseases
6 S. Gupta et al.

and killed millions of people from almost every continent. The growing challenges
to global public health and economic stability to a greater extent can be attributed to
various infectious agents including viruses, bacteria, fungi and parasites. These
infectious agents can be transmitted indirectly or directly, from human-to-human or
animal-to-human or human-to-animal. Though a lot has been done by global health
systems to protect and promote human health against infectious diseases, yet its
menace is further deepened by the sustained emergence and re-emergence of novel,
unrecognized, neglected and long standing infectious agents. At least 28.3% (17
million) of around 60 million deaths that occur globally every year are projected to
be due to infectious diseases. Some of these infections (such as pneumonia, AIDS,
tuberculosis, diarrhoea, measles and malaria) are more severe and deadly with high
incidence and fatality rates (https://www.who.int/healthinfo/global_burden_disease/
GBD_report_2004update_part2.pdf). The threats vary extensively in terms of
severity, infectivity, morbidity and mortality, as well as their effects on social and
global health and economy (https://www.who.int/healthinfo/global_burden_
disease/GBD_report_2004update_part2.pdf). Regardless of high morbidity and
mortality associated with many of these infections, the attempts in understanding
them are restricted to a remarkably small group of biomedical and public health
researchers. Whether the global health system as of today can provide effective
safety and protection against huge array of infectious diseases is doubtful and this is
very clear from by recent outbreaks of SARS-CoV-2 (severe acute respiratory
syndrome coronavirus-2) including previous epidemics of Ebola, HIV, Zika,
influenza, SARS-CoV-1 and MERS-CoV (Middle East respiratory syndrome
coronavirus) along-with looming threat of their increasing resistance (Kim et al.
2017; McNeil and Shetty 2017; https://www.worldometers.info/coronavirus/
#countries; Feldmann et al. 2020; Ksiazek et al. 2003; Memish et al. 2020). The
concern is magnified by rapid population growth in areas with weak healthcare
systems, globalization, urbanization, environmental/cultural variations, ecological
factors, civil conflict, global travel along with trade and the altered natural beha-
viour of pathogens and accelerated spread not only from human-to-human but also
from animal-to-human. Human-created epidemics/pandemics originating from
laboratory accidents or less possible but planned biological outbreaks are also of
increasing concern. These infectious diseases caused by pathogens obviously do not
respect human emotions, political and financial boundaries.
Thus, the global research communities have responsibilities to direct adequate
attention to studying these diseases, their etiologic agents, and natural history with
creating constant awareness and advanced efforts and effective strategies for
closly monitoring infectious diseases and their future emergence and re-emergence.
In this chapter, we sheds light on infectious agents particularly emerging and
re-emerging pathogenic viruses, and briefly introduce its association with human
diseases as well as their potential targets for development of new drug therapies
and/or vaccines.
Human Viruses: Infection, Prevention and Potential … 7

2 Infections: Acute and Chronic

Latent or Acute, chronic, recurrent and co-infections may involve in disease

pathogenesis and play a serious role in manifestation of disease. It is essential to
make a distinction between acute and chronic infections, as they play a different
role in the genesis of several diseases. Several acute infections may play a pro-
tective role for the development of some diseases while chronic infections appear to
be a predisposing factor for the onset of disease.
Acute infections are usually associated with an acute phase reaction with a local
inflammatory response, fever and an increased hepatic acute phase protein syn-
thesis. The acute process is characterized by the massive presence of activated
monocytes and macrophages in the inflammation area. These inflammatory cells
may promote angiogenesis (Corliss et al. 2015) by producing pro-angiogenic fac-
tors, such as VEGF (Zhang and Daaka 2011) and prostaglandin E2. Nevertheless,
acute infections do not involve new vessel growth. The variety of infection-induced
factors (TNF-a, IFN-a/b/c, IL-12, TGF-b and the acute phase proteins) represent a
critical regulator of acute inflammation that could prevent neo-angiogenesis. The
observations of spontaneous cancer regression in patients with acute infections,
pave the way for studies on the effects of infection and inflammation on cancer
(Kucerova and Cervinkova 2016). Acute inflammation can lead to cancer regression
as shown by early experiments that artificially infected tumors with erysipelas
bacteria cause regression in some cases of incurable cancer (Zhang and Daaka
2011). It is also important to note, that acute infections occurring in childhood,
adulthood or old age have different features. Some studies examined the acute
infectious disease of childhood and underlined that these infections were associated
to a reduced risk of future development of melanoma, ovarian cancer and multiple
tumors (Oikonomopoulou et al. 2013). The cancer risk reduction may also be the
effect and consequence of acute infectious diseases in childhood. These may pro-
vide protection against cancer, but will decrease with age, with the alteration of the
immune system. It seems also that acute infections after the infancy may give an
important protection against cancer (Jacqueline et al. 2017).
Chronic infections last for many years and are not associated with fever and present
variable symptoms. In addition, these kinds of infections can be a consequence of a
failed or deficient immune response. In chronic inflammation the active tissue
destruction and repair process occur simultaneously with the help of angiogenesis
and fibrosis (Kataoka et al. 2003). Chronic infections are a leading public health
issue in high-income countries, and they cause a significant toll in low or
middle-income countries as well. The onset of the infection and, subsequently, the
establishment of the infectious disease and its possible chronic evolution basically
depend on host and pathogen factors. These factors depend on biological charac-
teristics of pathogen in terms of pathogenecity, virulence, tenacity, toxinogenesis,
infection load, contagiousness and vitality. Instead, the factors inherent the host are
8 S. Gupta et al.

represented by sex, age, nutritional state, economic status, social, hygienic cultural
and conditions, presence of metabolic disorders and the state of the immune system.

