Pandemic Survival Guide

Swine Influenza

Swine Influenza

SWINE INFLUENZA frightening you? CONCERNED about the health implications? Coughs and Sneezes Spread Diseases! Stop The Swine Flu from Spreading. Follow the advice to keep your family and friends safe from this virus and not become another victim. These simple cost free guidelines will help you to protect yourself from the swine flu.

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Pandemic Survival

This eBook shows you what it takes to survive the next pandemic. There is no doubt that in the future, the world will be hit with a huge pandemic, either from natural causes or from a terrorist attack. As you look through history, you will be hard-pressed to find any pandemic in history that has killed less than 1 million people. You do not want you or your family to be among those millions. And with the help of the information in this eBook, you have a way to survive the global pandemic that will come. Wishing it won't happen doesn't do anything Preparing for it gives you the tools to survive AND thrive. This book contains the two-pronged approach of John Hartman's years of research in figuring out how pandemics work and living through a dangerous flu outbreak. This gives you the methods to both avoid getting a virus in the first place, and how to strengthen your immune system should you come down with a virus. You don't have to lay down and die. You can fight the next pandemic.

Pandemic Survival Overview


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Infection with Filoviruses Ebola and Marburg

The first outbreak of human VHF caused by a filovirus, Marburg virus, occurred in 1967 in Germany and Yugoslavia. In 1976, simultaneous outbreaks of two distinct Ebola virus subtypes erupted near the Ebola River Valley in Zaire and southern Sudan, resulting in hundreds of deaths. Since then, additional reports of human VHFs secondary to filoviruses have appeared sporadically, mainly in Africa, with mortality rates ranging from 50 to 90 percent. Outbreaks involving the Ebola virus subtypes, however, have remained the most deadly 2 . There are currently four recognized subtypes of Ebola virus Zaire (the most aggressive), Sudan, Reston, and C te d'Ivoire. The Reston subtype is pathogenic in monkeys but does not cause lethal infection in humans. Epidemiological evidence suggests that transmission of Ebola virus to humans usually occurs after direct contact with blood, secretions, or tissues of affected patients or nonhuman primates. Following infection, patients initially present with an...

Ebola Pathogenic Genes

In general, filoviruses possess a noninfectious, negativesense, single-stranded, nonsegmented RNA genome within a lipid envelope. The cellular receptors required for cell infection are not definitively clarified. The Ebola virus genome is 19kb long and includes seven open reading frames encoding structural proteins the glycoprotein (GP), the nucleoprotein (NP), and the matrix proteins VP24 and VP40 , nonstructural proteins (VP30 and VP35), and the viral polymerase (Figure 2). Additionally, the GP open reading frame of Ebola virus, through transcriptional editing, generates two different gene products a full-length 150- to 170-kDa protein (GP) that inserts into the viral membrane and a soluble 60- to 70-kDa protein (sGP), that is secreted from infected cells. The Ebola glycoproteins, GP and sGP, share approximately 300 amino-terminal amino acids, but contain an additional 380 and 70 carboxy-terminal amino acids, respectively. Both are thought to play important roles in viral...

Models to Study the Pathogenesis of Ebola Virus

In general, studies on Ebola virus require sophisticated yet inconvenient safety precautions, considerably limiting the investigation and understanding of Ebola pathogenesis. Fortunately, isolation of the viral cDNAs and the development of artificial expression strategies have allowed the study of Ebola virus gene products in vitro under less restrictive conditions. For example, an artificial replication system has been developed based on the vaccinia virus T7 expression model. Also, a reverse genetics system enables the generation of infectious Ebola virus from cloned cDNA. Using this strategy, cultured cells are transfected with plas-mids for the expression of the Ebola proteins, a plasmid for the Ebola viral RNA controlled by T7 RNA polymerase promoter, and a plasmid for T7 RNA polymerase. This system is effective for the study of mechanisms underlying the path-ogenicity of Ebola virus, as viral genes and proteins can be manipulated as desired. Several animal models have also been...

The Role of the Vascular Endothelium in Ebola Pathogenesis

Although we do not yet fully understand why Ebola virus is so potent, the clinical signs and symptoms of human infection with this agent point toward a dysfunction of the vascular system. The syndrome caused by this virus and all HFVs are acute multiorgan diseases, associated with widespread tissue damage and diffuse vascular dysfunction. Macrophages, monocytes, endothelial cells, and hepatocytes are the main cellular targets of the Ebola virus 4 . Macrophages and monocytes are considered the primary target for infection. The virus then spreads to the endothelium and the parenchyma of different organs rapidly. Several factors may enable Ebola to be such an invasive and cytopathic virus its effective blockage of the immune response, its unusually high rate of viral replication, its disruption of In Ebola infection, the vascular endothelium can be targeted in different ways by indirect dysregulation through cytokines, chemokines, and other mediators released upon infection of primary...


