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Archive for the ‘Epidemiology’ Category

What infectious diseases are due to be eradicated next?

Timeline of infectious disease eradication

 

Although Medical Science aims to eradicate Infectious Diseases in order to protect life and reduce the healthcare burden, it has only been able to achieve that goal against two diseases to date. While this remains a difficult task, there is a genuine possibility that additional diseases will be eliminated in the near future! Let’s explore the diseases that have been consigned to history…and those that are set to join them soon.

Smallpox: declared eradicated in 1980

Following a concentrated global effort spanning more than 20 years, Smallpox became the first infectious disease to be eradicated by mankind.  Smallpox was characterized by high fever, vomiting, and an extensive skin eruption characterized by vesicles, pustules, and permanent scarring. Thirty percent of cases were fatal, and recurring outbreaks affected virtually all countries,  leading to the deaths of as many as 300 million humans during the 20th century. 

The disease has already been eliminated in North America and Europe when, in 1959, the World Health Organization declared the eradication initiative to permanently eradicate Smallpox. A vaccine with enhanced efficacy became widely available in 1967, and a formal Eradication Programme was put into effect. The last cases were reported in Africa in 1977, and WHO officially declared that Smallpox had been eradicated in 1980.

Rinderpest: declared eradicated in 2011

31 years later, a second disease joined the “eradicated” list. Rinderpest was a viral disease that affected cattle and other hoofed animals. The condition was responsible for the deaths of countless livestock prior to the 20th century, causing fever, loss of appetite, and severe diarrhea. While not known to infect humans, this disease had a significant impact on food security and the livelihoods of countless individuals who worked in related industries. 

A vaccine was developed in 1918 and was improved upon throughout the 20th century, eventually leading to the eradication of Rinderpest in most regions. The FAO (Food and Agriculture Organization) initiated the Global Rinderpest Eradication Programme in 1994, which led to the last reported cases in 2001, Kenya. The official declaration of the eradication of Rinderpest was released in June 2011.

What are we eradicating right now?

Eradicating now: diseases that are in the process of being eradicated

The world is very close to eradicating wild Polio, with only 33 cases reported globally in 2018 and 176 in 2019, following an eradication initiative that began in 1988. Initially, the goal was to eliminate Poliomyelitis by 2019.  Although small pockets of infection continue to fester into 2021, workers in the field feel that mankind is very close to the eradication of this disease. 

Guinea Worm Disease (Dracunculiasis) is also “on the radar.”  This is a crippling parasitic disease, which is extremely painful and can prevent its victims from working and living normal lives for several months – a disaster for agricultural areas in Africa, where the disease is reported. Eradication of this disease was originally targeted to occur in 1981, and efforts were given further impetus by the WHA (World Health Assembly) in 2001.  Their goal is very much at hand… only 54 cases were reported in 2019!

Another lesser-known disease on the path to eradication is Yaws, which the WHO has been working to eradicate since the 1950s.  The bacterium which causes Yaws is closely related to the agent of syphilis and can be easily treated with a small dose of antibiotics. 80,472 suspected cases of Yaws were reported in 2018,  of which 888 were confirmed.

Finally, a more familiar disease – Rabies – is also targeted for eradication. The World Health Organization is working to prevent all human deaths from Rabies by 2030 while vaccinating all wild and domestic carnivores (foxes, dogs, etc) as well. 17,400 cases of human rabies were reported in 2015, and 29 million individuals were treated following the bites of animals that may have carried the disease. In 2019, Mexico was the first country to be validated by WHO for having eliminated human deaths from dog-mediated rabies; and hopefully, the rest of the world can soon follow suit and rid us of yet another disease.

What’s next?

Beyond the diseases mentioned there are several well-known diseases – such as Tuberculosis, HIV infection, and Malaria –  that could possibly be eradicated in the coming years. New drugs and vaccines are continually being developed, and the advent of the COVID-19 vaccine has demonstrated that a concentrated effort can make all the difference.