3 Infectious Agents that Can Cause Human Diseases

There are various infectious microbes such as viruses, bacteria, fungi and even
parasites have the ability to spread infection from animal-to-human or
human-to-human and transmit diseases directly or indirectly from one person to
another. Generally, several microorganisms are harmless and live in and on human
bodies but under certain conditions, some of them may purport to cause variety of
human diseases ranging from acute to chronic including cancers.
Persistent infection of certain pathogenic microorganisms can cause variety of
human diseases including cancers (cervical cancer, gastric cancer, liver cancer, oral
cancer etc.) in both developing (26%) and developed (8%) countries (IARC 2012;
Parkin 2006). Currently, more than 20% of the human malignancies are directly or
indirectly caused by pathogenic microbes of which more than 50% of infection
associated human malignancies are caused by different strains of human papillo-
mavirus (HPV) (Parkin 2006; zur Hausen 2000). A series of studies showed links
between infectious agents and cancer in the last 60 years. Worldwide, it has been
estimated that 2.2 million (13%) infection-attributable malignancies (excluding
non-melanoma skin cancers) were diagnosed in 2018 alone (de Martel et al. 2019).
As per International Agency for Research in Cancer (IARC), about 11 infectious
agents that have been classified as group-1 carcinogens, are responsible for more
than 90% of infection-associated human cancers globally. These are Helicobacter
pylori, high-risk human papillomaviruses (HR-HPVs), hepatitis B and C virus
(HBV/HCV), Epstein–Barr virus (EBV), Kaposi sarcoma-associated herpesvirus
(KHSV), human T-cell lymphotropic virus type 1 (HTLV-1), Schistosoma
haematobium, Opisthorchis viverrini and Clonorchis sinensis. Out of these,
Helicobacter pylori, HR-HPVs, HBV, and HCV are the most important pathogens
which caused  90% of infection-associated human malignancies world over
(Plummer et al. 2016).
In the 21st century, while the world contineus to fight and contain existing
diseaases (plague, AIDS/HIV, tuberculosis, hepatitis, Influenza etc.) and newly
emerging (Dengue, SARS, MERS, Ebola, Zika, and SARS-CoV-2) the newly
emerging agents are infectious wreaking havoc in both developed and developing
countries alike when an outbreak as an epidemic or a pandemic occurs. To date,
pathogenic diseases and associated fatalities have remained a significant menace
throughout the globe. In spite of current advances highlighting the role of infectious
agents in human diseases, the global incidence of infection associated diseases is
still high, thus an a strong and flexible global health system and focused research on
infectious disease surveillance, prevention, control and treatment strategies are
required.
Human Viruses: Infection, Prevention and Potential … 9

4 Viruses and Human Diseases

Viruses are a mystery and can quickly spread explosively around the world. They
are “obligate intracellular parasite” that can replicate inside the host cell (Summers
2009). These intracellular parasites can be found in all living organisms such as
bacteria, fungi, protozoans, plants, animals and humans. These are mainly those
microorganisms that have small genomes, insufficient to encode their own proteins
and every step of viral life cycle depends on the host machinery for almost all
essential functions. Viruses also can affect human health and cause a wide range of
acute to fatal human diseases including variety of cancers.
The World Health Organization (WHO) has reported various human diseases
caused by different types of viral infections, and that millions of individuals are at
risk globally (https://www.who.int/healthinfo/global_burden_disease/GBD_report_
2004update_part2.pdf). The best example is of the recent global pandemic of
coronavirus and COVID-19. Though, our understanding of the mechanisms of
pathogenic virus -induced diseases has significantly advanced but we are still
lacking in-depth knowledge of several existing, emerging and re-emerging viruses
that cause severe diseases in humans. Thus, a better in-depth understanding of
what types of viruses in which situation pose the highest risk to human health
would enable evidence-based targeting of surveillance, treatment and management
of these viral diseases.

5 Virus Infection Can Lead to Cancer

Currently, about 15–20% of all human malignancies are associated with persistent
infection of several DNA and RNA viruses (Liu and Richardson 2013). There are
six major families of animal viruses which have the ability to cause cancer in both
humans and animals. Tumor viruses fall into 2 categories; DNA-containing tumor
viruses (hepatitis B virus, papillomaviruses, Epstein-Barr virus, Herpesviruses,
polyomavirus and Adenoviruses) and RNA-containing tumor viruses (Retroviruses
and Hepatitis C virus). Viruses are unable to cause cancer directly, as several other
co-factors including host cell factors besides additional exposure to various car-
cinogenic agents and immune impairment that can influence tumor development
and progression.
Originally, tumor causing viruses were identified in animals but in 1964 onwards
several human carcinogenic viruses were discovered. In 1911, Francis Peyton Rous
showed that it is possible to transmit the tumour by injecting a solution made from
extracts of cancer, thus opening the way for studies on the association between
virus infections and cancer. Rous Sarcoma Virus (RSV) was the first carcinogenic
virus identified; the studies on RSV had a major role in the development of current
understanding on cancer. Nowadays, it is well known that infections caused by
certain viruses play key roles in the pathogenesis of several cancers. Viruses can
10 S. Gupta et al.

