www.elitecme.com | 2019 | INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE 19 itation that helped to lower mortality. These changes may have provided the false impres- sion that improvements in mortality were solely linked to advances in the medical arts. The third segment, which continues to the present time, is associated with logarithmic increases in scientific investigations and the resultant knowledge. Perhaps the greatest stimulus to this era was the understanding of specific microbial causes of disease by Pasteur and Koch. Their work further evolved into the present approach to scientifically exploring pathologies and disease (Kass, 1987). Some of the earliest-known major infec- tious disease outbreaks were associated with bacterial infections. On this basis, it may be surmised that people have been stricken by infectious diseases since the onset of human existence. In fact, records of such patholo- gies date back at least 5,000 years. Many doc- umented pandemic infections (infections covering a large geographic area, potentially impacting a major portion of a population) occurred over a course of hundreds of years. At their worst, pandemics have resulted in the decline, and even the decimation, of cities and nations. An infectious disease begins to spread when it is able to pass from person to person. In order for this to occur, the pathogen must be equipped to somehow reproduce in the host’s body; it is then transmissible to others (Boundless, 2016). An overview of some of history’s more impactful infectious disease outbreaks are described below. SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 1. Infectious diseases have plagued humans for thousands of years. Fortunately, mortality due to infectious disease has decreased signifi- cantly with the passage of time. Enhancements in health that occurred during the 18th and 19th century were likely influenced by all of the following factors EXCEPT: a) Improved classification of disease. b) Ready access to immunization programs. c) Improved sanitation. d) Enhanced prosperity. THE PLAGUE OF ATHENS In 430 BCE, the city of Athens was under siege by the Spartans in the Peloponnesian war. In the midst of this blockade, a wide- spread infectious pandemic struck that afflicted most of the Greek population over a course of three years. It is estimated that as many as 100,000 people, one-third of the total population, ultimately died. An eyewitness account of this deadly plague was prepared by the Athenian general and historian Thucydides. It was his hope that his detailed description of the events might allow future generations to identify the disease, should it again occur. Over the course of the past 100 years, the organism that caused this pandemic has been a subject of debate. Based on what is known about the symptoms, two diagnoses dominate the current discussion: smallpox and typhus. Whatever the source of illness, what is known is that it originated near what is now Ethiopia. It then spread throughout the Mediterranean region. It spared no one in its path—from slaves to noblemen. The epidemic occurred in at least three waves and lasted a combined period of about five years. Thucydides por- trayed the disease as having a high attack rate and a consistent course in persons of different age, sex, and nationalities (Littman, 2009). THE PLAGUE OF JUSTINIAN Beginning around 541, the bubonic plague (Yersinia pestis: mainly carried by fleas) spread throughout Europe. This plague killed as much as 10 percent of the world’s population. The pandemic was named after Justinian, the ruler of the Byzantine empire. Procopius, a scholar of the time, described the symptoms as producing delusions, night- mares, and coma. He noted that some people died immediately after the onset of these symptoms. Modern estimates of the disease toll suggest that approximately 5,000 people died each day. Current research suggests that the plague originated in China or India; it was transported through trade routes via Egypt to Europe. Cases were reported as far north as England. At the onset of the plague, Justinian had reconquered much of the former Roman empire. After several years of disease, many key members of the society were dead or gravely ill; this facil- itated the self-destruction of the empire (Sowards, 2016). THE BLACK DEATH Another devastating case of the bubonic plague was given the name “The Black Death of 1346-1361.” This outbreak was thought to have originated in China. It followed the Silk Road to the Mediterranean region of Europe on the backs of rats, which were ever-present on ships. It is estimated that the Black Death caused a major reduction in the world population: It was responsible for the death of approximately 75 to 100 million people. Bubonic plague struck London again in the 1600s; to this day, it infects about 1,000 to 3,000 people worldwide every year. In most cases, the causative bacteria respond well to a variety of antibiotics (Boundless, 2016). MIGRATION OF DISEASES TO NEW POPULATIONS Over time, many Europeans were able to develop immunity to many of the infec- tious diseases that they encountered. Native American populations exposed to these novel pathogens, however, were not immune. They were not prepared for these diseases: Communicable diseases, such as smallpox and measles, decimated native populations in their entirety from the 15th through the 19th cen- turies. Smallpox was especially deadly. It was thought of in some circles as one of the earliest cases of biological warfare. Available evidence suggests that up to 90% of Native Americans died from infectious diseases after the arrival of the Europeans to the New World (Patterson & Runge, 2002). As the 20th century began, a variety of infec- tious diseases had established a firm footing in the United States. This led to a large incidence of morbidity and mortality. In 1900 alone, a total of more than 21,000 cases of smallpox were recorded and resulted in the death of 894 patients. In 1920, nearly 470,000 instances of measles were reported, which resulted in 7,575 deaths. At that time, clinicians had few effective pre- ventive or treatment options to counter these diseases. Although a smallpox vaccine was developed in 1796, it is interesting to note that its use was not adequate to control the disease. Further, clinical scientists developed an addi- tional four vaccines for rabies, typhoid, cholera, and plague. As with the smallpox vaccine, the |  CONTINUING EDUCATION