1. Epidemics and Pandemics
Bugs Without Borders

2. November 3rd 2017

3. You’re never far from an epidemic.

4. Epidemics and Pandemics
Diseases, communicable or non-communicable, are relatively predictable in their patterns across regions and time.
Their ‘burden’ can be estimated and incorporated into development goals.
But epidemics and pandemics are:
Chaotic in time and space.
Respect no boundaries.
Burden is shared: like climate change it is unequally and inequitably distributed - caused by some, felt by all.
These types of disease are much more difficult to incorporate into development goals.

5. Epidemics Versus Pandemics
Epidemics are considered to be outbreaks of a disease that far exceed the normal ‘base-line incidence rate’ of that disease.
They can be of communicable (infectious) or non-communicable (not infectious).
They are usually confined within a larger region or nation.
Pandemics are all of the above, but the term is usually reserved for infectious diseases that cross national boundaries.
In this sense they are a phenomenon of globalization.

6. Epidemics and Income
No correlation between wealth and deaths from epidemics, though poorer people (and countries) are less able to cope.
Source: Gapminder

7. Pandemics

8. Spread of the Black Death in Asia, 1320s-1350
Followed the Silk Road and sea trading routes from China. Unknown how many people died in these areas but populations, and likely deaths, were high.
Saral
1346
1338
Beijing
Samarkand
Baghdad
Tibetan Plateau
& The Himalaya
Mecca
Hsian
Hangzhou
1349
1320s?
1340s?
Indochina Rivers:
Mekong, Chang

9. Kaffa

11. Bubonic plague bacilli
Yersinia pestis
Bubonic plague bacilli
Xenopsylla cheopis
Oriental flea
Rattus rattus Black rat

12. Debate About The Great Plague
Some researchers believed the Great Plague to be either a viral hemorrhagic fever or bacillus based anthrax and not caused by Yersinia pestis. But excavation of a plague pit in London, England in 2011 demonstrated that it was Yersinia pestis.

13. What is It.
The Plague is actually three distinct diseases caused by the same bacillus depending on which part of the body it infects, though all three sites can present. Bubonic plague: infects lymph system Mortality: 1-15% with treatment, 70-80% without. Septicemic plague: infects blood Mortality: 40-60% with treatment, 100% without. Pneumonic plague: infects lungs Mortality: 100% if not treated within 24 hours.

14. Nursery Rhymes
Ring around the rosy A pocketful of posies "Ashes, Ashes" We all fall down! This delightful nursery rhyme came into being around 1665 when the Black Death hit London, England, and it details symptoms, ‘treatment’, and outcomes of the disease. There are still about 1,000 to 3,000 cases each year around the world, and since 1990 there have been 134 cases reported in the U.S., 65 of them in New Mexico. Chance of dying from plague today is about 1 in 30 million. In the 14th century it was 1 in 2.

15. Ancient History?

16. Source: CDC Plague in the United States
Plague was first introduced into the United States in 1900, by rat–infested steamships that had sailed from affected areas, mostly from Asia. Epidemics occurred in these port cities. The last urban plague epidemic in the United States occurred in Los Angeles from 1924 through Plague then spread from urban rats to rural rodent species, and became entrenched in many areas of the western United States. Since that time, plague has occurred as scattered cases in rural areas. Most human cases in the United States occur in two regions:
Northern New Mexico, northern Arizona, and southern Colorado
California, southern Oregon, and far western Nevada
Between 1900 and 2010, 999 confirmed or probable human plague cases occurred in the United States. Over 80% of United States plague cases have been the bubonic form. In recent decades, an average of seven human plague cases have been reported each year (range: 1–17 cases per year). Plague has occurred in people of all ages (infants up to age 96), though 50% of cases occur in people ages 12–45. It occurs in both men and women, though historically is slightly more common among men, probably because of increased outdoor activities that put them at higher risk.
Source: CDC

17. CDC Plague in the United States
Plague was first introduced into the United States in 1900, by rat–infested steamships that had sailed from affected areas, mostly from Asia. Epidemics occurred in these port cities. The last urban plague epidemic in the United States occurred in Los Angeles from 1924 through Plague then spread from urban rats to rural rodent species, and became entrenched in many areas of the western United States. Since that time, plague has occurred as scattered cases in rural areas. Most human cases in the United States occur in two regions:
Northern New Mexico, northern Arizona, and southern Colorado
California, southern Oregon, and far western Nevada
Between 1900 and 2010, 999 confirmed or probable human plague cases occurred in the United States. Over 80% of United States plague cases have been the bubonic form. In recent decades, an average of seven human plague cases have been reported each year (range: 1–17 cases per year). Plague has occurred in people of all ages (infants up to age 96), though 50% of cases occur in people ages 12–45. It occurs in both men and women, though historically is slightly more common among men, probably because of increased outdoor activities that put them at higher risk.
CDC

18. Monday 2 October 2017 15.00 BST Thursday 19 October 2017 13.16 BST
A deadly outbreak of the plague has claimed more than 20 lives in Madagascar and is swiftly spreading in cities across the country, the World Health Organization has warned.
Public gatherings have now been banned in Madagascar’s capital, while critical medical supplies, including antibiotics and personal protective equipment, have been supplied by the WHO. At least 114 people have been infected since the outbreak was identified in late August.
'They should be much bigger': the heavy toll of hunger on Madagascar's children
Chronic malnourishment is causing profound damage to the minds and bodies of one in two children in Madagascar, leaving them too small for their age
Read more
Plague is endemic to Madagascar, where 400 cases of mostly bubonic plague are reported annually. But health authorities say the current outbreak is already spreading more rapidly than in previous years. Although epidemic season only begins in September, cases have already been reported in large urban areas, including the capital, Antananarivo, and port cities Toamasina and Mahajanga.
More than half of recorded cases – 73 out of 133 – are pneumonic plague, the most virulent form, which is passed through person-to-person transmission. If it is not treated, pneumonic plague can be fatal within 24 hours. The epidemic also involves bubonic plague, which is spread by rats and kills about 50% of people it infects.
Madagascar’s prime minister, Olivier Mahafaly Solonandrasana, said on Saturday that no public meetings or demonstrations would be allowed in the capital Antananarivo, where there has been six deaths in recent days.
“At airports and bus stations, measures will be taken for passengers to avoid panic and to control the disease,” he said in a televised address following an emergency meeting with the UN health agency.
The WHO has released $300,000 (£225,000) in emergency funds and is appealing for $1.5m to support the response.
“WHO is concerned that plague could spread further because it is already present in several cities and this is the start of the epidemic season, which usually runs from September to April,” said Dr Charlotte Ndiaye, WHO representative in Madagascar.
“Our teams are on the ground in Madagascar providing technical guidance, conducting assessments, supporting disease surveillance, and engaging with communities,” she added. “We are doing everything we can to support the government’s efforts, including coordinating health actors.”
The government said one girl among the dead had apparently been involved in a ceremony retrieving the bodies of deceased family members, rewrapping their remains.
Q&AHow infectious is plague?
Show Hide The plague, known as the Black Death, wiped out 30%-60% of the European population in the Middle Ages. Today, the disease is treatable with antibiotics, provided it is caught early. 
The Black Death has three forms: bubonic, pneumonic and septicaemic. A person with bubonic plague develops painful swollen lymph nodes or 'buboes' after being bitten by an infected flea.
Around one in 10 people affected with bubonic plague go on to develop pneumonic plague, where the infection gets into their lungs. 
Pneumonic plague can be transmitted through coughing.
Septicaemic plague occurs when infection spreads through the bloodstream, following a bubonic or a pneumonic plague.
If left untreated, bubonic plague has a fatality rate of around 30%-60%. The pneumonic and septicaemic forms are fatal without swift treatment. 
Between 2010 and 2015 there were 3,248 cases reported worldwide, including 584 deaths. 
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A WHO spokesman said that more measures were being put in place to educate communities on appropriate preventive measures. “The focus should be on hygiene promotion in surrounding areas,” he said.
Health authorities are also tracing people who had contact with a basketball coach from the Seychelles who died in a hospital in Antananarivo last week after catching pneumonic plague. Anyone who came into contact with the man will receive antibiotics as a precautionary measure.
“Anyone who is concerned they may have been exposed, either because they have been exposed to someone with symptoms or are in an endemic area, should alert health authorities immediately and go to a health centre,” a WHO spokesman said.
The Pasteur Institute of Madagascar said in a statement last month that a “major effort” was under way to contain the disease. It reported that cases had been identified in Atsinanana and Alaotra-Mangoro in eastern Madagascar; Vakinankaratra and Analamanga in central Madagascar; and Sava and Boeny in the north.
Thursday 19 October  BST

