1. Epidemics, Plagues & AIDS
Ethical Issues

2. History

3. Plague
“Plague” means a lot of different things...all equally terrifying
Bubonic plague, a specific disease caused by Yersinia pestis. Bubonic is one manifestation; Septicemic plague and Pneumonic plague are caused by the same organism.
Any bubo-causing disease
A pandemic caused by such a disease
Any pestilence, a virulent and highly infectious disease
Black Death, also known as The Black Plague: the Eurasian pandemic thought to have been caused by bubonic plague, beginning in the 14th century with repeated outbreaks until the 18th century.

4. The Black Death
The Black Death, or The Black Plague, was one of the most deadly pandemics in human history.
It probably began in Central Asia and spread to Europe by the late 1340s.
The total number of deaths worldwide from the pandemic is estimated at 75 million people There were an estimated 20 to 30 million deaths in Europe alone.
The Black Death is estimated to have killed between one-third and two-thirds of Europe's population.

5. Plague in Modern Times
Until the 20th century the cause of plague was unknown
Often doctors and nurses refused to treat the disease because there was an almost 80% mortality rate for health providers
However primitive epidemiology found that quarantining was the best way to limit the spread of the disease

6. Quarantine
Quarantine is voluntary or compulsory isolation, typically to contain the spread of something considered dangerous, often but not always disease. The word comes from the Italian (17th Century Venetian) language Italian quarantena, meaning forty day period.
The quarantining of people often raises questions of civil rights, especially in cases of long confinement or segregation from society, such as that of Mary Mallon (aka Typhoid Mary), a typhoid fever carrier

7. Typhoid Mary AKA Mary Mallon (September 23, 1869 – November 11, 1938),
She was the first person in the United States to be identified as a healthy carrier of typhoid fever. Over the course of her career as a cook, she infected 47 people, three of whom died from the disease.
Her fame is in part due to her vehement denial of her own role in causing the disease, together with her refusal to cease working as a cook.
She was forcibly quarantined twice by public health authorities and died in quarantine.

8. Other Notable Epidemics
Leprosy (Hansen’s Disease)
Cholera
Syphilis

9. AIDS

10. AIDS & HIV
In June of 1981 the Centers for Disease Control and Prevention (CDC) officially reported three cases of a mysterious “gay cancer”.
It was first called “Gay-related immune disorder” or (GRID)
One month later the incidence had increased to 108 cases with 43 deaths

11. AIDS & HIV
It was initially believed that GRID was only spread through sodomy
May anti-homosexual groups claimed that it was divine retribution against the gay community
However in the Fall of 1981 when the CDC reported that babies of drug-addicted mothers in New York City were testing positive for the “gay cancer” along with hemophiliacs suddenly the term “Gay-related Immune Disorder” had to be discarded
In July of 1982, one year after the first reports of the disease in the US we published, the CDC formally designated the disease “Acquired Immunodeficiancy Syndrome” or AIDS

12. AIDS & HIV
In 1982 on average people with AIDS lived 2 years after diagnosis
By ,000 young American men had died of AIDS, more than had died in Vietnam
By the end of 1997 nearly 641,000 cases of of AIDS had been diagnosed in the United States; 390,00 victims had died, and it was estimated that another 650,000 to 900,000 were infected

13. AIDS & HIV
According to estimates from the UNAIDS/WHO AIDS Epidemic Update (November 2007), around 30.8 million adults and 2.5 million children were living with HIV at the end of 2007.
During 2007, some 2.5 million people became infected with the human immunodeficiency virus (HIV), which causes AIDS.
The year also saw 2.1 million deaths from AIDS - a high global total, despite antiretroviral (ARV) therapy, which reduced AIDS-related deaths among those who received it. The number of deaths probably peaked around 2005, and has since declined only slightly.

14. AIDS, HIV & Cuba
In 1987 Cuba responded to the AIDS crisis by instituting national quarantine
Cuban nationals who test positive for HIV and AIDS are sent to live in a sprawling compound called the Sanatoria
Family members are allowed to visit residents of the Sanatoria are allowed to leave on day passes
Cuba has received harsh international criticism for this policy
Cuba has also been the most successful nation in the world at reducing the incidence and prevalence of AIDS among its population.

15. Case Study: Kimberly Bergalis

16. Kimberly Bergalis
In December 1987 Kimberly Bergalis had two molars extracted by Dr. David Acer, he appointed dentist under her CIGNA health plan.
Fifteen months later she developed a sore throat, ulcerated tonsils, and a fungal infection in the mouth called oral thrush.
In January of 1990 Kimberly Bergalis tested positive for AIDS

17. Kimberly Bergalis
Kimberly’s case was reported to the CDC but because she did not fall into any of the “high risk” groups investigators were baffled by the source of the disease
Anna Bergalis, Kimberly’s mother, a public health nurse, suggested her dentist Dr. David Acer as the source of the AIDS
The CDC investigated and confirmed this fact and Jane Pauley of the NBC Nightly News reported to the public that public health officials and the ADA had known of Acer’s AIDS and allowed him to practice anyway.
This news broadcast was how Kimberly Bergalis learned the source of her AIDS

18. Kimberly Bergalis
Little is known of David Acer’s personal life other than he was a bisexual and bragged that he had many sexual partners
He continued to practice dentistry until 1989 when he sold his practice and moved in with his parents
Most of his patient records were destroyed so few people were notified of their possible exposure
He died at age 40 on September 4, 1990

19. Kimberly Bergalis
Kimberly Bergalis filed a lawsuit against CIGNA medical corporation
Her claims were contested by CIGNA’s lawyers claiming that there were other ways she could have contracted the disease
However other patients of Acer came forward and tested positive for AIDS
A DNA sequence was performed that found matching strains of DNA in the virus each of the patients had

20. Kimberly Bergalis
CIGNA settled out of court with Kimberly Bergalis for one million dollars
Six people were confirmed to have contracted AIDS from David Acer
Just how Acer infected his patients though remains one of the biggest mysteries in the annals of epidemiology
Kimberly Bergalis died on December 8, 1991 at the age of 23

21. Discussion