subvert the functions of host cell purturting the pathways regulation of growth
arrest and apoptosis (Bagga and Bouchard 2014). Viral particles can induce tumor
as some of them have oncogenes while others can cause the transformation of a
proto-oncogene to oncogene in the host cell. The viral oncogene is a mutated,
hyperactive and homologue gene involved in cell proliferation, so it works rapidly
in all infected cells. Moreover, the over-expression of the proto-oncogene,
responsible for uncontrolled cell proliferation, is caused by the viral promoter or by
other factors that regulate the transcription. The carcinogenesis process requires
multiple steps, but it seems that virus-associated tumors may have common path-
ways; it could be, for viruses such as HBV, HPV and EBV, the functional inac-
tivation of p53 by virally encoded oncoproteins (Jiang and Yue 2014; Ko 2015;
Kordestani et al. 2014). The viruses associated with tumors are characterized by the
capacity of causing a persistent infection, but they are not exclusively carcino-
genetic agents; so cancer development may be considered as an accidental event in
the course of the infection. Obviously, the host immune status may influence the
evolution of the disease. Between the initial infection and the onset of cancer could
take several years, and carcinogenesis process in virus associated cancer, can be
promoted by direct and indirect mechanisms. The viral carcinogenesis also depends
on genome type; therefore, it is necessary to consider the main differences between
DNA viruses and RNA viruses and their implications on human cancers (Table 1)
and other diseases (Tables 2 and 3).
A. Pathogenic DNA viruses
DNA viruses are obligate intracellular parasites and important human pathogens
that have the ability to cause several acute and chronic diseases in humans.
Their DNA is replicated either by host or virally encoded DNA polymerases
(Fig. 1). Viruses lack the internal machinery to synthesize their proteins and their
lytic cycle is totally dependent on their capability to control/command host cell
genome and thus regulate different signalling pathways. Viruses essentially “hijack”
the host cell and its mRNA is translated into proteins and these early proteins are
accountable for changing normal cellular actions which in some cases permit the
infected lysogenic cells to escape the host restriction systems. The genomes size of
DNA viruses varies between 5 and 375 kb. During viral infection, majority of these
viruses stimulate host-cell DNA replication, or at least in the early stages of DNA
replication, it creates a suitable atmosphere for their own DNA replication.
Currently, 91 human DNA virus species have been identified with 22 genera and
8 families, many of them are associated with human diseases including cancer and
are of immense public health importance worldover (Woolhouse and Adair 2013).
According to International Committee on Taxonomy of Viruses (ICTV) (Kuhn
et al. 2019a) DNA viruses are divided into 3 major categories (i) single-strand DNA
(ssDNA) viruses, double-strand DNA (dsDNA) viruses and (iii) para-retroviruses
(that replicate their genome through an RNA intermediate; e.g. Hepadnaviruses)
(Katakura et al. 2005). There are 22 families of dsDNA viruses and 5 families of
ssDNA viruses which have been recognized by ICTV. There are six distinct
members of DNA virus families, Hepadnaviridae, Polyomaviridae,
Another random document with
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khans never for a moment dreamed of attempting to Tatarise their
Russian subjects. They demanded simply an oath of allegiance from
the princes, and a certain sum of tribute from the people. The
vanquished were allowed to retain their land, their religion, their
language, their courts of justice, and all their other institutions.
The nature of the Tatar
domination is well illustrated by
the policy which the conquerors
adopted towards the Russian
church. For more than half a
century after the conquest the
religion of the Tatars was a
mixture of Buddhism and
paganism, with traces of
sabaism or fire-worship. During
this period Christianity was more
than simply tolerated. The grand
khan Kuiuk caused a Christian
chapel to be erected near his
domicile, and one of his
successors, Khubilai, was in the
habit of publicly taking part in
the Easter festivals. In 1261 the
khan of the Golden Horde
allowed the Russians to found a
bishopric in his capital, and
several members of his family
adopted Christianity. One of
A Female Samoyed them even founded a
monastery, and became a saint
of the Russian church! The
orthodox clergy were exempted from the poll tax, and in the charters
granted to them it was expressly declared that if anyone committed
blasphemy against the faith of the Russians he should be put to
death. Some time afterwards the Golden Horde was converted to
Islam, but the khans did not on that account change their policy.
They continued to favour the clergy, and their protection was long
remembered. Many generations later, when the property of the
church was threatened by the autocratic power, refractory
ecclesiastics contrasted the policy of the orthodox sovereign with
that of the “godless Tatars,” much to the advantage of the latter.
At first there was and could be very little mutual confidence
between the conquerors and the conquered. The princes anxiously
looked for an opportunity of throwing off the galling yoke, and the
people chafed under the exactions and cruelty of the tribute
collectors, whilst the khans took precautions to prevent insurrection,
and threatened to devastate the country if their authority was not
respected. But in the course of time this mutual distrust and hostility
greatly lessened. The princes gradually perceived that all attempts at
resistance would be fruitless, and became reconciled to their new
position. Instead of seeking to throw off the khan’s authority, they
sought to gain his favour, in the hope of thereby forwarding their
personal interests. For this purpose they paid frequent visits to the
Tatar chief, made rich presents to his wives and courtiers, received
from him charters confirming their authority, and sometimes even
married members of his family. Some of them used the favour thus
acquired for extending their possessions at the expense of
neighbouring princes of their own race, and did not hesitate to call in
Tatar hordes to their assistance. The khans, in their turn, placed
greater confidence in their vassals, entrusted them with the task of
collecting the tribute, recalled their own officials who were a constant
eyesore to the people, and abstained from all interference in the
internal affairs of the principalities so long as tribute was regularly
paid. The princes acted, in short, as the khan’s lieutenants, and
became to a certain extent Tartarised. Some of them carried this
policy so far that they were reproached by the people with “loving
beyond measure the Tatars and their language, and giving them too
freely land, and gold, and goods of every kind.”c