 

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21st century outbreaks

21st century outbreaks infographic, displaying top 10 diseases with the most outbreak cases between 2001-2020

 

Which diseases have generated the highest number of cases from outbreaks during the first two decades of the 21st century?  In this blog, we can use GIDEON’s data to find out.

‘Disease outbreak’ is a scary term for many, but every year we suffer dozens, if not hundreds, of localized and international disease outbreaks across the world. While these outbreaks are always significant to those affected, they rarely generate headlines,  and can sometimes go unnoticed outside of the Healthcare Industry.

An “outbreak” is often defined as an increase in case numbers for a particular disease in a defined place and time. Outbreaks can evolve into pandemics (such as with COVID-19) or consist of an isolated cluster of cases, especially for rare and less-communicable diseases, and can persist for years and even decades.

GIDEON collects information on all cases of Infectious Disease worldwide, and much of this effort involves gathering data on outbreaks. The following list has been created using these data, assessing all outbreaks in excess of 500 cases reported from January 2001 to November 2020 – from the GIDEON database of 361 diseases and 233 countries and territories.

  1. Hand, foot & mouth disease (Enterovirus infection) – 2.9+ million outbreak cases

Prominent in Asia, especially over the last 10 years, the most significant outbreaks occurred in 2016 and 2017 – accounting for over 2 million out of total cases. The disease typically affects children, causing a distinctive rash, fever, and nausea (not to be confused with foot-and-mouth disease, which generally only affects livestock).

  1. Viral Conjunctivitis – 4.3+ million outbreak cases

Many outbreaks of this disease were recorded across Asia and South America, the most significant of which was in South Korea in 2002. The latter outbreak resulted in more than 1 million cases. Brazil has also suffered repeated outbreaks, with 10,000 to 100,000 cases reported throughout this period. Often linked with upper respiratory diseases, viral conjunctivitis is also referred to as a ‘pink eye’ due to its principal symptom.

  1. Measles – 5.4+ million outbreak cases

Surprisingly, measles has been one of the most common causes of outbreaks into the 21st century, involving much of the world.  The most notable of these outbreaks occurred in 2019, with nearly 1.5 million cases reported across 50 countries. The disease is best known for its distinctive combination of fever, cough, and a florid rash.

  1. Viral Meningitis – 5.4+ million outbreak cases

While the bacterial variant of the disease is typically associated with large outbreaks in sub-Saharan Africa (a region known as the ‘meningitis belt’), viral meningitis outbreaks are far more common.  Unusually large outbreaks have been reported in China, often affecting neighboring countries as well. Over 4.5 million cases were reported in the region between 2008 and 2012.  Viral meningitis is associated with a stiff neck, headaches, and high fever. Fortunately, rates of fatal viral meningitis have been steadily decreasing for a number of years.

  1. Chikungunya – 9.7+ million outbreak cases

Sometimes mistaken for Dengue or Zika, Chikungunya was most active in the Americas region in recent years.  Even the United States has reported local transmission, which South American countries have experienced hundreds of thousands of Chikungunya cases. Joint pain, high fever, and a rash are the characteristic symptoms, with headaches, chronic pain, and insomnia appearing in later stages of the disease.

  1. Viral Gastroenteritis – 10.2+ million outbreak cases

This entry is a bit of an anomaly here since the vast majority of cases were associated with a single outbreak. In 2006, viral gastroenteritis in Japan was caused by Norovirus, with no less than 10 million cases, – impacting the entire country. Symptoms include diarrhea and/or vomiting, accompanied by abdominal cramps and fever.

  1. Cholera – 12.8+ million outbreak cases

Cholera is an ancient disease that continues to produce regular and significant outbreaks, with case numbers in the 100,000s almost every year. A recent large outbreak that began in 2016 in Yemen, continues to this date – already totaling more than 2.4 million cases. The disease causes severe diarrhea and vomiting, resulting in extreme loss of fluids that can turn a patient’s skin to a bluish-gray color – as they succumb to dehydration. 