19. The 1918 Global Flu Pandemic
Camp Funston, Fort Riley, Kansas
Killed 40 million in just 24 weeks
Killed over 100 million in two years
Killed mostly year old cohort
Killed more Americans that WW1
An estimated 8-10% of the cohort died
“They were doubly dead in that they died so young.”
Dr. Harvey Cushing, prominent surgeon of the day.

20. Started at Camp Funston, February 1918
By March 1,100 sick, 237 pneumonia, 37 died
Hundreds of troops transfer between hundreds of camps
Starting June 1918 troops ship out to Europe
Sept to November 1918 the peak deaths period
In those 12 weeks over 20 million died
Pandemic lasted for three years 1918, 1919, 1920
Over that period 60 to 100 million died

21. Deaths Per Thousand
Week of Sept 28, 1918
Week of Dec 14, 1918

22. Age Specific Death Rates Per 100,000 Before and During the Pandemic
Crude death rates in US before and after 1918 pandemic
Year
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
Rate
10.0
12.3
8.9
15.7
27.0
17.4
301.8
99.0
70.5
11.3
31.0
44.1
Average crude death rate before and after 1918 = 21
Average crude death during the flu years = 157

23. Excess Mortality by Age and Gender
Age cohort 15-35

24. Number of cases and number of deaths, Switzerland

25. U.S. Life Expectancy 1900 to 1960

27. “The following 72 Inupiat Eskimos are interred in this common grave
“The following 72 Inupiat Eskimos are interred in this common grave. Pray, honor and remember these villagers who lost their lives in the short span of five days in the influenza pandemic November ”

28. He sends the samples to molecular biologist Jeffery Taubenberger.
In 1997, 71 year old retired pathologist Johan Hultin travels to Alaska and retrieves the lungs of an Inuit victim of the 1918 pandemic.
He sends the samples to molecular biologist Jeffery Taubenberger.
Taubenberger uses the lung tissue and tissue from army victims to reconstruct the 1918 virus.
He discovers that the 1918 virus was a mutated bird virus.

29. The pathogen of 1918 was a virus of the genus Orthomyxoviridae.
The 2009 pandemic was also H1N1 but did not show itself as virulent as the 1918 pandemic.
Antibody tests of 40 people born before 1920 show that they are resistant to the 2009 H1N5 strain.
That is very scary because it shows how genetically close H1N1 and H1N5 are.
The strain is called H1N1 and is a close relative to the current Avian Flu strain H5N1 - too close a kissing cousin to the virulent 1918 flu for comfort.
Normal mortality rates for flu are about 0.5%.
The fatality rate of the 1918 flu was between 2% & 20%.
In some isolated communities it was 100%.
The fatality rate of the recent Avian flu is about 35%.
The concern is a new flu with the virulence of the 1918 flu and the mortality rate of the current Avian flu.
And both came from birds.

30. Alphabet Flu
The labels H and N are named after the hemagglutinin and the neuraminidase protein groups. These are the surface protein groups that bind the virus to the body’s cells. The numbers are the numeric positions of the respective proteins in the group. The closer the H numbers are the closer the viruses are genetically. So far there are 16 H types and 5 N types that have been discovered.
Chickenpox – varicella
Whooping cough – pertussis
German Measles – rubella

32. What stands between humans and another far more deadly 1918 flu.
Pandemic Potential
Ebola
SARS
HIV
H1N1
H5N1
MERS
Deadliness.
Kills a large proportion of infected people. X
Spreads easily.
Infected people rapidly infect others.
Hard to contain.
People become infectious before they show symptoms.
No vaccines at first.
It takes months to mass produce vaccines.
What stands between humans and another far more deadly 1918 flu. X X
Source: New Scientist, 9th May, 2015, “Contagion”

33. Cholera

34. The pathogen is a bacterium called Vibrio cholera.
From first symptoms to death through hypotensive shock can be as short as 2-4 hours but more usually 4-16 hours. Families would wake up normal and be dead by evening.
The pathogen is a bacterium called Vibrio cholera.
Its natural hosts are humans and its vector is through human fecal contamination of the water supply.
There have been at least 7 major pandemics in the last 200 years, the first of these starting in Bengal in 1816.
About 10 million people died from the disease over this period.
Endemic to the Indian sub continent, with its major reservoir being the Ganges River.

35. Caused by a ballast discharge from an Indian cargo ship.
Between 1991 and 1994 in South America, cholera infected over one million people and killing 10,000.
Caused by a ballast discharge from an Indian cargo ship.
In ,000 cases of Cholera occurred in Haiti just after the earthquake, and caused over 6,600 deaths.
Globally there are still 2-5 million cases each year, resulting in 100,000 to 200,000 deaths.

