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2008 – A year of new outbreaks and new bugs

Predictably, 2009 will be greeted with endless publications that recount the divorces, disasters, political events, athletic records, and famous deaths of 2008. Sadly, the routine misfortunes which visit most of the world will be largely neglected. Individual countries are burdened by major outbreaks of infectious disease on an almost daily basis, but few people in the West hear of these episodes unless they are sensationalized by the media (Ebola) or are seen as a threat to other developed nations (Avian influenza).

Although the current outbreak of Avian influenza (“bird flu”) began in 2003 and has continued well into 2008, the number of reported cases and deaths has actually been decreasing since, 2006. A total of only 387 cases, and 245 deaths, from this infection, have been reported to date. In other words, the chance of dying from a lightning bolt or scorpion sting in one of the infected countries is far greater than the chance of acquiring bird flu.

During the past year, cases of human disease were reported in only 5 countries – while infection of birds occurred in 23 countries.

Note that the cases appear to occur in waves – first involving Vietnam, then Indonesia, and finally Egypt.

Speaking of Egypt, few realize that a classic disease associated with that country continues to affect many parts of the world. Four countries reported plague outbreaks during 2008: China, Madagascar, Uganda, and the Democratic Republic of Congo.

Does anybody still remember ‘Ebola.’? Ebola became a household word in 1995 when cases in Africa appeared on the backdrop of one or more Hollywood movies about lethal bugs carried to America by villains, monkeys, and other primates. The good news is that no Ebola outbreaks occurred in 2008; though few realize that more cases were reported in Africa during ’07 than during the panic-year of ’95.

The next panic-year in America was 2001 when anthrax evolved into a mail-order disease. In 2008, a man in London died of anthrax acquired from African animal skins used to make drums. Similar cases were reported in Scotland and in New York City in 2006. No fewer than twenty countries reported outbreaks of human (11 countries) or animal anthrax in 2008. As is often the case, these outbreaks occurred in areas of misery and upheaval – Iraq and Zimbabwe.

In fact, Zimbabwe has become a paradigm for epidemics in recent months. As we move into 2009, a massive outbreak of cholera is spreading through the country, with many cases in the capital city and infected refugees spreading the disease into neighboring South Africa. Outbreaks of cholera were officially reported by 37 countries in 2008, while many others reported “severe diarrhea” – a euphemism for cholera, often used by nations that would rather not scare tourists with the “C” word.

For diseases, 2008 was a matter of “business as usual.” Dysentery, salmonellosis, influenza, conjunctivitis, Legionnaire’s disease, Norovirus gastroenteritis, Lyme disease, plague, rabies … simply plague humanity.

The Health establishment once promised us that at least two diseases would be eliminated by the 21st century: Poliomyelitis and Measles. Sadly, outbreaks of both were still reported in 2008. In both cases, safe and effective vaccines are simply not being used in some populations. In contrast, other diseases for which vaccines do not exist will continue to worry us all into 2009 – AIDS, Malaria, Dengue, Hepatitis C, West Nile fever…

Inevitably, each new year heralds the discovery of new diseases and pathogens. Sadly, new antibiotics and vaccines appear at a slower pace. One of the more interesting outbreaks of 2008 involved over 1 million cases of Chikungunya in India, Malaysia, and nearby countries. Chikungunya is caused by a virus spread by mosquitoes and is characterized by fever, rash, and severe inflammation of joints. Inevitably, the disease began to be reported among tourists returning from affected countries (approximately 50 to the United States, and almost 1,000 to France) and ultimately 337 cases acquired in Italy in 2007, as local mosquitoes began to transmit the virus. These events remind us of the entry of West Nile fever into the United States in 1999, and to forebode similar events in years to come.

The good news is that some diseases are disappearing. Cases of leprosy are on the decline, with fewer than 500,000 lepers estimated for the entire planet as of this year. A rather nasty parasite, Dracunculus, incapacitated over 720,000 Africans in 20 countries as recently as 1988; fewer than 10,000 in 9 countries as of 2008. SARS has simply disappeared as a disease, with no cases reported since the outbreak of 2003. Active mass treatment and prevention campaigns continue to reduce the incidence of river blindness, childhood meningitis, tetanus, diphtheria, and some forms of hepatitis.

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