Quantification of the SARS CoV RNA Real-time RT-PCR was performed to quantify the virus RNA on a Roche LightCycler system using RealArt HPA-CoV LC RT Reagents. The result is shown in Fig. 3. The quantification standards (a-d) were 101, 102, 103, and 104 copies L SARS viral RNA, respectively. Between the log concentration of quantification standards and their crossing points, a regression curve has been drawn but not shown (r -1.00). According to the curve, the concentration of the sample RNA was 103 copies L. In Fig. 3, we can see that the curve of the sample RNA (s) almost overlaps the curve of quantification standard (c). Because the sample RNA has been diluted 105 times before quantification, the concentration of the original RNA is approx 108 copies L. Fig. 3. Quantitative analysis of SARS CoV RNA by means of real-time RT-PCR. (a-d), quantification standards (HPA-CoV LC QS 1-4) supplied within the kit by the manufacturer. Concentrations of SARS virus RNA in (a-d) are 101,...

Pandemic influenza

Pandemic influenza is defined as virulent human influenza that causes a global outbreak, or pandemic, of serious illness. There are three requirements for a pandemic (1) novel HA or NA types (thus no pre-existing immunity in population) (2) a highly virulent strain of influenza virus and (3) easy human-to-human spread. A worldwide influenza pandemic occurred in 1918. At least 21 million people (possibly 50-100 million) worldwide died from the ,Spanish flu' - the most devastating plague in human history. Many of the deaths were in healthy young adults and two-thirds occurred during a 4-month period 7, 8 . The propensity for high mortality in previously healthy young adults was a very unusual feature of the 1918 influenza virus. Routine seasonal influenza viruses cause the highest mortality in the very young (< 6 months of age) and the elderly (> 65 years old). The increased virulence of the 1918 virus in healthy young persons has been hypothesized to be due to a cytokine storm, but...

What Is A Virus Basic Virology Virus Anatomy

While host organisms use only DNA for their genetic material, a viral genome may be composed of either DNA or RNA. The size of viral genomes varies greatly. The genome of variola major, the DNA virus that causes smallpox, is 190 kb. The RNA genome of the SARS-causing coronavirus is 29.7 kb those of Ebola and Marburg viruses are each 19 kb, while the HIV and poliovirus are 9.2 kb and 7.4 kb, respectively.

Microbevector interactions in vectorborne diseases

Several billion people are at daily risk of life-threatening vector-borne diseases such as malaria, trypanosomiasis and dengue, and the dark shadow of plague hovers in the few endemic foci where it waits ready to re-emerge in a deadly pandemic. The abortive attempt to control malaria in the 1960s showed us the problem that we face in eradicating vector-borne diseases. Research into these tropical diseases fell into neglect during the 1960s, but in the 1970s research was once more directed towards vector-borne diseases and more recent initiatives such as the Roll Back Malaria Campaign have kept them in the international spotlight. If we are not to repeat the mistakes of the past it will be necessary to use all of our knowledge of vector biology. Written by international researchers in the field this volume describes the way in which pathogens interact with the vectors that transmit them. It details the elegant biological adaptations that have enabled pathogens to live with their...

Electron Microscopy for Virus identification

Virus morphology is as diverse as that seen in other microscopic organisms. Because of this, viruses can be identified based on their appearance under the microscope. The researcher is able to examine both the external and internal structure of the virus. Particle morphology has been observed to appear ribbon-like (rabies), rod-shaped (measles), spherical (poliovirus), and filamentous (Ebola) (Figure 4.3). Many viruses show multiple morphologies under the microscope and are referred to as pleomorphic. An example of a very pleomorphic virus is influenza A, which can appear kidney bean-shaped or filamentous. Some viruses have very characteristic spikes, club or pin-like projections present on the viral envelope. A very interesting example of spikes is seen in the emerging SARS virus. FIGURE 4.3 (A) Ebola virus particles showing filamentous morphology. Courtesy of the CDC C. Goldsmith. (B) Polio virus particles showing spherical morphology. Courtesy of the CDC Fred Murphy, Sylvia...

Outlook For Subsaharan Africans

One recent influence is the catastrophic HIV AIDS pandemic that already affects a quarter of the men in many countries in Southern Africa and women and children to a lesser extent. The consequent increases in early morbidity and mortality54 have decreased mean survival time in South Africa from 62 to 44 years.55,56 In neighboring Botswana, half of all deaths are due to the infection.57 However, the HIV AIDS situation primarily affects the young and those in early middle age it will not diminish the likelihood of rises in CHD in the near future in the less affected upper-middle aged and elderly Africans, particularly those in better circumstances.

Opposition from the Livestock Industry

In the case of Zimbabwe, at least, the tsetse control hunting, miles of cordon fences, the use of persistent insecticides like dieldrex and DDT, and the habitat destruction that accompanied these actions proved to be an official scam that was perpetuated for more than 60 years. It was based on a false initial assumption that tsetse recessions around the turn of the 20th century were due to the rinderpest pandemic that swept though the region in the late 1890s (Summers, 1971). Tstse fly was eventually eliminated in South Africa and parts of Zimbabwe using fly traps, but where this was achieved by other means it led to significant lasting veldt deterioration and loss of ecological productivity (Riney, 1963).