ALEXANDER NEVSKI

The recognition of Tatar sovereignty was

[1245 a.d.] complete in the homage and tribute they
demanded and received. Every prince was forced to solicit his
investiture from the khan of Kiptchak; and even when Iaroslav was
established as grand prince over the rest, Batu cunningly allowed
several rivals to put in their claims to that authority, and obliged them
to wait so long for his decision that the order of succession remained
unsettled. This state of suspense in which the feudal lords were kept,
and a series of famines which followed the destructive march of the
Tatars, plunged the country into a condition of abject wretchedness.
During this period of indecision on the one hand, and forlorn
imbecility on the other, the Lithuanians succeeded in appropriating to
themselves some portions of the northwestern division of Russia;
and the Swedes, and Danes, and Livonian knights of the sword
proceeded to make demonstrations of a descent upon Novgorod.
Alexander, however, who had succeeded his father in that
principality, finding that the grand prince was unable to render him
any assistance towards the defence of the city, anticipated the
advance of the intruders, and giving them battle on the banks of the
Neva gained a decisive victory. He immediately built strong forts on
the spot to repel any future attempts, and returned in triumph to
Novgorod. So signal was the overthrow of the enemy that Alexander
was honoured by the surname of Nevski, in commemoration of the
achievement.
Flushed with a triumph as unexpected as it was important,
Alexander Nevski desired to enlarge the bounds of his power at
home. The army was warmly attached to him, for his personal
intrepidity was no less remarkable than his sagacity—qualities which
were rarely so strongly developed in so young a man. The
Novgorodians, however, always jealous of their municipal privileges,
and suspicious of the motives of their rulers, resisted the extension
of Alexander’s power, and, apprehensive that he would abuse his
advantages, they remonstrated against his proceedings, and at last
broke out into open rebellion. The proud spirit of the young prince
was justly offended at the impetuous revolt of his subjects, and he
retired at once from the city, going over to his father at Vladimir, to
request the aid of a sufficient force to restore order. But Iaroslav, in
the conviction of his own inadequacy, was unwilling to interfere with
the wishes of the Novgorodians; and, conferring upon Alexander the
inferior principality of Pereiaslavl, he sent another of his sons, at the
request of the people, to reign over the disaffected province.
The Novgorodians, however, speedily discovered their error. The
Danes, induced to speculate upon the absence of Alexander, a
second time appeared within the boundary, and the new prince, an
inexperienced young man, made choice of such measures as clearly
proved him to be unfit for his office. The people became dissatisfied,
and, being now convinced that Alexander was the only man who
could relieve them in their difficulty, petitioned him to return; but he
indignantly rejected the request. A second embassy, headed by the
archbishop, was more fortunate, and Alexander Nevski once more
placed himself at the head of the army, and obtained a second
victory over the invaders. Resolved to profit by the obligations under
which he laid his subjects by resuming, at their own instance, the
reins of government, and by freeing them from the presence of a
dangerous foe, he now pushed on to Livonia, and routed the
combined forces of a triple alliance of Germans, Danes, and Tchuds,
on the borders of Lake Peipus. This exploit, which the youthful hero
achieved in the year 1245, not only obtained him the love and
admiration of his own subjects, but speedily spread his name
through every part of the empire, until it finally reached the court of
the Golden Horde, where it elicited an unusual degree of curiosity
and applause.
In the person of the prince of Novgorod, a new dawn of hope
broke over Russia, and nothing but the disheartening feuds of the
chiefs checked the growth of that incipient desire for liberty which the
influence of his successes was calculated to create. Alexander was
adapted to the occasion; and if the disunited sovereigns could now
have consented to forego their low animosities, and to merge their
personal differences in the common cause, Alexander was the
instrument of all others the most fit to undertake the conduct of so
gallant an enterprise. But it required an extraordinary combination of
circumstances to awaken the Russian princes to a full sense of their
degradation, and to inspire them with resolution to set about the
rescue of their country from the chains of the spoiler. Alexander’s
example was useless. He could do no more than demonstrate the
possibility of improvement within the reach of his own domain; but for
all purposes of a national and extensive character, his exertions
failed to procure any favourable results.
On the death of the grand prince Iaroslav,
[1252 a.d.] whose reign appears to have passed unmarked
by any events of importance, the khan invited or
rather summoned Alexander to the horde. A number of competitors
or claimants for the grand princedom had already brought forward
their petitions: some were lingering in person at the court; others
were represented by ambassadors bearing rich tributes; and all were
in a state of considerable anxiety pending the decision of the Tatar.
Alexander alone was silent. The fame of his deeds had preceded
him. He did not come to supplicate for an honour to which he felt that
he possessed an unexceptionable claim, but he attended as a point
of duty, without reference to a nomination that could hardly increase
his popularity. His independent bearing, his manly figure, and the
general candour and fearlessness of his manners gained him at
once the confidence and admiration of the khan, who did not hesitate
to assure him that, although he had heard much in his favour, report
had fallen short of his distinguished merits.
Auspicious, however, as this reception was, it did not terminate in
Alexander’s appointment to the suspended sceptre of Vladimir. The
policy of the Tatar was to keep the order of succession in periodical
uncertainty, so that the Russians might the more distinctly see how
much the destinies of the country depended on his supreme will. It
was not until Alexander paid a second visit to the horde, in 1252, that
he was raised to the dignity of grand prince. It was accorded to him
in a very gracious spirit, and he entered upon his new office with
more earnest zeal than had for a long time before been displayed by
his predecessors.
The first act of the grand prince was an expedition against
Sweden, undertaken with two objects: (1) to crush a formidable foe
that occasionally harassed the frontier districts; and (2) to give
employment and opportunity for pillage to his numerous army, which
he had already taught to calculate upon the rewards of spoliation.
The expedition terminated in victory. The triumphant army laid a part
of the Swedish territory under contribution, succeeded in capturing a
number of prisoners, and returned home laden with spoils.
These successes and the skilful policy of the grand prince made
the most favourable impression on the mind of the khan, who now,
whenever dissensions arose amongst the princes, either referred the
adjustment of their differences to Alexander, or confiscated their
dominions and annexed them to the grand princedom. Two
instances of the latter description may be recorded as evidences of
the cunning displayed by the Tatar in the protection of the Greek
religion. While Alexander was at the height of his prosperity, the
prince of Kiev, affected by some sudden admiration of the Roman
Catholic ritual, signified his submission to the pope, acknowledging
his holiness’s supremacy over the churches of his principality.
Another prince, his brother-in-law, adopted a similar measure, which
was equally offensive to Tatars and Russians. The khan, irritated by
proceedings so directly at variance with his will, deprived them of
their authority, and transferred their territories to the grand prince,
who, according to some writers, was even assisted by the Tatars in
seizing upon them.
The tribute which had been originally imposed upon the Russians
by their conquerors had always been levied by the princes, the khan
being satisfied to receive it at their hands. As the power of Alexander
increased, the khan gradually recalled this system of delegation, and
adopted a more strict and jealous mode of collection. The first
contribution was raised upon the princes, as tribute money, and they
were left to procure it amongst their subjects as well as they could.
But it now assumed the shape of a tax on persons and property. In
order to ensure the regularity of its payment, and protect the khan
against evasions, Tatar officers were appointed in every district to
attend exclusively to the rigid collection of the revenue. From this
tax, which was imposed without distinction upon every Russian, and
rated according to his means, the clergy alone were exempt: and
even they, in one instance, were attempted to be taxed in later times;
but the khan who sought to enforce it was obliged to yield to the
double argument of long-established usage and weighty presents
from the wealthy monks.
The new burthen lay heavily upon the people, and the mode in
which it was enforced through foreign collectors, of the nation of their
oppressors enhanced its mortifications. Universal discontent
followed the tax-gatherers. They were treated with unreserved
displeasure. It was with great difficulty they could carry into effect the
objects of their unpopular mission, and in some places, particularly
the cities where the population was more compact, and the
communication of opinion more rapid and complete, they were
received with execration. This resistance on the one hand no doubt
produced increased severity on the other; and as the levy advanced,
the people became less cautious in the exhibition of their feelings,
and the collectors more rigorous and despotic. Novgorod, which had
always been the rallying point for the assertion of freedom in Russia,
took the lead in this revolt against the khan’s authority. The
Novgorodians, to a man, refused to pay the tax, and even threatened
to wreak their vengeance upon the officers who were appointed to
collect it. The prince of Novgorod, one of Alexander’s sons, urged to
extremities by his republican advisers, sanctioned these declarations
of independence, and openly signified his determination to prevent
the exactions of so ignominious a tribute within the districts
dependent upon his rule. Alexander, perceiving, in this dangerous
obstinacy of his son, the source of serious calamity to the empire at
large, and knowing well that neither the Novgorodians, nor any other
fraction of the Russian people, were in a condition to resist the
powerful armies of the khan, should he be provoked to compel
compliance at the point of the sword, undertook in person to
appease the growing tumult, and presenting himself in the city,
rebuked the inhabitants for having perilled the safety of the country
by their contumacy, severely punished rash advisers of his son, and
finally arranged the payment of the tax to the satisfaction of the Tatar
offices. Still the Novgorodians were not content. They remonstrated
against the unequal pressure of the tax, setting forth that it fell more
grievously upon the poor than upon the rich, and that if they were
obliged to submit to such a penalty, it should at all events be
adjusted proportionately to the means of individuals. Even this
difficulty Alexander was enabled to meet by assuming the
responsibility of the payment himself, a vexatious and ungrateful
duty, which, however, he willingly accepted, as it afforded him the
means of quelling discontents that might have otherwise terminated
in a sanguinary convulsion.d