  1. Dengue – 26.0+ million outbreak cases

The number of Dengue outbreaks has been increasing in recent years, with cases reaching almost 5 million in 2019 alone. Brazil has experienced major difficulties with this disease, as have neighboring countries, and much of Asia and Africa. Dengue is characterized by high fever, vomiting, headaches, musculoskeletal pain, and a characteristic rash. 

  1. Malaria – 27.7+ million outbreak cases

This mosquito-borne disease typically causes fever, headache, fatigue, and vomiting, but can be complicated by seizures, coma, multi-organ failure, and death in severe cases. Malaria outbreaks have been somewhat less frequent than other diseases on our list over the  21st century; however, the severity and impact of malaria outbreaks are relatively high.  Two major outbreaks of over 8 million cases each have occurred during the past four years. This is not to downplay the overall burden of disease, which the World Health Organization estimated to be as high as 229 million cases in 2019 alone.

Graph of malaria cases worldwide 1973 - today, GIDEON
Malaria cases worldwide 1973 – today, GIDEON

 

 

  1. COVID-19 – 64.5+ million outbreak cases (at the time of writing)

A disease which did not even exist until eleven months ago – is at the top of our list.  The growing number of cases and deaths have made “COVID-19” the most commonly used word used by mankind.  The disease can have a wide range of symptoms but commonly causes coughing, fever, loss of smell and taste, and breathing difficulty. Elderly individuals and those with pre-existing conditions are particularly at risk of developing complications. Even with a vaccine available in the next few months, we must all remain cautious and follow safety measures at all times. 

 

Stay healthy, stay safe!

 

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Pneumonia – “a disease of the ancients”

Doctor examining a lung radiography - pneumonia
Doctor examining a lung radiography

 

The COVID-19 pandemic has been a painful reminder of how important lung health is. But there are many other threats to this very vital organ. Numerous lung diseases have plagued the human race throughout history, and doctors have been working tirelessly to find effective means of beating them – a battle that continues to the present day. 

While many diseases cause symptoms in the lung, several of them attack this organ directly. “Pneumonia” is not a single disease, but rather a generic term for inflammatory conditions affecting the lungs. Pneumonias affect hundreds of millions of people each year, and are the leading causes of mortality among both children and elderly individuals, with an estimated 4 million deaths every year [1]. 

An old enemy

Pneumonia has existed for thousands of years, with Hippocrates himself describing the symptoms during the fifth to fourth centuries BCE [2]. Knowledge of the disease likely dates back even further, as Hippocrates himself considered it to be ‘named by the ancients’. The name appears to be derived from the Greek word pneúmōn, meaning ‘lung’.

Maimonides’ (12th century) stated ‘The basic symptoms that occur in pneumonia and that are never lacking are as follows: acute fever, sticking pleuritic pain in the side, short rapid breaths, serrated pulse, and cough.’ This is mirrored by many modern textbooks even today.

It was not until the late 1880s that the link between bacteria and pneumonia was established.  This concept was prompted by Edwin Klebs in 1875, who first observed the bacteria in patients dying from the disease (the bacterial genus Klebsiella is named after him) [3]. Viral pneumonia was not discovered until 1938, by Hobart Reimann [4].

 

Four types of pneumonia

Is pneumonia contagious? Yes, and it has a wide etiological spectrum – including a large variety of bacteria, viruses, fungi [5] which cause alveoli (air sacs) in one or both lungs to become inflamed and fill with fluid or pus, resulting in restricted breathing ability.

The choice of treatment is largely determined by the nature of the infecting organism – and will include one or more antibiotics, antiviral drugs, or antifungal agents.

A number of clinical “clues” may help the doctor decide which pathogen is involved in a given case of pneumonia.   For instance, Mycoplasma pneumoniae infection is most frequently observed in patients below the age of 30 and is often accompanied by a bullous otitis media and a ‘hacking’ cough. Pneumocystis pneumonia, on the other hand, is characterized by dyspnea and hypoxia – and is usually encountered in severely immunosuppressed patients.