36. Early Epidemiology - Dr
Early Epidemiology - Dr. John Snow’s 1854 map of cholera deaths and the Broad Street Pump

37. A Story of Global Cooperation
Smallpox Eradication
A Story of Global Cooperation
In the late eighteenth century England, Edward Jenner noticed that milkmaids rarely came down with smallpox, but did show mild symptoms of the related disease cowpox. He reasoned that the cowpox caused immunity to the more serious disease. He concocted a mixture of extracts from the cowpox-infected milkmaid Sarah Nelmes and, contrary to the spirit of modern experimental medicine and the principle of informed consent of subjects, injected it into an unknowing eight year-old boy, John Phipps, on May 4, He found that, despite all his attempts, the boy could subsequently not be infected with variola. Almost two years later, he took an extract from the hand of Thomas Virgoe, who had been infected through contact with the heel of one of his mares. This was injected into one John Baker, who also became impervious to variola. Thus was born the smallpox vaccine. [By the way, vaccine comes from the Latin word vacca, meaning cow.]
As with all new discoveries, vaccination was very slow to take hold. Jenner had to publish the results himself, since no medical journals would accept it.
The disease has been "completely eradicated" after instigation from the Soviet Union before the World Health Assembly in At that time, the disease claimed two million lives each year with cases in thirty-three different countries. Smallpox was "eradicated" because:
There were no subclinical infections, so that there were no well-carriers;
Victims were infectious for at most five days and the disease's effects severely limited its victim's mobility and the probability of further spread;
The virus was completely eliminated from the body upon recovery and resulted in total immunity to all future infection;
There were no animal reservoirs for the infection, hence, no vectors of transmission; humans were the only hosts;
The symptoms were clearly recognizable and infected cases could be readily identified;
An inexpensive, effective, and easily transported vaccine was available.
The eradication program began in 1967 under the direction of the American Donald Henderson working for the United Nations. Each subsequent outbreak was attended by a cadre of experts who immunized everyone (whether they wanted it or not—although that frequently took quite a bit of diplomatic cajoling) in the area. Teams operated in times of natural disasters, wars, and insurrections, from Bangladesh to Sudan to Yugoslavia (it was a single country back then) to Ethiopia, and elsewhere.
Finally during November of 1975, a three-year-old Bangladeshi girl Rahima Banu was cured in the last natural case of variola major. On October 26, 1977, Ali Maow Maslin (Merka, Somalia) was the last (cured) case of variola minor. Unfortunately, in 1978 in Birmingham, England there was a major security breach in the ventilation system of a (supposed) BSL-2 laboratory and a photographer, Janet Parker, working upstairs of the lab was infected and died of smallpox. Her mother, with whom she lived, came down with the disease but survived. On May 8, 1980, the World Health Assembly formally declared the earth free of smallpox. No other cases have been reported since.
There are only two stores of smallpox virus in the world today, the CDC BSL-4 lab in Atlanta and the Russian State Research Center of Virology and Biotechnology in Koltsovo, Novosibirsk. The stores were scheduled to be destroyed on December 31, 1996, but the US has decided against destruction because of the possibility of the virus's use in bio-warfare.
In 1969, the US and the Soviet Union signed a treaty banning biological weapons. The US has adhered to the treaty while it has been reported that Russia has not. Russia is alleged to currently have several metric tons of freeze-dried genetically engineered hemorrhagic smallpox virus. [For more details, read Germs: Biological Weapons and America's Secret War by Miller, Engelberg, and Broad.]

38. SMALLPOX ERADICATION – A GLOBAL SUCCESS STORY
Smallpox is a horrifying and deadly disease that had plagued humanity for thousands of years.
It is also the villain of a success story – the only one that has resulted in the eradication of a disease.
Caused by a pox family virus called Variola – v. major and v. minor. Both cause disease but v. major is deadly – 35% mortality.
In the late eighteenth century England, Edward Jenner noticed that milkmaids rarely came down with smallpox, but did show mild symptoms of the related disease cowpox. He reasoned that the cowpox caused immunity to the more serious disease. He concocted a mixture of extracts from the cowpox-infected milkmaid Sarah Nelmes and, contrary to the spirit of modern experimental medicine and the principle of informed consent of subjects, injected it into an unknowing eight year-old boy, John Phipps, on May 4, He found that, despite all his attempts, the boy could subsequently not be infected with variola. Almost two years later, he took an extract from the hand of Thomas Virgoe, who had been infected through contact with the heel of one of his mares. This was injected into one John Baker, who also became impervious to variola. Thus was born the smallpox vaccine. [By the way, vaccine comes from the Latin word vacca, meaning cow.]
As with all new discoveries, vaccination was very slow to take hold. Jenner had to publish the results himself, since no medical journals would accept it.
The disease has been "completely eradicated" after instigation from the Soviet Union before the World Health Assembly in At that time, the disease claimed two million lives each year with cases in thirty-three different countries. Smallpox was "eradicated" because:
There were no subclinical infections, so that there were no well-carriers;
Victims were infectious for at most five days and the disease's effects severely limited its victim's mobility and the probability of further spread;
The virus was completely eliminated from the body upon recovery and resulted in total immunity to all future infection;
There were no animal reservoirs for the infection, hence, no vectors of transmission; humans were the only hosts;
The symptoms were clearly recognizable and infected cases could be readily identified;
An inexpensive, effective, and easily transported vaccine was available.
The eradication program began in 1967 under the direction of the American Donald Henderson working for the United Nations. Each subsequent outbreak was attended by a cadre of experts who immunized everyone (whether they wanted it or not—although that frequently took quite a bit of diplomatic cajoling) in the area. Teams operated in times of natural disasters, wars, and insurrections, from Bangladesh to Sudan to Yugoslavia (it was a single country back then) to Ethiopia, and elsewhere.
Finally during November of 1975, a three-year-old Bangladeshi girl Rahima Banu was cured in the last natural case of variola major. On October 26, 1977, Ali Maow Maslin (Merka, Somalia) was the last (cured) case of variola minor. Unfortunately, in 1978 in Birmingham, England there was a major security breach in the ventilation system of a (supposed) BSL-2 laboratory and a photographer, Janet Parker, working upstairs of the lab was infected and died of smallpox. Her mother, with whom she lived, came down with the disease but survived. On May 8, 1980, the World Health Assembly formally declared the earth free of smallpox. No other cases have been reported since.
There are only two stores of smallpox virus in the world today, the CDC BSL-4 lab in Atlanta and the Russian State Research Center of Virology and Biotechnology in Koltsovo, Novosibirsk. The stores were scheduled to be destroyed on December 31, 1996, but the US has decided against destruction because of the possibility of the virus's use in bio-warfare.
In 1969, the US and the Soviet Union signed a treaty banning biological weapons. The US has adhered to the treaty while it has been reported that Russia has not. Russia is alleged to currently have several metric tons of freeze-dried genetically engineered hemorrhagic smallpox virus. [For more details, read Germs: Biological Weapons and America's Secret War by Miller, Engelberg, and Broad.]
A vaccine for the disease was first discovered in 1796 by Edward Jenner who found that milkmaids with cowpox - a milder cousin - did not contract smallpox.
By injecting people with extracts from cowpox sores he thus prevented them from getting smallpox. Hence the term vaccine – from the latin word for cow – vacca.
But it is what happened between 1958 and 1974 that is of interest.

