Pandemics

Leonard Bryan B. Paet

Tyrel Jonas H. Mora

Environmental Science 1 WFR

1st Semester, AY 2008 – 2009
 Pandemic
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Outline

What are Pandemics?

Past Pandemics
Pandemics of the 20th Century
Pandemic Severity Index
Being Ready for Pandemics
 Pandemic
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Definition

Wikipedia:
Pandemic is an epidemic of infectious disease
that spreads through human populations across
a large region, for example a continent, or even
worldwide.

Merriam-Webster Online:
[Pandemic is a disease] occurring over a wide
geographic area and affecting an exceptionally
high proportion of the population.
 Pandemic
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Definition

Common Definition:
Pandemic is an epidemic that becomes very
widespread and affects a whole region, a
continent, or the world.

What is an epidemic?
An epidemic affects more than the expected
number of cases of disease occurring in a
community or region during a given period of
time.
 Pandemic
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Definition

According to the World Health Organization

(WHO), a pandemic can start when three
conditions have been met:

 the emergence of a disease new to the

population.
 the agent infects humans, causing serious
illness.
 the agent spreads easily and sustainably
among humans.
 Pandemic
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How they Start and How they Spread

A pandemic usually start whenever a new or

“novel” virus to which the general population has
no immunity appears.
 result of mutation or and antigen shift in
presently available viruses
the novel virus also must spread easily from
person to person for a pandemic to occur
 Pandemic
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How they Start and How they Spread

It’s most likely that no one will have

immunity, or antibodies to protect
people against the new virus
anyone who is exposed to the virus
—young or old, healthy or weak—
could get sick
if the new virus is related to some
virus that circulated long ago, older
people might have some level of
immunity
 Pandemic
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Their Potential Impact

how virulent the virus is

how fast it spreads across the population
how effective the efforts for pandemic prevention
and response turn out

A pandemic’s impact
shouldn’t be measured
only by the amount of
deaths that it will
produce.
 Pandemic
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History

Plague during Peloponnesian War:

war between Athens and

Sparta in 430 BC
Thucydides (Greek Historian):

"People in good health were all of a

sudden attacked by violent heats in the head,
and redness and inflammation in the eyes, the
inward parts, such as the throat or tongue,
becoming bloody and emitting an unnatural
and fetid breath."
 Pandemic
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History

Plague during Peloponnesian War:

killed 40% of Athens’ population

killed the leaders of Athens and many of its
army
The word pandemic is derived from: Greek
word pan meaning all, and demos meaning
people
In January 2006, researchers from the
University of Athens analyzed teeth recovered
from a mass grave underneath the city, and
confirmed the presence of bacteria responsible
for typhoid.
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History

Antonine Plague:

spread throughout Europe

The disease was said to have been carried by
Roman soldiers returning from their campaigns
from the eastern portion of the Roman Empire
back in AD165.
It killed 5 million people, 25% of those who
were infected by the disease.
 Pandemic
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History

Antonine Plague:

It killed Marcus Aurelius Antoninus, a Roman

emperor, of whom the plague was named after
Antoninus: “Weep not for me; think rather of the
pestilence and the deaths of so many others.”
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History

Antonine Plague:

Symptoms: fever, diarrhea, and inflammation of

the pharynx, along with dry or pustular eruptions
of the skin after nine days. (account by Greek
physician and writer Galen)
Scholars that the disease is likely to be
smallpox.
A second outbreak occurred between AD251
and 266, and at its height some 5,000 people
were said to be dying in Rome every day.
 Pandemic
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History

Plague of Justinian:

swiped Europe in
6th century AD (500s)
named after Byzantine Emperor Justinian I
killed about 40% of Constantinople’s population
(Istanbul today)
found out to be caused by fleas carried in the
backs of ship-borne rats
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History

Plague of Justinian:
killed 10,000 people in the city every day
(account by Byzantine historian Procopius)
world’s first encounter with a bubonic plague
Bubonic plague is a bacterial disease plague
caused by the bacteria Yersinia pestis
famous symptom of bubonic plague is swollen
lymph nodes, called buboes
An infected person would not live by 24 hours
 Pandemic
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History

