Emerging Infections Microbial Threats to Health in the United States (1992) / Chapter Skim
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1 BACKGROUND
1 BACKGROUND
Pages 16-33
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From page 16... ...
Both demonstrate the potential danger of uncontrolled infectious disease. PLAGUE Plague, caused by the bacterium Yersinia pestis, has ancient roots.
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From page 17... ...
Untreated bubonic plague is fatal in half of all cases; untreated pneumonic plague is invariably fatal. Plague is probably best known because of its role in the Black Death (so called because of the gangrenous extremities often seen in those with advanced disease)
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From page 18... ...
Although influenza pandemics have varied in the severity of their impact, all have caused widespread disease and death. This was especially true of the 1918 influenza A pandemic, which claimed more than 20 million lives worldwide in less than a year and ranks among the worst disasters in human history.
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From page 19... ...
Although the 1918 pandemic ranks as one of the single most devastating outbreaks of infectious disease in human history, the technology of the time did not permit the virus to be isolated. Thus, no sample of the causative influenza strain is available for study, which means that the virus's remarkable virulence and transmissibility have not been investigated using the tools of modern molecular virology.
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From page 20... ...
Also important in the battle against infectious disease have been interventions against arthropod vectors of disease agents. Pesticides have played a critical role in suppressing arthropod-borne diseases in the United States and abroad.
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From page 21... ...
Sanitation and Hygiene The practices of public sanitation and personal hygiene have dramatically reduced the incidence of certain infectious diseases. In the United States, the mistaken notion that exposed refuse was somehow responsible for outbreaks of yellow fever led to early efforts at sanitary control.
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From page 22... ...
Quarantine proved to be an appropriate tool for controlling smallpox, an infectious viral disease spread easily from person to person, but the practice was ineffective in combating the spread of yellow fever, a mosquito-borne viral disease. In 1799, Congress granted authority for maritime quarantine to the secretary of the treasury and directed that state health laws (including quarantine of ships)
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From page 23... ...
Smallpox The most heartening evidence of humankind's ability to triumph over infectious diseases is the eradication of smallpox. A systemic viral disease characterized by fever and the appearance of skin lesions, smallpox is believed by some to have been responsible for the death of more people than any other acute infectious disease.
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From page 24... ...
The practice of quarantine, instituted for the first time in the American colonies in a misguided effort to prevent the spread of yellow fever, was used with some cilrrPc~ in the. ~.v~n~eenth century in the battle against smallpox.
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from the Western Hemisphere. Begun in 1985, the PAHO polio eradication and surveillance program had three goals: achieving and maintaining high levels of vaccine coverage; intensifying surveillance to detect all new cases; and aggressively controlling outbreaks of disease.
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TROUBLE AHEAD Balanced against this history of progress is the reality of a world still very much engaged in confronting the threats to health posed by a broad array of microbes. Medical and epidemiological uncertainties make it impossible to obtain an exact count of the number of infectious diseases that afflict human populations at any point in time.
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From page 27... ...
Army's Research Institute of Infectious Diseases determined that the causative agent was a virus closely related to the fatal Ebola virus of Zaire and Sudan. (In Africa in 1976, 50 to 90 percent of those infected with the Ebola virus died.)
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From page 28... ...
Peptic Ulcer Few, if any, infectious disease specialists 10 years ago would have predicted an infectious etiology for gastritis, peptic ulcer, or duodenal ulcer disease. Yet there is now considerable evidence that a bacterium, Helicobacter pylori, infects gastric-type epithelium in virtually all patients with these conditions.
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From page 29... ...
Antibiotic treatment of gastritis, peptic ulcer, and duodenal ulcers associated with H pylori currently is experimental.
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From page 30... ...
Tuberculosis Tuberculosis (TB) was the leading cause of death from infectious disease in the United States and Western Europe until the first decade of this century, and it remained the second leading cause from that time until the advent of antimicrobial drugs in the 1950s (Rich, 1944; Waksman, 1964; Dubos and Dubos, 1987~.
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From page 31... ...
Of major importance are increased poverty and a growing number of homeless individuals and families, substance abuse, a deteriorating health care infrastructure for treating chronic infectious diseases, and the HIV disease pandemic (perhaps the most significant factor at present)
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From page 32... ...
By and large, however, awareness of and concern about the threats to human health posed by other emerging and reemerging microbial diseases remain critically low. A small minority, mainly infectious disease specialists, have for years warned of the potential for serious epidemics and our lack of preparedness for them.
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From page 33... ...
History has shown and this committee believes that the threat from the emergence of infectious diseases is not one to be taken lightly. The development of a strategy for addressing emerging infectious disease threats requires that we understand the factors that precipitate the emergence of these agents and the resultant diseases.
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