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

2. 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

3. 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?

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

5. 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.

6. 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.

7. 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.

8. 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

9. 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

10. 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

11. 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.

12. Looking Ahead

13. 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

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

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

16. Questions ?

17. Thank You