Black Death:

In 1300s, the bubonic plague returned to

Europe
Name derived from the blackening of the skin
which victims suffered through hemorrhaging
under the skin
 Pandemic
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History

Black Death:

killed a total of 25 million people, 25% of

Europe’s population
reached Middle East and Asia, making it the
very first recorded plague to be labeled as a global
pandemic
has been described as the deadliest pandemic
in human history
 Pandemic
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History

Black Death:

some of the iconic images that can be

remembered during the Black Death are the
plague doctors
Bubonic plague outbreaks occurred repeatedly
in Europe, reportedly gathering strength with each
generation, until the 1700s
worldwide death toll for the bubonic plague had
reached a dizzying 137 million
 Pandemic
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History

Cholera:

Endemic to India, the disease

spread along trade routes all over the world
except Antarctica
It had affected urban areas worse, where poor
sanitation provided a perfect breeding ground for
Vibrio cholerae, the bacteria causing the disease
Symptoms: acute diarrhea, rapid dehydration,
rapid pulse, dry skin, tiredness, abdominal
cramps, nausea, and vomiting
 Pandemic
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History

Cholera:
The First Pandemic began in 1816 in Bengal,
India and it spread across India, China and
Caspian Sea until 1826
The Second Pandemic affected Europe and
Northern America from 1821-1851
The Third Pandemic primarily affected Russia
during 1852-1860 (about 1 million deaths were
recorded)
The Fourth Pandemic affected Europe and
Africa from 1863-1875 and in 1866, it spread to
North America
 Pandemic
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History

Cholera:
The Fifth Pandemic killed 8,600 in 1892 after
the water supply of Hamburg, Germany was
contaminated
The Sixth Pandemic badly affected Russia
during 1899 to 1923. The pandemic could have
spread in Europe but improving public health
systems are believed to have helped preventing it
from spreading
The Seventh Pandemic, the last of cholera
pandemics, began in Indonesia in 1961. It reached
Bangladesh, India and Russia before it stopped in
1966
 Pandemic
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History

Influenza:

16th century: some

outbreaks in Africa and Europe
19th century: Asiatic flu
1918: Spanish Flu
 It started in three far-flung locations in 1918:
Brest, in France; Boston in the US; and Freetown
in Sierra Leone. It moved across the globe with
breathtaking speed, killing 25 million people in the
course of six months; a fifth of the world's
population was infected
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History

Influenza:
Approximately 20-40% of the entire world’s
population became ill from Spanish flu
Many died from the disease very quickly –some
were well by morning, sick by noon and dead by
nightfall
people aged 20-40 were its victims rather than
the old and weak. This remains a mystery up to
this day
By 1919, it disappeared almost as fast as it
appeared
 Pandemic
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History

Influenza:

it already killed about 40 million people, more

the death toll of World War I which also ended that
year
Spain, which is not part of World War I and thus
have no other things to report but the disease,
have published numerous news articles about the
pandemic.
Influenza is caused by a variant of viruses which
is collectively referred as influenza viruses
1958-59: Asian Flu (70,000 U.S. deaths)
1968: Hong Kong Flu (34,000 U.S. deaths)
 Pandemic
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The Flu (Influenza Virus)

 Influenza or the “Flu” is a disease caused by a

virus that attacks the upper respiratory tract
Infection usually lasts for about one week
characterized by fever, headache, malaise,
cough and sore throat
 Pandemic
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The Flu (Influenza Virus)

Influenza A: have the potential to be pandemic

Influenza B: mild viruses that produce
discomfort and no deaths
 Pandemic
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The Flu (Influenza Virus)

Influenza A viruses are further divided into subtypes

depending on the difference in their two surface
proteins: hemagglutinin (H) and neuraminidase (N).
Influenza viruses evolve and mutate rather easily
their genetic composition changes gradually:
antigenic drift