39. SMALLPOX ERADICATION – A GLOBAL SUCCESS STORY
Before 1958 smallpox infected 50 million people a year in over 30 countries, killed about 2 million, and left millions more with horrifying disfigurements.
At the instigation of the Soviet Union, in 1958 the World Health Authority (later to become the WHO) commenced campaign to eradicate smallpox from the earth.
What makes smallpox a disease that could be eradicated?
No sub-clinical infections (you caught it, you showed it).
2. No non-human reservoirs or vectors.
3. Victims infectious for only 5 days.
4. Effects severely debilitating limiting mobility.
5. Clearly recognizable symptoms.
6. Cheap, effective, easily transported vaccine available.
7. Once vaccinated, always protected.
In the late eighteenth century England, Edward Jenner noticed that milkmaids rarely came down with smallpox, but did show mild symptoms of the related disease cowpox. He reasoned that the cowpox caused immunity to the more serious disease. He concocted a mixture of extracts from the cowpox-infected milkmaid Sarah Nelmes and, contrary to the spirit of modern experimental medicine and the principle of informed consent of subjects, injected it into an unknowing eight year-old boy, John Phipps, on May 4, He found that, despite all his attempts, the boy could subsequently not be infected with variola. Almost two years later, he took an extract from the hand of Thomas Virgoe, who had been infected through contact with the heel of one of his mares. This was injected into one John Baker, who also became impervious to variola. Thus was born the smallpox vaccine. [By the way, vaccine comes from the Latin word vacca, meaning cow.]
As with all new discoveries, vaccination was very slow to take hold. Jenner had to publish the results himself, since no medical journals would accept it.
The disease has been "completely eradicated" after instigation from the Soviet Union before the World Health Assembly in At that time, the disease claimed two million lives each year with cases in thirty-three different countries. Smallpox was "eradicated" because:
There were no subclinical infections, so that there were no well-carriers;
Victims were infectious for at most five days and the disease's effects severely limited its victim's mobility and the probability of further spread;
The virus was completely eliminated from the body upon recovery and resulted in total immunity to all future infection;
There were no animal reservoirs for the infection, hence, no vectors of transmission; humans were the only hosts;
The symptoms were clearly recognizable and infected cases could be readily identified;
An inexpensive, effective, and easily transported vaccine was available.
The eradication program began in 1967 under the direction of the American Donald Henderson working for the United Nations. Each subsequent outbreak was attended by a cadre of experts who immunized everyone (whether they wanted it or not—although that frequently took quite a bit of diplomatic cajoling) in the area. Teams operated in times of natural disasters, wars, and insurrections, from Bangladesh to Sudan to Yugoslavia (it was a single country back then) to Ethiopia, and elsewhere.
Finally during November of 1975, a three-year-old Bangladeshi girl Rahima Banu was cured in the last natural case of variola major. On October 26, 1977, Ali Maow Maslin (Merka, Somalia) was the last (cured) case of variola minor. Unfortunately, in 1978 in Birmingham, England there was a major security breach in the ventilation system of a (supposed) BSL-2 laboratory and a photographer, Janet Parker, working upstairs of the lab was infected and died of smallpox. Her mother, with whom she lived, came down with the disease but survived. On May 8, 1980, the World Health Assembly formally declared the earth free of smallpox. No other cases have been reported since.
There are only two stores of smallpox virus in the world today, the CDC BSL-4 lab in Atlanta and the Russian State Research Center of Virology and Biotechnology in Koltsovo, Novosibirsk. The stores were scheduled to be destroyed on December 31, 1996, but the US has decided against destruction because of the possibility of the virus's use in bio-warfare.
In 1969, the US and the Soviet Union signed a treaty banning biological weapons. The US has adhered to the treaty while it has been reported that Russia has not. Russia is alleged to currently have several metric tons of freeze-dried genetically engineered hemorrhagic smallpox virus. [For more details, read Germs: Biological Weapons and America's Secret War by Miller, Engelberg, and Broad.]
A campaign of (1) identify cases, (2) surround and buffer outbreak, (3) immunize everyone was started in 1967.

40. SMALLPOX ERADICATION – A GLOBAL SUCCESS STORY
By 1975 the last case of v. major was cured in Bangladesh, and by 1977 the last case of v. minor was cured in Somalia.
In 1978 a photographer working at a government lab in England was accidentally infected and died – the last case to do so. On May 8th 1980 the WHO declared the earth smallpox free.
While no naturally occurring smallpox virus is alive today, both the U.S. and Russia keep samples in case the other uses it as a weapon.
In the late eighteenth century England, Edward Jenner noticed that milkmaids rarely came down with smallpox, but did show mild symptoms of the related disease cowpox. He reasoned that the cowpox caused immunity to the more serious disease. He concocted a mixture of extracts from the cowpox-infected milkmaid Sarah Nelmes and, contrary to the spirit of modern experimental medicine and the principle of informed consent of subjects, injected it into an unknowing eight year-old boy, John Phipps, on May 4, He found that, despite all his attempts, the boy could subsequently not be infected with variola. Almost two years later, he took an extract from the hand of Thomas Virgoe, who had been infected through contact with the heel of one of his mares. This was injected into one John Baker, who also became impervious to variola. Thus was born the smallpox vaccine. [By the way, vaccine comes from the Latin word vacca, meaning cow.]
As with all new discoveries, vaccination was very slow to take hold. Jenner had to publish the results himself, since no medical journals would accept it.
The disease has been "completely eradicated" after instigation from the Soviet Union before the World Health Assembly in At that time, the disease claimed two million lives each year with cases in thirty-three different countries. Smallpox was "eradicated" because:
There were no subclinical infections, so that there were no well-carriers;
Victims were infectious for at most five days and the disease's effects severely limited its victim's mobility and the probability of further spread;
The virus was completely eliminated from the body upon recovery and resulted in total immunity to all future infection;
There were no animal reservoirs for the infection, hence, no vectors of transmission; humans were the only hosts;
The symptoms were clearly recognizable and infected cases could be readily identified;
An inexpensive, effective, and easily transported vaccine was available.
The eradication program began in 1967 under the direction of the American Donald Henderson working for the United Nations. Each subsequent outbreak was attended by a cadre of experts who immunized everyone (whether they wanted it or not—although that frequently took quite a bit of diplomatic cajoling) in the area. Teams operated in times of natural disasters, wars, and insurrections, from Bangladesh to Sudan to Yugoslavia (it was a single country back then) to Ethiopia, and elsewhere.
Finally during November of 1975, a three-year-old Bangladeshi girl Rahima Banu was cured in the last natural case of variola major. On October 26, 1977, Ali Maow Maslin (Merka, Somalia) was the last (cured) case of variola minor. Unfortunately, in 1978 in Birmingham, England there was a major security breach in the ventilation system of a (supposed) BSL-2 laboratory and a photographer, Janet Parker, working upstairs of the lab was infected and died of smallpox. Her mother, with whom she lived, came down with the disease but survived. On May 8, 1980, the World Health Assembly formally declared the earth free of smallpox. No other cases have been reported since.
There are only two stores of smallpox virus in the world today, the CDC BSL-4 lab in Atlanta and the Russian State Research Center of Virology and Biotechnology in Koltsovo, Novosibirsk. The stores were scheduled to be destroyed on December 31, 1996, but the US has decided against destruction because of the possibility of the virus's use in bio-warfare.
In 1969, the US and the Soviet Union signed a treaty banning biological weapons. The US has adhered to the treaty while it has been reported that Russia has not. Russia is alleged to currently have several metric tons of freeze-dried genetically engineered hemorrhagic smallpox virus. [For more details, read Germs: Biological Weapons and America's Secret War by Miller, Engelberg, and Broad.]
U.N. has voted several times to destroy these samples but the U.S. and Russia refuse. Genome has been sequenced so no reason to keep the actual virus around.
It is reported that Russia currently has several tons of freeze dried genetically engineered hemorrhagic smallpox virus stored.

