Infectious Disease, Past and Present Jay Miller, MSPH Principal, CTR Associates Program Manager (BARDA), Aveshka

Overview Introduction What causes infectious disease? Infectious Agents Methods of Spread Historic Disease Events The Plague (Justinian's Plague, the Black Plague, Third Pandemic, and modern outbreaks) The Birth of Epidemiology (Cholera, London, 1854) Spanish Flu (1918, H1N1 Influenza) Mass Vaccination (Polio, Jonas Salk) West African Ebola (Ebola Virus Disease, 2014) Infectious Diseases Now and Looking Ahead Biosecurity, Genetic Manipulation, Climate Change and Disease X Global Health Security What we can do to make a difference now Questions Overview

Who are you, and why should we listen? Jay Miller, MSPH Epidemiologist, Science Diplomat, and Global Health Security Expert (“epi” “demic” – upon the people) Extensive experience designing, developing and implementing infectious disease prevention and mitigation efforts in Africa, Southeast Asia, the Middle East, and here in the United States. Currently supporting BARDA and CTR Associates Who are you, and why should we listen?

What Causes Infectious Disease? Infectious Disease Agents: Viruses Bacteria Parasites Fungi Prions What Causes Infectious Disease?

Methods of Spread Airborne (Droplets, Coughing and Sneezing) Fecal-oral Transmission Blood and Body Fluid Sexual Transmission Foodborne/Waterborne Fomites Methods of Spread Reference the importance of hand washing, showering, cooking food, trash removal, clean water, sewage, safe sex, - set the stage for an explanation of major events in history.

Diseases that have Shaped our World Reminder: to note the affect of disease spread on modern life etc. These next slides represent, some but definitely not all of the events that have affected the world.

The Plague Causative Agent: Yersinia Pestis, Bacterium Transmission routes: Flea bites (vector borne), contact with body fluid, or contact with droplets. Major historical events: Justinian’s Plague (began 541 AD and killed up to 10,00 people a day) World population at this time: less than 200 million The Black Plague (killed 30-60% or Europe) The Third Pandemic (lasted more than 100 years, ended after the discovery of the bacterium) The Plague today Sporadic Treated easily Still deadly, still problematic, but generally under control The Plague Yersinia Pestis Gram Negative rod Called the black death due to the black bubos found under the arms of those infected.

Cholera, the Broad Street Pump, and the Birth of Epidemiology Tell the story Causative Agent is Vibrio Cholerae, transmitted by the fecal oral route. It is deadly and often seen in modern times during disasters and emergencies where people cannot get treated water. People did not treat water in these days Epidemiology is the core science behind public health and the first line of defense in public health emergencies. Dr. John Snow London, 1854

Spanish Flu (La Grippe), H1N1 Influenza, and Globalization Not actually from Spain The cause of more than 50,000,000 human deaths, more than World War I Case fatality reported as up to 50% The first example we have of a truly global pandemic Spanish Flu (La Grippe), H1N1 Influenza, and Globalization

Polio, Mass Vaccination, and Dr. Jonas Salk, 1953 First viable vaccine against the poliomyelitis virus First mass vaccination campaign Dr. Jonas Salk offers his invention for free, acquiring untold fame and ceding untold fortune Sets the stage for a drastic increase in human life expectancy, and in arguable the greatest ever advancement in medicine Polio, Mass Vaccination, and Dr. Jonas Salk, 1953 Note some facts about the virus, that it would kill and cripple the youth. It was transmitted via the fecal oral route, and is still around today, sadly in small pockets of the developing world. Use this slide to express the importance and impact of vaccines

First discovered in Zaire (Modern day Democratic Republic of Congo) on the Ebola river Transmitted by bats and primates Extreme case fatality rate Medical staff highly susceptible Extreme presentation of illness No cure, no vaccine (at the time), novel to this region of the world Ebola, West Africa, 2014 Caused by ebola disease virus, note of extreme globalization, and example of health and economic panic.

Looking Ahead

Are we in the clear? Unfortunately… No, but as humans, we are in a better place than we have ever been despite some outstanding threats to health security: Bioterrorism Genetic Manipulation/Laboratory created agents Antimicrobial resistance Extreme globalization Disease X

What are we doing to stop the next great pandemic? Health Security

What can I do? Health Security Support Science Support Collaboration Learn from the past Health Security

Questions ?

Thank You