Death of Alexander Nevski; Appreciation of His Character

In 1262, disturbances arose in the country of

[1263 a.d.] Rostov, where the people became exasperated
at the violence of the Tatar collectors of tribute;
a council was called together and the collectors were driven out of
Rostov, Vladimir, Suzdal, Pereiaslavl, and Iaroslavl; in the last
mentioned town the enraged inhabitants killed the collector Izosim,
who had embraced Mohammedanism to become a Tatar tax-
gatherer, and persecuted his former fellow-citizens worse than the
Tatars themselves. Naturally such an occurrence could not be calmly
passed over by the horde, and Tatar regiments were already sent to
take the Christians into captivity. In order to avert this calamity from
the people, Alexander repaired a fourth time to the horde; he was
evidently successful, possibly because of the Persian War which was
then greatly occupying the khan Bergé. But it was his last work; he
left the horde, where he had passed the whole winter, a sick man,
and died on the way back to Vladimir on the 14th of November,
1263; “having laboured greatly for the Russian land, for Novgorod
and Pskov, for all the grand princedom, and having given his life for
the orthodox faith.” By preserving Russia from calamities on the
east, and by his famous exploits for faith and country in the west,
Alexander gained for himself a glorious memory throughout Russia
and became the most conspicuous historical personage in Russian
history from Monomakh to Donskoi. A token of this remembrance
and fame is to be found in the special narrative of his exploits that
has come down to us. “The grand prince Alexander Iaroslavitch,”
says the author of the narrative, “conquered everywhere, but himself
was nowhere conquered;” there came to Novgorod from the western
countries a famous knight, who saw Alexander, and when he
returned to his own land he said: “I have gone through many
countries and nations, but nowhere have I seen such a one, no such
king among kings and no such prince among princes;” and a similar
honourable mention was made of him by the khan. When, after the
death of his father, Alexander came to Vladimir, his coming was
terrible, and the news of it flew even to the mouth of the Volga, and
the Moabite women began to frighten their children by saying: “Be
quiet, the grand duke Alexander is coming!” It happened once that
ambassadors were sent to him from great Rome by the pope, who
had commanded them to speak to Alexander as follows: “We have
heard of thee, O Prince, that thou art honourable and wonderful, and
that thy country is great, therefore have we sent unto thee two of the
wisest of our twelve cardinals, that thou mayest hearken to their
teaching.” Alexander, having taken counsel with his wise men, wrote
down and described to the pope all that had taken place from the
creation of the world to the seventh œcumenical council, and added:
“All this is well known unto us, but we cannot accept your teachings.”
Following in the footsteps of his father, Alexander gave much gold
and silver to the horde to ransom prisoners. The metropolitan Cyril
was in Vladimir when he heard of the death of Alexander, which he
thus announced to the people: “My beloved children! learn that the
sun of the land of Russia has set;” and all the people cried out in
reply: “Then we perish!”e
“It was as vassal and agent of the khan,” says Brueckner, “that
Alexander broke the resistance of Novgorod and compelled it to pay
tribute. On the one hand representing the interests of the khan and
repressing the revolts of the Russians, on the other hand mollifying
the anger of the khan and acting like a shrewd diplomat, Alexander
represents a curious combination of egotism and patriotism. We are
not in the possession of sufficient evidence to form a just estimate of
the measure of his services or of his opportunistic policy, but he is
certainly a most interesting character in that unfortunate and
disgraceful period of Russian history.”i