41. Ebola

42. The Ebola Pandemic
Ebola virus budding from dead cell

43. Graph 1: Total suspected, probable, and confirmed cases of Ebola virus disease in Guinea, Liberia, and Sierra Leone, March 25, 2014 – February 14, 2016, by date of WHO Situation Report, n=28603

44. As of April 13, 2016 (Updated April 13, 2016)
Total Cases (Suspected, Probable, and Confirmed):
28,652
Total Deaths:
11,325
Mortality Rate:
40%

45. Ebola Overreaction?
Ebola is a disease that has been in the news due to the recent pandemic in West Africa that has been active since Two things make this epidemic interesting to us: The direct effect of globalisation on its spread. The reaction of authorities and people to it. Because the Ebola epidemic is not one that should have elicited such a response.

46. Ebola Factoids
No doubt that this is a scary pathogen: Ebola prevents clotting so when it buds from a cell the cell disintegrates and you bleed out internally, leaking from your orifices and other breaches in the dermis. Mortality Rate is very high: 30% to >90%. It is extremely infectious (as few as a single virion can infect you) but not very contagious (it’s hard to catch since its not airborne). It’s not very virulent (doesn’t spread easily) but is lethal (you likely will die and quickly).

47. Ebola Factoids
Reservoir is thought to be fruit bats (that remain asymptomatic), and it also effects other primates such as gorillas and especially chimps. Spread by direct contact with infected body fluids. Cultural actions such as corpse washing, kissing, touching spread the disease. Incubation about 8-10 days, symptoms in last 4-6 days of incubation period, death within 2-4 days of symptoms presenting. Corpses remain infectious for as long as there are cells to colonise, but recovered victims do not remain infectious.

48. So what was different in 2014?
Ebola History
First came to light in 1976 in villages along the Ebola River in Zaire (formerly DR Congo).
Several other outbreaks in Zaire, Sudan, Ivory Coast between 1976 and the 2014 outbreak, the most significant being one that was started by Belgian nuns at a medical mission who used infected needles.
Outbreaks have been caused in most cases by the butchering of infected chimps as bush meat.
Historically the disease is controlled by its lethality – it incapacitates and kills too quickly for it to spread.
So what was different in 2014?

49. Ebola 2014
Globalisation was different. Population densities increased greatly, especially in cities. Free trade agreements opened cross border work options for people so they moved further, quicker. Speed of travel increased due to more and different modes and mediums of travel. Inadequate governance could not control the infection once it started to spread: inadequate health facilities and knowledge, corrupt and incompetent officials, poor communication.

50. Ebola 2014
Global Village echoed what was happening around the world, media show up, people see the disease and its victims, along with the poor response from their governments on their TVs and internet. Misinformation about the disease spreads through available channels such as TV, internet, cell phones, social media resulting in: Proper prevention information is ignored or lost in the noise. People shy away from what few (and later better) facilities exist. People hiding sick relatives because they think hospitals are killing them. Continue with cultural burial practices that spread the disease.

51. Total Number of Ebola Cases: 25,978 Total Number of Deaths: 11,091
RECORDED EBOLA CASES, (Source: CDC)
Date
Country
Number of human cases
Number of deaths
% Fatality Rate
2014
Multiple Countries, incl. DR Congo
23,472
9,506
40.5%
2013
Uganda 6 3
50.0%
2012
DR Congo, Uganda 44 17
38.6%
2011 1
100.0%
2008
Congo, Philippines, Uganda
187 52
27.8%
2007
Uganda, DR Congo
413
224
54.2%
2004
Russia, South Sudan 18 8
44.4%
2003
DR Congo
178
157
88.2%
2002
Gabon, DR Congo
122 96
78.7%
2001
425
52.7%
1996
S. Africa, USA, Philippines, Russia, Gabon
100 68
68.0%
1995
315
250
79.4%
1994
Gabon, Ivory Coast 53 31
58.5%
1990
Philippines, USA 7 -
0.0%
1979
South Sudan 34 22
64.7%
1977
Zaire (now DR Congo)
1976
Sudan, Zaire (now DR Congo)
602
431
71.6%
Total Number of Ebola Cases:
25,978
Total Number of Deaths:
11,091
Fatality Rate:
42.7%

52. Current Ebola 2014-2016 Pandemic
As of April 13, 2016: Guinea – 3,814 cases, 2,544 deaths (67%) Liberia – 10,678 cases, 3,956 deaths (37%) Mali - 8 cases, 6 deaths (75%) Nigeria - 20 cases, 8 deaths (40%) Sierra Leone – 14,124cases, 4,800 deaths (34%) DR Congo – 66 cases, 49 deaths (74%) Senegal - 1 case, 0 deaths (infection originated in Guinea) Spain - 1 case, 0 deaths United Kingdom - 1 case, 0 deaths United States - 4 cases, 1 death (two infections originated in the United States, one in Liberia and one in Guinea) Italy – 1 case, 0 deaths
Source: World Health Organization and CDC.

53. Ebola Range

54. Malaria Range

55. World Bank Estimates of Ebola Pandemic
Putting Things Into Perspective
Malaria:
According to WHO data about 3.2 billion people – almost half of the world's population – are at risk of malaria.
In 2013, there were about 198 million malaria cases and an estimated 584,000 malaria deaths.
That’s about 7,622 times more cases, and 52 times more deaths than Ebola.
World Bank Estimates of Ebola Pandemic
Treating the Ebola pandemic so far:
$518 million.
Cost of recovery packages:
$450 million.
Loss to economies:
$1.6 billion.

56. Cost of Treating Malaria: Cost of Treating Ebola:
Putting Things Into Perspective
Cost of Treating Malaria:
$60 per case.
$20,547 per death.
Cost of Treating Ebola:
$19,939 per case.
$46,704 per death.