A pandemic is possible when an Influenza A virus

makes a dramatic change and acquires a new H or
H+N. This shift results in a new or “novel” virus to
which the general population has no immunity.
 Pandemic
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The Flu (Influenza Virus)
 Pandemic
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The Flu (Influenza Virus)

Past Influenza Pandemics:

1918: Spanish Flu (A/H1N1)
1957: Asian Flu (A/H2N2)
1968: Hong Kong Flu (A/H3N2)
1976: Swine Flu Scare (A/H1N1)
1977: Russian Flu Scare (A/H1N1)
1997: Avian Flu Scare (A/H5N1)
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Pandemic Severity Index

[US] a proposed
classification scales for
reporting the severity of
influenza pandemics was
proposed – the Pandemic
Severity Index (PSI)
Feb 1, 2007
designed to resemble
the Saffir-Simpson
Hurricane Scale
 Pandemic
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Pandemic Severity Index

Case-Fatality Ratio (CFR), the percentage of deaths out

of the total reported cases of the disease, is the main
criterion used to measure pandemic severity.
focuses less on how likely a pandemic is going to get
out of control, and more upon how severe the pandemic
actually is
 Pandemic
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Pandemic Severity Index

CDC Pandemic Severity Index scheme

Category CFR example(s)

1 less than 0.1% Seasonal flu

2 0.1% to 0.5% Asian Flu and Hongkong Flu

3 0.5% to 1%
4 1% to 2%
5 2% or higher Spanish Flu
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Pandemic Severity Index

The report recommends four primary measures for

slowing down a pandemic:
Isolation and treatment of people who have suspected
or confirmed cases of pandemic influenza
Voluntary home quarantine of household contacts of
those with suspected or confirmed pandemic influenza
Dismissing school classes and closing daycare centers
Changing work schedules and canceling large public
gatherings
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Pandemics Today

Present Threats:

Ebola virus
AIDS (Acquired Immunodeficiency Syndrome)
SARS (Severe Acute Respiratory Syndrome)
Avian Influenza (more commonly known as Bird
flu)
antibiotic resistance
 Pandemic
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Pandemics Today

Avian Influenza:

Every year, reports on outbreaks of bird flu are

reported in different countries
It is still bird-to-human transmittable
Caused by flu virus strain known as H5N1
H5N1 evolved into a virus strain which infects
more species
It is the current deadliest flu virus
 Pandemic
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Pandemics Today

Avian Influenza:

It may evolve into a strain which is human-to-

human transmittable and will result to a new
global pandemic
Disease-control centers around the world are
making avian flu their top priority today
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Pandemics Today

Prevention:

University of Michigan Medical School study

(2006):
compared the different measures 43 U.S. cities
have implemented during the Spanish flu
cities that early on adopted "old-fashioned,"
non-pharmaceutical interventions — such as
school closures, social-distancing in the
community and workplace and quarantine — and
"layered" multiple interventions at once for a long
period of time fared better than other cities, with
slower rates of infection and lower rates of death
 Pandemic
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Pandemics Today

Prevention:

World Health Organization:

currently focused in the surveillance of influenza
has a network of 112 National Influenza Centres
WHO: “Rapid detection of unusual influenza
outbreaks, isolation of possible pandemic viruses
and immediate alert to the WHO system by
national authorities is decisive for mounting a
timely and efficient response to pandemics.”
 Pandemic
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Pandemics Today

Prevention:

World Health Organization:

WHO: “A major component of pandemic
preparedness is to strengthen the capacity to
respond to yearly epidemics of influenza.”
developing specific contingency plans,
stockpiling of antivirals, strengthening risk
communications, investing in pandemic vaccine
research and promoting domestic production of
influenza vaccines
 Pandemic
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Pandemics Today

Prevention:

Philippine Pandemic Preparedness Plan:

Stage 1 - Avian influenza-free Philippines
Stage 2 - Avian influenza in domestic fowl in the
Philippines.
Stage 3 - Confirmation of avian influenza from
poultry to humans in the Philippines.
Stage 4 - Avian influenza with human-to-human
transmission of pandemic influenza causing
outbreaks in the country