The Grand Princedom

 With the death of Alexander commenced afresh the hurtful
contests of the princes for the grand princedom. The division of
interests which had gradually grown up amongst the Tatars, greatly
increased the internal disorders of Russia. Nogay, the Tatar chieftain,
who had thrown off the rule of the khan of Kiptchak, asserted his
sovereignty in the southern provinces, and contended against his
rival of the horde, for the right of tribute in many districts which had
hitherto acknowledged implicitly the government of the first
conqueror. This strife between the ruling powers produced much
treachery amongst the Russian princes, who generally allied
themselves to the chief who happened at the moment to obtain the
ascendency, and who thus played a false game to assist them in the
accomplishment of their own individual objects. In this way they
wasted their strength; for whenever a prince profited by the sale of
his allegiance, he paid so dearly for the assistance which procured
him the end he had in view, that the gain in such a case was usually
discovered to be a severe loss. The grand princedom was the prize
for which they all struggled; and in the contentions which marked the
struggle, almost every inferior principality became more enfeebled
than before.
Alexander Nevski was one of the few great men whose names
stand apart from the tumultuous throng that crowd the early pages of
Russian history. He was a wise statesman, and a brave soldier. His
victories over the enemies of his country were not less remarkable
for completeness and brilliancy, than his measures of domestic
improvement were distinguished by prudence and foresight. The
Danes, the Swedes, the Lithuanians, and the Teutonic knights
severally gave way before him: he enlarged the bounds of his
territory, inspired his army with a fresh spirit of activity, rebuilt several
Russian cities that had been destroyed during the Tatar invasions,
and founded others in well-chosen situations. Russia, under his
sway, might have redeemed her fallen fortunes; but the unnatural
hostility of the feudal princes to the grand princedom, their hatred to
any chief whose virtues elevated him above them, and their ruinous
conflicts amongst themselves upon insignificant grounds of quarrel,
paralysed the efforts of Alexander, and deprived him of the power of
rendering that service to his country which he was eminently
qualified to confer. His fame was so universal, that his death gave
opportunity to the display of a fresh burst of superstitious feelings.
His approaching decease was said to have been notified to the
metropolitan by a voice from heaven; and as the body lay in the
coffin, the dead man was said to have opened one of his hands, as
the prayer of absolution was spoken by the officiating clergyman.
These miracles obtained Alexander a niche amongst the Russian
saints; and, less in honour of his real merits than his attributed
powers, he was duly canonised after death. Some centuries
subsequently, a monastery was raised to his memory by Peter I, and
his relics were removed to St. Petersburg with extraordinary
ceremonies of devotion. An order of knighthood was afterwards
instituted in his name, which ranks amongst its members some of
the monarchs of Europe. These facts connected with the reputation
of Alexander Nevski in Russia are memorable, as proofs of the
veneration in which he was held.d
The khans committed a serious fault in preserving a grand prince;
it was a still more striking one, and a consequence of the first, to
place in his hands a sovereignty disproportioned to those by which
he was surrounded, to select him for too long a time from the same
branch, and to give him armies to establish himself, and the means
of seducing even themselves by the most costly presents. The
consequence of this was, that the appanaged princes dared not
enter so readily into a contest with the grand princes, who were
already more powerful than themselves, and were so formidably
supported. Not daring to contend with them, they turned their arms
against each other, and thus enhanced by their own weakness the
strength of the grand princes.
Nevertheless, till 1324, that is, for a century posterior to the Tatar
invasion, the power of the grand princes was doubtful; but then,
amidst the crowd of pretenders to the grand princedom, two rival
branches made themselves conspicuous, and the other princes of
the blood resigned to them an arena, in which the scantiness of their
own resources no longer permitted them to appear. One of these
branches was that of the princes of Tver; the other that of the princes
of Moscow.g
 THE GROWING ASCENDENCY OF MOSCOW