57. And Lest We Forget – The Current Measles Epidemics
This one is close to home and speaks to the complacency of the majority and the scientific ignorance and irresponsibility of the anti-vaccine group. The so called “anti-vaxxers” continue to spread discredited and unfounded rumours and misinformation that is dangerous to everyone and not just them. Let’s look at some of their claims.

58. Vaccination – What Happens When You Do

59. Vaccination begins 1963

60. Pertussis (Whooping Cough) Death Rates 1900-1966
Prophylactic care.
Widespread vaccination begins late 1940s.

61. Diphtheria Death Rates 1900-1966
Use of Diphtheria antitoxin begins 1894.
Vaccination routinely used in the 1940s.

64. Tuberculosis Death rates 1900-2000
Tuberculosis Mortality Rate in the United States
Similar pattern to measles: declining rates due to better prophylactic care. Then rapidly declining rates due to immunization in 1951.
In 2011 an estimated 8.6 million new cases of TB, with 976,000 deaths, 84% in lower income nations. Number of deaths decreased 27% between 1990 and About one third of the world’s population is infected.
Source: CDC.
DEMOGRAPHIC Transition

65. Multi Drug Resistant Tuberculosis (MDR-TB)
Russia, Europe, China, Africa have seen largest increases, exacerbated by smoking.
2005
2012

66. Vaccination – What Happens When You Don’t

67. Measles Immunization Rates 1984-2012
All rates going up – except in North America where they have declined due to the anti-vaxxer movement and changes to compulsory coverage. Vaccination rates of 95% are the minimum required for effective herd immunity against measles.
Source: WHO, Database: Health Nutrition and Population Statistics.

68. Cases of measles show a sharp upturn after the fraudulent Wakefield paper was published.

70. MMR vaccination rates declined in 1998 after Wakefield paper.
By 2001 cases of measles (blue line) began to increase dramatically.
In 2004 vaccination rates began to increase again reaching pre-Wakefield study rates by 2013 at which time measles cases began to decline.

71. Anti-Vaxxer Claim #1
Vaccines cause autism: This myth came from a completely discredited but published study by a UK ex-doctor called Wakefield who was later struck off the register for using fraudulent data, incompetent statistics and dangerous claims. The problem here is partly society’s. We don’t publish papers that don’t find anything – it’s called negative results bias in statistics. Wakefield still wanders the world being paid by anti-vaxxers to talk about his “results” and is seen as a folk hero to some of them, including well known Hollywood and political personalities, and has met with Trump who, Wakefield says, is “sympathetic to his ideas”.

72. Anti-Vaxxer Claim #2
Thimerosal causes autism: Thimerosal is a mercury containing preservative once used in vaccines, and a organization known as Generation Rescue, which appears bent among other things on “saving” people from vaccinations, along with Robert F. Kennedy Jr. started rumours that it caused autism. There had been no studies either way to support of deny the claim, so they were done and found no correlation between the thimerosal and autism. And the mercury? There’s more in a tuna fish sandwich – or an Advil.

73. Anti-Vaxxer Claim #3
Cases have been decreasing long before vaccines. This is just wishful thinking on the part of anti-vaxxers. Yes the number of cases of just about every major infectious disease have been decreasing through better prophylactic care and public health knowledge. BUT: The population is not immune from these diseases. The fact that the number of cases decreases does not mean that the disease has gone – it hasn’t. There is no herd immunity – diseases still sit waiting for an outbreak. Lower is not the same as zero. Decreasing numbers of cases is not the same as zero cases. Some people, mostly kids, still die and the disease still lives in the host population.

74. Anti-Vaxxer Claim #4
Your own immune system is good enough. Well, would that it was true but if it were we wouldn’t need vaccines or antibiotics to start with. Your immune system will not protect you against measles, which is just about the most contagious disease in the world, or any other infectious disease. Walk into a doctor’s waiting room two hours after an infected person had been in there and there is a high probability you will catch the disease if your are not vaccinated. If you are vaccinated, you are safe unless: You are in chemotherapy. You are pregnant. You have an otherwise compromised immune system.

75. Anti-Vaxxer Claim #5
Everyone else is vaccinated so what’s the problem. Apart from the selfishness of this claim, it’s ill-informed nonsense. This refers to “herd immunity” which theorizes that if enough people in a population (the herd) are protected, then the disease cannot easily spread. But measles, like any disease, continues to exist because of wild reservoirs of the pathogen – in the case of measles the wild reservoir is unvaccinated people. Measles is so contagious it requires a “herd” immunity approaching 98% of a population, so even a few unvaccinated people form a viable reservoir. As well, you are only protected by herd immunity as long as you stay in the herd. Visit anywhere without herd immunity (such as most of the world) and you can catch the disease.

76. Diseases with Human Only Reservoirs
Measles – leading cause of death among children Mumps – leading cause of deafness among children Rubella – variation of measles, causes miscarriage in women. Diptheria – 50%/20% fatality rate with/out treatment Polio – crippling paralytic disease with 2-5% fatality rate Meningitis – 70% fatality rate without treatment Pertussis – complications include pneumonia, seizures, brain damage Tuberculosis – 35% fatality rate All have vaccines. Together they were the principal killers of babies and children under five until vaccines for them were discovered. Without vaccines, they will again once again become the killers that they are.

77. Measles Epidemics – The Real Danger
Measles is not a harmless disease, nor are rubella, pertussis, mumps or chickenpox, or the crippling killers than are tuberculosis, polio, diphtheria and meningitis. Together these diseases accounted for most of the very high infant mortality rates in pre-vaccination days. More disturbing, antibiotics are getting fewer and less effective, and anti-virals are few and far between or non-existent, so if people do get these diseases, they will have virtually no effective drug interventions. That is why we invented vaccines – the single most effective way to prevent illness and death.
Chickenpox – varicella
Whooping cough – pertussis
German Measles – rubella

78. “But It’s Just The Measles!”
Measles is still one of the leading causes of death among young children in the world even though a safe and cost-effective vaccine is available.
In 2015, there were 134,200 measles deaths globally – about 367 deaths every day or 15 deaths every hour.
In 2016, 89,780 kids died from measles – marking the first year since records have been kept of measles deaths dropping below 100,000.
Measles vaccination resulted in a 84% decrease in measles deaths between 2000 and 2016 worldwide.
During this period, measles vaccinations prevented an estimated 20.4 million deaths.

79. Vaccination Benefits
CDC modeling estimated that, among children born during 1994–2013, vaccination prevented:
an estimated 322 million illnesses
21 million hospitalizations
732,000 deaths
over the course of their lifetimes.
Net savings were estimated at $295 billion in direct costs and $1.38 trillion in total societal costs.
Page 13.