GIDEON chronicles the epidemiology of pneumoniae caused by bacteria such as Streptococcus pneumoniae, Klebsiella pneumoniae, Chlamydia, Mycoplasma pneumoniae, and fungi, such as Cryptococcus neoformans and Pneumocystis jirovecii.

 

History of treatment

An extensive array of therapeutic options have evolved for the treatment of pneumonia. Hippocrates pioneered thoracic drainage, leaving tubes in place for up to two weeks [6];  while in medieval times we might have encountered the occasional bloodletting. As crude as those methods may seem, the treatments of the early 20th century were far from elegant, though somewhat more comfortable.

Electronic inhalers such as the one shown below have now been consigned to the history books and museums. While the design of inhalers improved considerably during the last 100 years, their function has changed little. 

 

A woman using an electric inhaling apparatus which produces a medicated fog used in the treatment of colds and influenza, circa 1929.
A woman using an electric inhaling apparatus which produces a medicated fog, circa 1929. Rare Historical Photos.

 

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References:

[1] “Pneumonia”, Who.int, 2020. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/pneumonia. 

[2] R. Feigin, Textbook Of Pediatric Infectious Diseases, 5th ed. Philadelphia: Saunders, 2004, p. 299.

[3] I. Gerard and K. Root, “Pneumonia”, Library.leeds.ac.uk, 2017. [Online]. Available: Pneumonia | Special Collections | Library | University of Leeds.

[4] F. Wagner and J. Hodges, Thomas Jefferson University: Tradition and Heritage. Philadelphia, Pa.: Jefferson Digital Commons, 1989, p. 253.

[5] “Pneumonia”, John Hopkins Medicine, 2020. [Online]. Available: https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumonia. 

[6] S. Walcott-Sapp and M. Sukumar, “A History of Thoracic Drainage: From Ancient Greeks to Wound Sucking Drummers to Digital Monitoring”, Ctsnet.org, 2015. [Online]. Available: https://www.ctsnet.org/article/history-thoracic-drainage-ancient-greeks-wound-sucking-drummers-digital-monitoring. 

Hepatitis C

Hepatitis C is a recently discovered disease. Harvey J. Alter identified the variant form of Hepatitis during the 70s, which then became known as a ‘non-A, non-B Hepatitis (NANBH)’. In the 1980s, Michael Houghton and his team isolated the genome of the new virus, and it was named ‘Hepatitis C’. Finally, in 1997 Charles M. Rice proved that the virus is a disease agent, capable of acting alone to cause Hepatitis.

This year’s Nobel Prize in Medicine has been jointly awarded to Harvey J. Alter, Michael Houghton, and Charles M. Rice for the discovery of the virus. Their contributions (illustrated below) have led to improved understanding, prevention, and treatment of the disease.

 

Nobel Prize in Physiology or Medicine 2020 to HJ Alter M Houghton and CM Rice for discovery of Hepatitis C virus

 

5 types of Hepatitis

There are five known types of viral Hepatitis – A, B, C, D, and E –  of which types A and B and E are currently preventable by vaccines.  Over 71 million cases of chronic Hepatitis C infection were estimated in 2015, though that number has been steadily falling over the past decade. The majority of deaths are caused by liver cancer or cirrhosis brought on by the infection, with an estimated 399,000 fatal cases in 2016.

To learn more about the differences between Hepatitis A, B, and C, see our earlier blog here.

Diagnosis and treatment

Hepatitis C can often be asymptomatic, or associated with mild symptoms, and may smolder for up to six months before becoming active. Acute infections are associated with fatigue, nausea, fever, abdominal pain, and loss of appetite; while chronic infections are more often associated with progressive dysfunction of the liver.

Although many laboratories are seeking an effective vaccine for this disease, currently available antiviral drugs have been shown to cure more than 95% of infections. 

The World Health Organization is approaching the end of its Global Health Sector Strategy on Viral Hepatitis, 2016-2021 which has the vision of reducing new infections by 90% – and deaths by 65%- by 2030.