Moscow
[1303-1313 a.d.] becomes a
princely
appanage at a rather late date,
although it is mentioned in the
chronicle as early as 1147. The
place is also called Kutchkovo.
With this appellation there is
connected a tradition, which
seems quite trustworthy, that
Moscow had belonged to a
certain Kutchka, and the
chronicle also speaks of the
Kutchkas as relatives of the wife
of Andrew Bogoliubski and of his
murderers. It seems that the first
prince of Moscow was Michael
Iaroslavitch, who died in 1248.
Other princes are mentioned as
having been at Moscow before
that time, but it is difficult to
decide whether they resided
there temporarily or
permanently. The true line of Muscovite Woman
Moscow princes begins with
Daniel Alexandrovitch [a son of
Alexander Nevski], who died in 1303 and was succeeded by his son
Iuri, the famous rival of the Tver princes.b
Iuri married, in 1313, the sister of Usbek Khan. It was then that,
after having excited the hatred of the Novgorodians, in persisting to
subdue them by means of the Tatars, Michael of Tver drew down
upon his head all the wrath of Usbek, by defeating Iuri, and taking
prisoners his wife, who was the khan’s sister, and Kavadgi, a Tatar
general, who came to put the prince of Moscow in possession of the
grand princedom.
For Usbek, after having preferred and supported the rights of
Michael of Tver to the grand principality, had changed his mind in
favour of Iuri of Moscow, who had become his brother-in-law. The
enmity of Usbek, however, remained suspended, until his sister, the
wife of Iuri, and the prisoner of Michael, expired at Tver. Iuri then
hastened to the horde, and accused Michael of having poisoned the
princess. The offended pride of Usbek lent itself to this base
calumny; he entrusted the investigation of the affair to Kavadgi;
appeared to the summons; the vanquished passed sentence on his
vanquisher, whom he caused to be put to death; and the infamous
Iuri of Moscow was appointed grand prince in the place of his
murdered rival (1320). His triumph was short: being accused of
withholding the tribute due to the khan, he journeyed to the horde,
and was assassinated by the son of his victim, who was himself
immediately executed by Usbek. This vengeance restored the grand
principality to the branch of Tver, in the person of Prince Alexander
Michael’s second son. It remained in it for three years; but then, in
1328, this madman caused all the Tatars at Tver to be massacred.
To the brother of Iuri, Ivan I, surnamed Kalita,[13] prince of Moscow,
Usbek immediately gave Vladimir and Novgorod, the double
possession of which always distinguished the grand princedom. This
concession formed, in the hands of Ivan, a mass, the connection of
which Tver, weakened as it was, did but little diminish. Consequently,
with this power, and the troops that Usbek added to it, Ivan speedily
compelled all the Russian princes to combine, under his orders,
against the prince of Tver; who, after having undergone various
misfortunes, was executed with his son at the horde.
Here begin the two hundred and seventy years of the reign of the
branch of Moscow. This first union of the Russians, under Ivan I,
denominated Kalita, constitutes an epoch; it exhibits the ascendancy
of this second grand prince of Moscow over his subjects; an
ascendancy the increase of which we shall witness under his
successors; and for which, at the outset, this branch of the Ruriks
was indebted to the support they received from the Tatars. For as a
word from the khan decided the possession of the throne, that one of
the two rival branches of Moscow and Tver was sure to triumph
which displayed the most shrewd and consistent policy towards the
horde. It was not that of the princes of Tver which thus acted. On the
contrary they sometimes solicited the protection of the khans, and
sometimes fought against them; we have even seen one of them
ordering the massacre of the Tatars in his principality.
The princes of Moscow pursued a different system; they no doubt,
detested the yoke of the khans as much as their rivals did; but they
were aware that, before they could cope with the Tatars, the
Russians must be united, and that is was impossible to subject and
unite the latter without the assistance of the former. They therefore
espoused the daughters of the khans, manifested the utmost
submission to the horde, and appeared to be wholly devoted to its
interests.
Now this policy, which, at the commencement of the Mongol
invasion acquired for Alexander Nevski the empire of all Russia,
gave it, seventy-four years later, still more completely to Ivan I: for
the sway of the Tatars was then more recognised; the Russians were
more docile to their yoke; and the cities, which composed the grand
principality were more powerful in themselves, and also by
comparison with the rest of Russia, which became daily more and
more exhausted. The wealth of Ivan I was another cause of the
extension of his power.
The complaints of the prince of Tver, in 1323,
[1323 a.d.] prove that Iuri I, grand prince of Moscow, when
he undertook to execute the vengeance of his
brother-in-law Usbek, against Tver, was also entrusted with the
collecting of the tributes; which, however, he retained, instead of
sending them to the horde. Ivan Kalita, his brother and successor,
profited by this example. Thus it was, that by making themselves
lieutenants of the khan, the Muscovite grand princes first became the
collectors, and finally the possessors, of the taxes throughout the
whole of Russia; and thus they succeeded to all the rights of
conquest enjoyed by the Tatars, and to their despotism.
 There can be no doubt that one of the most copious sources of
power to those sovereigns was the periodical census and the
perpetual imposts, so alien to feudalism, and especially to a
feudalism of princes: these imposts and censuses nothing but the
Tatar conquest could have established, and they were inherited by
the grand princes. Already, in the first half of the fourteenth century,
these taxes had rendered Ivan Kalita rich enough to purchase entire
domains and appanages,[14] the protection of Usbek Khan, and the
preference of the primate, who removed his residence from Vladimir
to Moscow, by which means the latter city became the capital of the
empire.
It was by virtue of his authority as collector for the Tatars that Ivan
Kalita practised extortion upon his subjects. We see him requiring a
double tribute from the Novgorodians, under pretext that such was
the will of the khan. Armed against the Russians with the dread
inspired by the Tatar name, and against the Tatars with the money of
the Russians; intoxicating the khan and his courtiers with gold and
adulation in his frequent journeys to the horde; he was enabled, as
lord paramount, to bring about the first union of all the appanaged
princes against his competitor, the prince of Tver, whom he drove
from Pskov and from Russia, being aided by the primate with the
thunder of the church, then heard in the empire for the first time. The
nobility imitated the clergy. Impelled either by fear, or cupidity,
several boyars of other princes rallied round this grand prince,
preferring the fiefs of so rich and so potent a lord paramount to those
of the petty princes whom they abandoned.
Ivan Kalita pushed forward with horrible vigour in his ambitious
career. “Woe, woe to the princes of Rostov!” exclaims Nicon,
“because their power was destroyed, and everything was
concentrated in Moscow.” In fact, from the Kremlin, which he
fortified, Ivan proclaimed himself the arbiter of his kinsfolk; he
reigned in their principalities by the medium of his boyars; he
arrogated to himself the right of being the sole distributor of fiefs,
judge, and legislator; and if the princes resisted, and dared to wage
against him a war of the public good,[15] he hurried to the horde, with
purse in hand, and denunciation on his lips; and the short-sighted
Usbek, deceived by this ambitious monitor, was impolitic enough to
disembarrass him of the most dangerous of his competitors, whom
he consigned to frightful torments. The prince of Tver and his son
were the most remarkable victims of this atrocious policy.
Meanwhile, Lithuania, which, from the period of the first
overwhelming of Russia by the Tatars, had emancipated itself from
its yoke, had now become a conquering state. About 1320, Gedimin,
its leader, seized on the Russian appanages of the south and west,
which had long ceased to be dependent upon the grand principality
of Vladimir. Kiev, Galitch, Volhinia, became sometimes Lithuanian,
sometimes Polish or Hungarian: driven to despair, their inhabitants
emigrated; they formed the two military republics of the Zaparogians
and Cossacks of Don. Rallying around them the unfortunate of all
countries, they were destined to become one day strong enough to
make head against the Turks and Tatars, between whom they were
situated; and thus to embarrass the communication between those
two peoples, whom a common religion, origin, and interest conspired
to unite.
The grand principality was, on the other hand, repeopled by
unfortunate fugitives from the southern Russian provinces, who
sought refuge at Moscow. The empire, it is true, lost in extension; but
it was thus rendered more proportionate to the revived power of its
grand prince, who had also fewer competitors in it: those who
remained could not, in point of resources, be compared with the
grand principality. After all, it was much better that the latter should
one day have to recover some provinces from a foreign foe, than
from its domestic enemies: it was suffering an external evil instead of
an internal one, which is the worst of all.
Thus, the macchiavellism of Ivan prospered. It is true that, by the
confidence with which he inspired the horde, and the terrible war
which he waged against his kinsmen, he restored to Russia a
tranquillity to which she had long been a stranger. A dawning of
order and justice reappeared under a sceptre acquired and
preserved by such horrible acts of injustice; the depredations to
which Russia had been a prey were repressed; commerce again
flourished; great marts and new fairs were established, in which
were displayed the productions of the East, of Greece, and of Italy;
and the treasury of the prince was swelled still further by the profit
arising from the customs.[16]
Such were the rapid effects of the first steps which Ivan took to
execute the system of concentration of power; this great political
impulse was so vigorously given, that it was perpetuated in his son
Simeon the Proud, to whom Ivan left wherewithal to purchase the
grand princedom from the horde, and in whom he revived the direct
succession. Accordingly, Simeon effected, against Novgorod, a
second union of all the Russian princes. It is to be remarked, that he
was obliged to cede one half of the taxes to his brothers; but, at the
same time, he reserved to himself the whole authority, which soon
gives to its possessor the mastery of the revenue.
Simeon having died without children, in 1353,
[1353 a.d.] after a reign of twelve years, Ivan II, his brother,
purchased the sovereignty with the wealth of
Kalita. After the six years’ reign of Ivan II, this system and this order
of succession were, indeed, transiently interrupted in the person of a
prince, alien to the branch of Moscow; but we shall soon see the
great Dmitri Donskoi establish them as fixed principles; that prince
did not neglect to increase the wealth[17] of his grandfather Ivan. The
people had given to Ivan the surname of The Purse; as much,
perhaps, with allusion to his treasures, as to the purse, filled with
alms for the poor, which is said to have been always carried before
him. At a later period, the constantly progressive riches of the grand
princes of Moscow enabled them to enfeoff directly from the crown
lands three hundred thousand boyar followers; and next, to keep up
a body of regular troops, sufficiently strong to reduce their enemies
and their subjects.[18]
This system of concentration of power which
[1359 a.d.] Ivan Kalita commenced, by means of his wealth,
by the union of the sceptre with the tiara, and by
restoring the direct order of succession; his horrible but skilful
macchiavellism against the princes holding appanages; finally, the
fifty years’ repose which, thanks to his policy, and to their
dissensions, the Tatars permitted Russia to enjoy; these are the
circumstances which entitle Ivan to be considered as standing next
after Alexander Nevski among the most remarkable grand princes of
the third period. It was he who had the sagacity on this stubborn soil
to open and to trace so deeply the path which led to monarchical
unity, and to point out its direction so clearly to his successors that
they had nothing to do but to persevere in it, as the only safe road
which it was then possible for Russia to follow.
This concentration of power brought about great changes from
1320 to 1329; as, at that epoch, all the Russian princes in concert
solicited from the horde the recall of the Tatar governors. It was then
that, more firmly fixed, the throne of the grand princes became the
rallying point of the Russians: along with the consciousness of their
strength, it inspired them with a public spirit, which emboldened
them. This good understanding was, in reality, an effect of the
ascendency which a direct and sustained succession, in a single
branch of the Ruriks, had already given to it over all the others.

