
Contents
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14.1 Introduction 14.1 Introduction
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14.2 The baseline: the chronic and persisting burden of infectious disease 14.2 The baseline: the chronic and persisting burden of infectious disease
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14.3 The causation of pandemics 14.3 The causation of pandemics
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14.4 The nature and source of the parasites 14.4 The nature and source of the parasites
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14.5 Modes of microbial and viral transmission 14.5 Modes of microbial and viral transmission
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14.6 Nature of the disease impact: high morbidity, high mortality, or both 14.6 Nature of the disease impact: high morbidity, high mortality, or both
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14.7 Environmental factors 14.7 Environmental factors
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14.8 Human behaviour 14.8 Human behaviour
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14.9 Infectious diseases as contributors to other natural catastrophes 14.9 Infectious diseases as contributors to other natural catastrophes
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14.10 Past plagues and pandemics and their impact on history 14.10 Past plagues and pandemics and their impact on history
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14.11 Plagues of historical note 14.11 Plagues of historical note
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14.11.1 Bubonic plague: the Black Death 14.11.1 Bubonic plague: the Black Death
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14.11.2 Cholera 14.11.2 Cholera
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14.11.3 Malaria 14.11.3 Malaria
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14.11.4 Smallpox 14.11.4 Smallpox
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14.11.5 Tuberculosis 14.11.5 Tuberculosis
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14.11.6 Syphilis as a paradigm of sexually transmitted infections 14.11.6 Syphilis as a paradigm of sexually transmitted infections
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14.11.7 Influenza 14.11.7 Influenza
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14.12 Contemporary plagues and pandemics 14.12 Contemporary plagues and pandemics
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14.12.1 HIV/AIDS 14.12.1 HIV/AIDS
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14.12.2 Influenza 14.12.2 Influenza
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14.12.3 HIV and tuberculosis: the double impact of new and ancient threats 14.12.3 HIV and tuberculosis: the double impact of new and ancient threats
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14.13 Plagues and pandemics of the future 14.13 Plagues and pandemics of the future
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14.13.1 Microbes that threaten without infection: the microbial toxins 14.13.1 Microbes that threaten without infection: the microbial toxins
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14.13.2 Iatrogenic diseases 14.13.2 Iatrogenic diseases
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14.13.3 The homogenization of peoples and cultures 14.13.3 The homogenization of peoples and cultures
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14.13.4 Man-made viruses 14.13.4 Man-made viruses
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14.14 Discussion and conclusions 14.14 Discussion and conclusions
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Suggestions for further reading Suggestions for further reading
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References References
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28714 Plagues and pandemics: past, present, and future
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Published:July 2008
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Abstract
This chapter is about pandemics, a somewhat ambiguous term, defined in the Oxford English Dictionary as ‘a disease prevalent throughout a country, a continent, or the world’. In present modern usage the term takes greater cognizance of its original Greek derivation and is largely restricted to global prevalence (pan demos) – all people. The same source tells us that ‘plague’ has a broader meaning, implying a sudden unexpected event that is not necessarily a disease, but introducing the concept of acute, lethal, and sudden danger – characteristics that are connoted but not specifically denoted by the term ‘pandemic’. It will become apparent that glimpses of the future must consider the emergence of new pathogens, the re-emergence of old ones, the anthropogenic fabrication of novel agents, and changes in the environment and in human behaviour. In other words ‘the problem’ in addressing infectious disease threats is not one but many separable problems, each of which must be isolated in traditional scientific fashion and separately evaluated as components of what I like to call ‘holistic epidemiology’. This emerging discipline comprises microbial and human genetics, human behaviour, global ecology, toxicology, and environmental change. As we leave our mothers’ wombs and enter this vale of tears (and sometimes before) we are invaded by microbes that may become our lifelong companions, profiting from this intimate relationship by the food and shelter that our bodies offer. They, in turn, often provide us with nutrients or vitamins derived from their own metabolic processes and may even immunize us against future assaults by related but less kindly microbes. In other words, we and they (usually) coexist in a state of armed neutrality and equilibrium. But humans bear a chronic burden of infectious diseases. Included in this burden are some diseases that have demonstrated a capacity to break out in pandemic form, depending on the circumstances that are defined later. The less overt contributors to human misery will be briefly reviewed before discussing the nature of the acute aberrations that comprise the more dramatic pandemics and plagues that suddenly burst forth in a catastrophic manner.
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