The universal presence of this disease demands a robust response from all health authorities across the globe,  and recognition given by the Nobel committee will raise the profile of the disease and encourage new avenues for research into Hepatitis C treatment and prevention.

 

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Learn more about Hepatitis C

Bayes in Medicine

Calculator and sthetoscope on blue background

What is Bayesian Analysis and where did it come from?

Sometimes referred to as Bayesian Inference in Mathematics, Bayes’ is a method of statistical inference centered around population information, variables, and evidence to determine the probability of a particular event occurring. In essence, it is the mathematical calculation of how likely something is to happen based on the evidence. 

The creator of the method was Thomas Bayes –  an 18th century English statistician and Presbyterian minister. Although he did not publish his mathematical theories during his life, the publication of his work was post-humously carried out by another famous non-conformist, Richard Price. 

In his life, Thomas Bayes defended Sir Issac Newton’s calculus and explored the concept of probability with a passion, challenging the work of domestic and French contemporaries. 

If he was alive today, Bayes might not believe the impact of his work – and as a minister, he would surely frown over gambling applications using his theorem…

 

How does GIDEON use Bayes’?

Bayesian analysis requires data to be reliable and accurate, which is why GIDEON is uniquely positioned to take advantage of the formula and put millions of data points to use!

GIDEON applies this system to generate a list of likely Infectious Diseases based on the patient’s location, recent travel, and clinical findings. It might sound simple, but with over 200 signs and symptoms for over 360 diseases in 230+ countries and territories, the number of possibilities is vast. 

Regardless of extensive options, the GIDEON application is easy to follow, delivering instantaneous results.

Predicting outcomes in a clinical setting – or future developments of the Infectious Diseases landscape – are currently hot topics, and Bayesian Analysis, combined with a vast epidemiological data set, is ideally suited to help.

GIDEON is not alone in using this method for scientific and medical purposes, as it is also used in the Continuous Individualized Risk Index (CIRI) for identifying the risk of developing cancer over time, assessment of emergency room patients for heart attack, etc, etc.

Medicine aside, Bayes’ has many real-world applications, including computer software for machine learning, security systems, and gambling – and has even been used in a court of law by jurors assessing evidence and determining verdicts. 

 

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Herd immunity and COVID-19

By Dr. Stephen A. Berger

Herd immunity concept. People of different age groups, men, women and children are protected from the harmful effects of viruses. Preventive measures, human protection, group immunity.

WHAT IS HERD IMMUNITY?

It stands to reason that a contagious disease should disappear from a population when a sufficient percentage of potential victims – “the herd” has become immune. This outcome may arise because a massive number of individuals have been either infected or vaccinated.

Most authorities dealing with COVID-19 have set the goal for herd immunity at >60 percent; however, the precise percentage for any infectious disease will depend on many factors involving demography, virulence, route of infection, etc. 

 

HAS AN INFECTIOUS DISEASE EVER BEEN ERADICATED BY REACHING HERD IMMUNITY?

Infectious Diseases have been known to reach herd immunity, however, none have been permanently eradicated by it. For instance, although there was an observed decrease of measles infections during the 1930s, recent outbreaks indicate the disease is far from being eliminated – despite effective vaccination measures introduced in 1963.

 

IMPORTANT CONSIDERATIONS

As many countries enter into a second-wave of this pandemic, the bottom-line question for those who advocate the achievement of herd immunity through mass infection of the population will be one of cost-benefit. 

This prompts a few thoughts and questions. Any program to actively infect large numbers of individuals will begin with the isolation of the elderly and other high-risk populations. How many countries are truly equipped to house, feed, isolate, and treat millions of people in these categories? Do they have the manpower, physical structure, and funding?

It is important to note that the 2002-2004 SARS outbreak was not brought to an end by herd immunity, but rather through stringent public health methods implemented by affected countries. 

 

HOW MUCH TIME WILL BE REQUIRED TO ACHIEVE HERD IMMUNITY?

My country (Israel) has a population of 8.8 million and is currently experiencing 1,000 to 2,000 new cases per day. If we allow the current disease rate to continue, it will take perhaps three more years (!) to exceed 60 percent immunity. 