80. Not Fake News

81. And Now… (from Spring 2017)
The second ‘M’ in MMR, has seen another outbreak this past few week among young adults – you. For whatever reasons, many young adults have not had their booster shots – second round – of the MMR vaccination. The danger of complications from mumps are low, but: Deafness, mastitis, orchitis, meningitis, encephalitis. Check with your G.P. – have you had your two doses?
Chickenpox – varicella
Whooping cough – pertussis
German Measles – rubella

82. This just in…
Beppe Grillo, the populist M5S Party’s leader who campaigns on an anti-vaccination platform, keeps repeating the debunked myths about vaccines being linked to autism and other ailments.
700 cases to date compared to 220 in Vaccination rates among 2 year olds have dropped from 95% to 85%.

83. Pandemics and Globalisation
Pandemics are a fact of life anywhere there is life. Natural control is infection burn-out as viable hosts either die or recover and become immune. The higher the virulence, the faster the burn-out, the smaller the spread. Changes in the speed of transmission now threatens these controls, especially virulence. Resistance to drugs makes pandemics more likely. Eight major links between increased threat of pandemics and globalization…

84. Pandemics and Globalisation
Speed of transmission.
People’s propensity and means to travel.
Trade and volume has provided new vectors.
More wild ecosystems in contact with humans.
Climate change is increasing insect carrier vector range.
Industrial agriculture’s abuse of antibiotics.
Industrial agriculture’s abuse of chemical controls (DDT).
Environmental concerns limit effective controls (DDT).
Cultural memory is short: because we have not experienced a disease due to vaccination, we forget its awful toll.
THE INTERNET??
Giving the word “virus” a whole new meaning…