The Principle of Direct Succession

In fact, sometimes natural justice, sometimes oriental negligence

and cupidity, often the fear of being disobeyed, and lastly, and
especially, the power and riches of the princes of Moscow—whose
presents always surpassed those of the other princes—all these
motives had induced the khans to allow the succession to the grand
principality to descend regularly from father to son in the branch of
Moscow.[19] This natural order of succession Dmitri Donskoi, in
1359, established by a treaty, in which his kinsmen consented to
renounce the mode of succession from brother to brother. It was the
most remarkable among them, Vladimir the Brave, who was the first
to sign this act. In several other conventions, Vladimir acknowledged
himself the vassal and lieutenant, not merely of Dmitri, but also of
Vasili his son, and even of the son of Vasili, when he was only five
years of age. This example, set by a prince who, of all the
possessors of appanages, was the most renowned for his prudence
and his valour, was followed by the others. Thus, like the Capets,
kings of France, did Ivan I, and particularly Dmitri Donskoi, begin the
monarchy by restoring the direct succession, in causing, while they
lived, their eldest sons to be recognised as their successors.
Afterwards we see Vasili, son of Dmitri, persevering in this practice,
and Vasili the Blind, his grandson, raising up his tottering throne, and
preparing the autocracy of the fourth Russian period, by associating
with himself his next heir, the great Ivan III.
It is easy to conceive the infallible effect of this order of
succession, and with what promptitude it must necessarily have
extended and consolidated the power of the grand princes. In fact,
the ideas of the father being transmitted to the son by education,
their policy was more consistently followed up, and their ambition
had a more direct object. The nobles could not fail to attach
themselves more devotedly to a prince whose son and heir, growing
up amongst them, would know only them, and would recompense
their services in the persons of their children; for the necessary
consequence of the succession of power in the same branch, was
the succession of favours and dignities in the same families.
Even before Dmitri had established the principle, the boyars saw
the advantages which this order of succession held out to them.
Here, as elsewhere, the fact preceded the law. This was the reason
of their restoring the direct line in the grandson of Ivan Kalita; it was
they who made him grand prince at the age of twelve years, and who
subjected the other princes to him. In like manner, about 1430, they
maintained this order of succession in Vasili the Blind. Contemporary
annalists declare that these ancient boyars of the grand principality
detested the descent from brother to brother; for, in that system,
each prince of the lateral branch arrived from his appanage with
other boyars, whom he always preferred, and whom he could not
satisfy and establish but at the expense of the old. On the other
hand, the most important and transmissible places, the most
valuable favours, an hereditary and more certain protection, and
greater hopes, attracted a military nobility around the grand princes.
In a very short time, their elevation to the level of the humbled petty
princes flattered their vanity, and completed their junction with the
principal authority. This circumstance explains the last words of
Dmitri Donskoi to his boyars, when he recommended his son to their
protection. “Under my reign,” said he, “you were not boyars, but
really Russian princes.” In fact (to cite only some examples), we see
that his armies were as often commanded by boyars as by princes,
and that, from this epoch, it was no longer a prince of the blood, but
a boyar of the grand prince, who was his lieutenant at Novgorod.
Nay, more, when the succession from father to son was once
established, there were, at the very beginning, two minorities (those
of Dmitri, and of Vasili, his grandson), during which the boyars
composed the council of regency, governed the state, and were the
equals, and even the superiors, of the princes who held appanages.
This will explain why, in 1392, the boyars of Boris, the last prince of
Suzdal, gave up him and his appanage to Vasili Dmitrievitch of
Moscow. The motive is to be found only in their interest; as the grand
prince of Moscow entrusted them with the government of the
appanages, and thus substituted the nobles in the place of the
princes.
A very remarkable circumstance, with respect to Dmitri Donskoi,
is, on the one hand, the energy with which he subdued those
princes, and, on the other, his circumspect treatment of his boyars.
According to Karamsin, it is more especially to their pride and
jealousy of the tyssiatchsky of Moscow (the boyar of the city, or of
the commune, a sort of civil and military tribune, elected by the
people), that we are to attribute the abolition of that office by
Donskoi. During the preceding reign, another tyssiatchsky of
Moscow, who claimed precedence of even the boyars of the grand
prince, had been murdered by them.
When this hereditary protection afforded by the grand princes of
the Moscow branch was once fairly established, the nobles of each
appanage, who constituted its army, had thenceforth an asylum, and,
as it were, a tribunal for redress, to which they could appeal
whenever they were dissatisfied with their prince. It was this which
made Tver fall before Ivan Kalita; for the sovereign prince of that first
and last rival of Moscow having preferred to his boyars the people of
Pskov, who had defended him, the former withdrew to Moscow.