Would the Health System – already at capacity – be able to sustain all of this? Is there proof that COVID-19 infection even leads to immunity?  In what percentage of patients? Does immunity persist for more than a year or two?  Will immunity also “cover” newer strains of coronavirus?

Several COVID-19 vaccines will be released for general use in the next three to six months. Assuming that these vaccines are effective, targeted mass-infection at this point will cause more harm than good… and at best be a case of “too little, too late.”

 

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Let’s end Polio

An Egyptian stele thought to represent a polio victim. 18th Dynasty (1403–1365 BC).
An Egyptian stele thought to represent a polio victim. 18th Dynasty (1403–1365 BC).

 

Poliomyelitis dates back to ancient times, as captured in this 14th century BC Egyptian carving, detailing a typical symptom of atrophy in one or more of the limbs. 

The modern name is directly derived from Ancient Greek, poliós meaning ‘grey’ and myelós meaning ‘marrow’, the latter signifying the effect on the grey matter of the spinal cord.

But while the ancient Egyptians and Greeks knew about the disease, it wasn’t clinically described until the late 18th century (AD), by the English doctor Michael Underwood. The disease was finally ‘formalized’ in the 19th century, thanks to the work of physicians Jakob Heine, who completed the first study on the disease, and Karl Oskar Medin, the first to detail the epidemic nature of Poliomyelitis. This led to the illness often being referred to as Heine-Medin disease.

SYMPTOMS

Polio is highly infectious and is spread through the fecal-oral exchange, mainly affecting children under the age of 5 but adult cases are not uncommon. Symptoms include fever, sore throat, headache, vomiting, and still neck.

Although the disease is feared for its more extreme outcomes, such as paralysis, these develop in only 1-2% of all cases. Less than 10% of cases are fatal, with as most infections being asymptomatic.

CAMPAIGN TO END POLIO

It is unknown how many deaths Polio has caused through the ages, but a significant global campaign has been in place since the 1950s as a response to the epidemic in the United States. 294,094 cases were reported from 1944 to 1953; 108,159 from 1954 to 1963; and 514 from 1964 to 1973. The campaign, combined with the effective vaccine, has led to the country being declared polio-free in 1979.

The establishment of the Global Polio Eradication Initiative (GPEI) in 1988 had a huge impact on the fight to end polio.  Over 2.5 billion children were vaccinated since then, with 20 million volunteers in 200 countries taking part in the campaign.

Fantastic progress has been made with wild cases dramatically reducing from an estimated global incidence of 350,000 in 1988 to only 33 reported cases in 2018 – but the work isn’t over yet. The infectious nature of the disease could easily lead to extensive outbreaks and see the numbers increase again, despite the effective vaccine, as has been recently observed with measles. 

Although Type 2 has not been detected since 1999, nine outbreaks of vaccine-strain virus infection were reported since the OPV2 withdrawal in 2016, posing a threat to its complete eradication. The last reported case of Type 3 was in Nigeria, back in November 2012.

 

Polio cases worldwide, 1996-today. GIDEON.
Wild polio cases worldwide, 1996 – today, GIDEON.

 

Now is the time for the final push to limit the disease to the history books (and databases). If you want to be a part of the solution, head over to End Polio Now and get involved! It could make the world of difference to those affected.

 

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Interested in learning more about this disease? Check out our 2020 eBook Poliomyelitis: Global Status 

Hepatitis A in the United States

Liver Infection with hepatitis viruses - 3d illustration

 

Few Americans are aware of a major epidemic that has taken hold of large areas of their country in recent years – by a disease that is easily diagnosed and prevented. Sadly, public – and even professional interest in these events have been overshadowed by COVID-19.   

AN UPTICK IN CASES

Hepatitis A had been largely under control until three years ago and can be easily prevented through the use of a safe and effective vaccine. 

From January 2017 to January 2019, at least 26 separate outbreaks were reported, to a total of 11,628 cases and 99 deaths, nationwide. Homeless individuals and users of illicit drugs accounted for a large percentage of these patients. 