85. Number of Syphilis Cases, U.S., 2005-2013
Use of online “hook-up” apps such as Tinder, Grindr has led to significant increase in syphilis cases and other STDs.
Tinder has about 50 million users since 2012 and makes 15 million matches a day.
About 40% of the increase in syphilis is attributed to hook-ups via these apps, and about 40% of the rest from a relaxing of attitudes towards safe sex due to perception that HIV/AIDS is no longer a death sentence.
Source: New Scientists, #3002, 2015
A date with disease: Get the app, risk the clap?
03 January 2015 by Shaoni Bhattacharya
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For similar stories, visit the Love and Sex Topic Guide
Swipe and burn (Image: Daniel Stolle)
Swipe right and your next-but-one date could be in a clinic. Apps like Tinder and Grindr are being linked to a flare-up of sexually transmitted infections
SOME people do it in bed. Others slope off to the bathrooms at work. Look carefully and you'll probably spot someone at it on the train. You might even be one of them.
Whether or not you have joined the millions regularly logging on to hook-up apps such as Tinder and Grindr, it is clear that over the past few years they have become an accepted part of today's dating scene. With touchscreen interfaces that allow users to swipe through profiles of available matches, they make finding a date as quick and easy as flicking through the pages of a magazine.
Tinder, used by men and women, generates 15 million mutual matches a day. Grindr, a similar app for men seeking men, has 6 million users, with 10,000 joining daily. And because these apps rely on GPS to recommend potential matches within a given radius, they make meeting people in the flesh easier than ever.
But for all the fun and spontaneity, a darker side is emerging. The rise of such apps has coincided with a surge in outbreaks of sexually transmitted infections (STIs) that had long been under control, and an increase in other rare diseases. Public health officials are now pointing the finger of blame at a combination of relaxed attitudes towards safe sex and the easy access to partners provided by these apps.
"What it comes down to is mobile convenience leading to more efficient STI transmission," says epidemiologist Matthew Beymer at the Los Angeles LGBT Center. That's not all. Research is starting to explore the idea that this technology makes you more likely to change your behaviour, causing you to leave your common sense at the bedroom door.
Syphilis was once one of the most feared STIs, but was almost confined to the history books after it became treatable with penicillin in the 1940s. By 2000, it was on the brink of elimination in both the US and the UK.
But cases of syphilis have rocketed over the past few years in many Western countries, including the US, Canada, UK, Germany, Sweden and Australia. Now the UK sees more than 3000 cases a year and the US more than 16,500 (see graph). Australia had its highest-ever recorded levels last September.
It's not just syphilis. Infection rates for other STIs that had plummeted during the AIDS epidemic in the 1980s are also on the rise. In Australia, gonorrhoea cases rose by 70 per cent between 2009 and Chlamydia and multidrug-resistant gonorrhoea are on the increase in numerous countries.
In their public responses to these outbreaks, health officials have repeatedly blamed hook-up apps. "You've suddenly invented a way of discovering where the nearest sexually available person is to the nearest metre – it's not difficult for you to get with them," says Peter Greenhouse at the British Association for Sexual Health and HIV.
Rash behaviour
Research into the cause of the STI increase is still in the early stages, but evidence is starting to stack up in support of this idea.
An investigation of six regional outbreaks of syphilis across the UK since 2012 found that location-based networking apps played an important part in how patients had met their sexual partners, especially for men who have sex with men.
The team behind the research, led by Ian Simms at Public Health England in Colindale, UK, says that as well as making it quicker and easier to find new partners, the technology joins together isolated sexual networks in which disease would previously have been contained. This results in "hyper-efficient transmission" of infections, Simms says, so epidemics spread faster and further.
Further evidence that links app use with STIs comes from a small study of men who have sex with men. This found that those who met up through smartphone apps had significantly more past sexual partners and were more likely to have ever been diagnosed with an STI than those who didn't use the apps (PLoS One, DOI: /journal.pone ).
That finding was backed up by Beymer and his colleagues, who conducted the first major study to compare STI rates in people who use apps and those who don't. His team had noticed that increasingly, men who came to their clinic for testing were using apps such as Grindr, Jack'd, Recon and Scruff (see "Fast Love").
The team looked at disease incidence in 7000 men who came in for screening and found that those who used phone apps to meet sexual partners were 40 per cent more likely to test positive for gonorrhoea than those who met sexual partners online. They were 25 per cent more likely to have the disease than men who had met partners socially.
What was "startling", Beymer says, is that even when they controlled for other factors that are known to influence STI risk, such as age, ethnicity and drug use, the link to phone app use remained.
STIs are the core concern, but in the past two years Simms and others have been surprised to find that infections that weren't traditionally thought to spread through sexual contact also now seem to be spreading this way. Two infections that had hitherto been known as travel-related stomach bugs, the gastroenteric bacterium Shigella flexneri and the rare verocytotoxin-producing Escherichia coli (VTEC), were reported in clusters of gay and bisexual men in the UK. Many cases weren't linked to travel to countries where the disease is endemic, and later interviews with the men revealed factors such as the use of the internet and apps to meet partners.
"Essentially we are saying all these overlapping epidemics are all sides of the same dice," Simms says. "They are sustained by very closely related sexual networks facilitated by geospatial networking apps which allow all these previously un-joined networks to be linked up."
These studies suggest a link, but it could be that the results aren't about the apps but the users, says Ian Holloway at the Luskin School of Public Affairs at the University of California, Los Angeles. "We don't yet know if there's something inherent about these apps or the individuals choosing to use them," he says.
Meeting up has never been easier (Image: Jesse Untracht Oakner/Plainpicture)
Anecdotally, the spontaneity involved seems to make people more relaxed. "You are more likely to throw caution to the wind," says Kate (not her real name), who started using Tinder after a breakup. She didn't originally sign up to Tinder for casual sex, but ended up sleeping with three of the five men she met. "Sometimes we'd been chatting for ages so you feel more advanced in your flirtation when you meet them for the first time than with someone you meet in a bar, so it's more likely that things will happen," she says.
But what's the evidence? Working out why and how people behave the way they do when it comes to sex is delicate and complicated. Yet studies suggest that the way people meet their sexual partners might influence what happens when they end up in bed – translating into health consequences.
"We have done work to show that the actual process of interaction online can increase risk-taking," says John de Wit at the University of New South Wales, Australia. With colleague Philippe Adam, he conducted a survey of 2000 men who have sex with men to see if their online experiences affected their actions.
"We found out that 70 per cent of gay men who use these online chat sites or apps fantasise around unprotected sex with their partner as a way of getting aroused – without the intention to actually do that. But in fact all these fantasies modify their sexual script," says Adam, and some men act on them regardless of their initial intentions.
Safer swiping
Much of the research has so far focused on men having sex with men, but the surge of STIs is far from confined to this community, with outbreaks also occurring in heterosexual adults. Similar research on Tinder would be interesting, says Holloway.
One of the reasons officials are confident that apps are helping to drive the problem is a result of contact tracing, one of the first things they do when trying to address an outbreak. Those who test positive in the clinic are asked for the contact details of recent sexual partners so that they can be alerted of the risk. And it's this process, they say, which often reveals the role of hook-up apps: in the Canadian city of Winnipeg, for example, 50 per cent of people being treated for syphilis said they had met sexual partners through them.
Apps also make contact tracing harder than if people meet through social connections as there is no need for users to reveal their real name or contact details, making halting an outbreak more difficult.
But although apps have been implicated in the STI surge, they are far from the only factor. Cases of syphilis have been rising for around a decade, and this coincides with a reduction in sexual health campaigns and a change in attitudes towards HIV. As the perception of AIDS has changed from it being seen as a death sentence to a chronic condition that can be managed with drugs, a so-called "safe-sex fatigue" has ensued. The same generation that is now connecting more easily using mobile devices is also less concerned about safe sex than the generation before.
The success of preventative pre- and post-exposure pills for HIV, which protect against HIV but don't stop other STIs, may add to the issue, officials say, as well as the popularity of "serosorting" websites. These connect people on the basis of their HIV status. Without the HIV risk, people may be less likely to practice safe sex.
With such a complex issue, Holloway cautions against vilifying networking apps. Instead, he thinks they could be harnessed as valuable prevention tools.
That's why he and his colleagues have teamed up with Online Buddies, which owns internet sites and mobile apps such as Manhunt and Jack'd, to conduct a study into how HIV prevention advice through mobile apps might be received by at-risk groups.
Online Buddies has a research arm, OLB Research Institute in Cambridge, Massachusetts, which is focused on gathering evidence on the best way to get sexual health messages across on their platforms. It also acts as a consultancy to health agencies to help them design mobile campaigns that users are more likely to engage with. The institute is headed by David Novak, who was previously National Syphilis Elimination Coordinator at the US Centers for Disease Control but felt that he could do more by working in the industry.
The approach can work. During a deadly meningitis outbreak in New York City in 2012, Novak says they worked with local public health authorities and directed one-third of local Manhunt users to get vaccinated using an advert on the site.
Other app companies are also getting on board. In October last year, Grindr and six other app makers formed a collaboration with the San Francisco AIDS Foundation and the Foundation for AIDS Research with the aim of finding new ways to encourage testing, raise awareness and reduce stigma.
Getting the message right is crucial, however. "Once you make a change to a site of millions of users, if you don't do it properly it can have a bad health outcome," says Novak.
Online Buddies will turn down paid public health advertising or campaigns it feels aren't right for their mobile platforms. For example, it recently refused a syphilis campaign that it felt stigmatised people who had the disease.
And a barrage of criticism fell on the public health department of San Mateo County in northern California recently for its use of fake Grindr accounts to send users sexual health advice. The accounts use stock photos as avatars and are operated by trained STI counsellors, says Darryl Lampkin, Community Program Supervisor at the department. Once they get chatting to users, the counsellors find the first opportune moment to reveal that they are actually healthcare providers, and use the chat to supply health information. But critics have slammed this as patronising and unethical, and have likened it to entrapment.
"We recognise how this strategy can be perceived as being deceptive," says Lampkin. But he says it works, with 80 per cent of men remaining online after the counsellors they are chatting to have come clean. They have also seen a rise in the number of men coming in to be tested.
Encouraging testing is crucial, but sending people their results quickly and in a shareable, electronic format can also help to increase dialogue about STIs, says Ramin Bastani, CEO of health platform Healthvana, which works with public health bodies in the US to develop electronic test results. Bastani envisages a day when app users will expect to see some kind of verified sexual health tick or "badge" on people's profiles – noting that many men in the gay community already post their HIV status on their online profiles.
Quite how this technology will evolve remains to be seen. Holloway points out that the possible re-sharing of test results raises privacy issues that have yet to be resolved.
But what is clear is that there is a real drive to change the way sexual health messages are presented. "Young people don't want boring messages about public health," says Adam. "They want to know about relationships. Sexual health messages need to be embedded in this." As Basani puts it, "the healthcare of the 21st century will not look like healthcare – it will look like your iPhone, your computer. The things you use every day."
This article appeared in print under the headline "Swipe and burn"
Fast love
Tinder
Linked to Facebook, it finds potential matches in the local area. Swipe left for no, right for yes
Grindr
Location-based social network for men, it provides users with a grid of potential matches in the vicinity
Growlr
The social network for gay "bears" – heavier, hairier men. More than 4 million users
Jack'd
Location-based gay social app. Launched in 2010, it now has 5 million users
Manhunt
Launched as an online site and also a mobile network for "guys looking for fun, dates, or friends"
Recon
Fetish hook-up site for gay men
Scruff
Dating and social networking app for men. Fifty million messages are exchanged each week
Shaoni Bhattacharya is a consultant for New Scientist based in London
Source: New Scientists, 2015

86. Changing Demographics Demographic transition
Summary
Changing Demographics
Aging
Demographic transition
Changing Economics
Development
Industrialisation
Global Health
Burden of Disease
Changing
Changing
Culture
Environment
Pandemics
Changing Geography
Global village
Transportation
Communication
Changing Territory
Borders
More countries
Conflict

87. Now don’t Forget. Wash your hands!