The graph below shows that the number of reported cases, which had been declining steadily since 1997, has taken a dramatic upturn during the current epidemic. 

 

Hepatitis A cases in the United States, 1947 - today
Hepatitis A cases in the United States, 1947 – today

 

As of September 2020, more than 1,000 cases have now been reported in each of seven states: Florida, Georgia, Indiana, Kentucky, Ohio, Tennessee, and West Virginia. Indeed, the total number of cases reported since the arrival of COVID-19 in the United States has reached 6,650 (to October 10, 2020)  – a major concern to public health specialists.

 

WHAT ARE THE SYMPTOMS?

Hepatitis A is a highly contagious disease that affects the liver. Infection may cause symptoms such as vomiting, jaundice, anorexia, dark urine, and light stools, occasionally accompanied by rash or arthritis. Symptoms normally persist between two to eight weeks, although the illness may last longer and be more severe in patients with underlying conditions.

The case-fatality rate of Hepatitis A ranges from 0.15% to 2.7%, with children faring better than adults.

 

SUPPORTIVE THERAPY IS THE ONLY TREATMENT

At the time of writing, there is no known cure for Hepatitis A. To speed up recovery, it is recommended that patients get plenty of rest and avoid substances that may have adverse effects on the liver, such as alcoholic beverages and certain medications.

 

WHAT IS THE DIFFERENCE BETWEEN HEPATITIS A, B, AND C?

Even though there is no drug therapy against Hepatitis A, it is less dangerous than Hepatitis B and C.

While most Hepatitis A patients recover with lifelong immunity to the disease, Hepatitis B and C may ‘reappear’ in the form of hepatic cirrhosis or hepatocellular carcinoma years after the acute illness. 

Hepatitis B is responsible for 60% to 80% of the world’s primary liver cancer cases. Thankfully, its rates continue to decline in  the United States:

Hepatitis B cases in the United States, 1966 - today graph
Hepatitis B cases in the United States, 1966 – today

 

The mode of transmission also differs among the three viruses. HepA is transmitted via the fecal-oral route, HepB, and HepC through the exchange of infected bodily fluids. 

As of 1998, injecting-drug abuse accounts for 60% of Hepatitis C transmission in the United States:

Hepatitis C cases in the United States, 1992 - today graph
Hepatitis C cases in the United States, 1992 – today

 

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Disease names – what do they mean?

Medical dictionary with disease names

In the midst of the continuing pandemic, World Dictionary Day seems like the perfect occasion to consider the meaning and origin behind some of the most well-known disease names. We’ve been speaking with Dr. Steve Berger, our co-founder, to learn more.

CORONAVIRUSES

Let’s start with the obvious one. COVID 19, which began as a localized outbreak of “Novel Coronavirus” infection,  is now a name almost every household in the world will know. COVID-19 comes from COrona VIrus Disease which first appeared in 2019, with the disease itself being caused by the SARS-CoV-2 virus.

SARS was a prominent name back in the early 2000s, with a simpler acronym Severe Acute Respiratory Syndrome. 

The names of COVID-19 and SARS-CoV-2 have been used throughout mainstream media, but not without a certain degree of confusion, which is similar to the one sometimes seen with HIV and AIDS. A useful analogy is that the Human Immunodeficiency Virus (HIV) causes Acquired Immunodeficiency Syndrome (AIDS) much like SARS-CoV-2 causes COVID-19.

A lesser-known fact outside of the medical community is that there are many different species of a type of virus. Each type is given a name derived from the kind of virus it is and often its discovery whereabouts. As of 2020, seven coronavirus species have been associated with human disease:   

  •       HCoV 229E 
  •       HCoV OC43 
  •       SARS-CoV 
  •       HCoV NL63 (New Haven coronavirus) 
  •       HCoV HKU1 
  •       MERS-CoV (the Middle East Respiratory Syndrome coronavirus) 
  •       SARS-CoV-2 

 

TYPES OF DISEASE NAMES

Not all diseases are given acronyms and the discordance between the name of the virus and the name of the disease is unusual. In many cases, viruses that infect humans are named for the disease that they cause. For example, poliomyelitis is caused by the poliomyelitis virus, while influenza is caused by the influenza virus. 

Disease names themselves are typically taken from either the area of the body it affects, or where it was discovered, or who discovered it. 

For instance, poliovirus’s name is derived from the Ancient Greek poliós, meaning grey, as it attacks nerve cells located in the grey matter at the center of the spinal cord. Influenza originates from the Italian term for influence. It was believed the illness was caused by ill omens from the sky, just as it was thought that another infectious disease, malaria, was caused by foul swamp air (mala aria).

Even the current pandemic has symbolic origins for its name, as the virus resembles a crown (Latin, corona) under the electron microscope. Similarly, rotavirus, a common cause of childhood diarrhea, resembles small wheels (Latin, rota). 

The Ebola disease, on the other hand, takes its name from the village it was first discovered, near the Ebola River in the Democratic Republic of Congo in 1976. Likewise, the West Nile virus was first identified in the West Nile District of Uganda in 1937; and the Zika virus in the Zika Forest of Uganda during the 1940s. Two of the coronaviruses identified this year are named after the places they were first reported in: New Haven, Connecticut, and the Middle East. 

 

A DOUBLE-EDGED SWORD

The naming of a pathogen for the region it was discovered can be stigmatizing and have geopolitical ramifications. The World Health Organization made a point to exclude the terms “Wuhan” and “China” when naming the current pandemic disease. Even the naming of disease after the discovering professional, or in someone else’s honor can be considered contentious, as is the case with Listeria. 

Listeria, found in contaminated food, was named after Joseph Lister, who pioneered hospital health standards throughout his career. He championed the use of early antiseptics, and even such novel ideas as washing hands… Imagine needing to justify the benefits of cleanliness in a hospital! However, during his career, Lister was shunned for his approach despite proving it hugely successful in preventing surgical mortality. 

Would you consider it an honor to have your name immortalized in the naming of a species, even if it is a bacteria? 

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“Under the radar” – Ongoing Lassa Fever Outbreak

By Dr. Stephen A. Berger

Stethoscope on Africa map
Nigeria is battling the largest recorded Lassa Fever outbreak to-date

 

Lassa Fever in Nigeria is a paradigm for Infectious Disease outbreaks that continue to threaten massive populations “under the radar” during the COVID-19 pandemic. As of October 3, 2020, a total of 1,112 fatal cases of COVID-19 had been reported in Nigeria.

In terms of population size, the statistical likelihood of dying from this disease in Nigeria – or in Singapore – is exactly the same. But then…nobody in Singapore is dying these days from Lassa Fever.    

WHAT IS LASSA FEVER?

The disease was first recognized in 1969, in northeastern Nigeria. The virus is acquired from African rodents and their secretions, primarily the Multimammate rat (Mastomys natalensis) which is its natural reservoir. A secondary person-to-person transmission can occur through contact with infected bodily fluids.

The illness is characterized by fever, pharyngitis, headache, chest pain, and diarrhea. 

Leukopenia, proteinuria, and hepatic dysfunction may also be present. Permanent hearing loss is common – indeed, this disease is the most common cause of acquired deafness in West Africa. Reported case-fatality rates range between 15-25%.

Multimammate rat (Mastomys natalensis)
Multimammate rat (Mastomys natalensis), a reservoir of Lassa Fever

DISTRIBUTION

It is estimated that as many as 500,000 individuals are infected in West Africa each year, resulting in 5,000 deaths. During the past 50 years, at least 88 travelers have returned home to other countries with this disease – including 11 importations into the United States. 

An ongoing outbreak of Lassa Fever continues in Nigeria well into 2020 – with 5,527 cases (222 fatal) reported as of August 16…all against the background of COVID-19.

Lassa Fever outbreaks map 2018-2020
Recent outbreaks map, 2018-2020, GIDEON

 

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