Matrix Attachment Regions Allow DNA Looping

During interphase, a filamentous web of proteins, the nuclear matrix, appears just on the inside of the nuclear membrane. DNA is attached to the proteins of the matrix by sites known as matrix attachment regions, or MARs. Because the same DNA sites are used for attachment to the chromosomal scaffold during replication as for attachment to the nuclear matrix during interphase, they are sometimes also called SARs (scaffold attachment regions).

Fluorescence Scanning

Part of the hybridization images is shown in Fig. 5. Every QC or EC probe was positive, and every BC or NC probe was negative in all hybridization images, indicating high-quality performance and excellent reproducibility. For the BC PCR, no hybridization signal was visible for the other probes, but the IC probe had a positive signal for the NC PCR. For SARS detection, the hybridization signal of probe 40 was always invisible when symmetric PCR was performed (a), although bands of amplicons with the right size (257 bp) were seen in Fig. 4. However, once the concentration of primer uf to primer ur was disproportional, hybridization signals were observed (b), (c) or (d) see Notes 4-6 . Fig. 5. Part of the hybridization results. (A-D), SARS CoV RNA and human total RNAat concentrations of 103, 102, 101, and 100 copies L or 167, 16.7, 1.67, and 0.167 ng L, respectively, were used as templates for RT-PCR. (a-d) In multiplex PCR the ratios of universal primers uf to ur were 1 1, 1 25, 1 100,...

Epidemiologic Investigation

Forensic epidemiology is a new discipline. However, epidemiologic evidence has proven to be powerful in litigation involving such diverse hazards as swine flu vaccine, Agent Orange, silicone breast implants, and tampons.36 Several studies describe the use of epidemiological evidence in legal proceedings.37-43

Cosmetic psychopharmacology

Kamer(47> has described how a selective serotonin uptake inhibitor used for the treatment of depression and for other psychiatric alterations can remove personality traits in some people. He has considerered traits previously considered as an expression of human misery or, in some cases, as the consequence of negative childhood experiences. Kamer even questions whether there could be a 'pandemic' of cosmetic psychopharmacologies which would lead to the disappearance of phenomena such as anguish which are essential for personal realization in the arts, religion, and creativity. In the light of present knowledge, it can be deduced that the characteristics of personality disorders do not have to be present in the traits of a normal personality. The disappearance of clinical symptoms as a result of pharmacological treatment directed at potentiating the serotonergic metabolism of, for example, a violent or obsessive patient is not the same as modifying personality traits which contribute...

Land and Wildlife Management in the Commercial Sector

It is important that commercial wildlife producers become more professional, for at least two reasons. First, the commercial wildlife sectors of in Namibia and South Africa have been growing extremely rapidly, possibly as fast as 25 per cent per annum,18 over the past 10 years, implying that the supply of wildlife recreation has increased at a similar rate. It is unlikely that either the international or domestic demand for wildlife-based recreation has increased at these rates given the global recession, international conflicts and the fear of SARS, the common figure stated being between 7 and 20 per cent. With supply increasing faster than demand, the increased competition in the market place is likely to cause some wildlife-based enterprises to fail.19 Competition would select for improved management skills, particularly of the commercial elements of the enterprise, as they would increase the chances of survival and profitability in an increasingly challenging environment.20

Strategy of Negative Strand RNA Viruses

The negative-strand RNA viruses are divided into several families and include the agents of well-known diseases such as rabies, mumps, measles and influenza as well as more exotic emerging pathogens such as Ebola virus. In all of these, the ssRNA in the virus particle is complementary to the messenger RNA and is therefore the minus strand. These viruses vary in shape and structure but are similar in having an outer envelope derived from the membrane of the host cell where they were assembled.

Considerations And Concerns Raised By Analysis Of Other Infections

Some of the principles discussed above are highlighted by a recent report on SARS. This coronavirus disease also evoked concern of a possible terrorist origin at the onset. A report in the Morbidity and Mortality Weekly Report (MMWR)14 on the Prevalence of IgG Antibody to SARS-Associated Coronavirus in Animal Traders discussed the need to validate and interpret tests in the appropriate populations the IgG test, discusses its inability to date the time of the infection, and the possibility of reactivity to a near neighbor that might be unknown. In a Promed bulletin, Dr. Berger looked at the data from a different angle and reported This week's study in MMWR indicates that animal contact may indeed promote infection however, the most striking finding seems to have eluded the authors 1.2 percent to 2.9 percent of individuals in a healthy control group of adults were also found to be seropositive The population of Guangdong Province is 86.42 million (2001), of whom 61.14 million are adults...

Molecular Epidemiology

An epidemic is a disease or condition that affects many unrelated individuals at the same time. A rapidly spreading outbreak of an infectious disease is an epidemic. A pandemic is a disease that sweeps across wide geographical areas. Epidemiology includes collection and analysis of environmental, microbiological, and clinical data. In microbiology, studies are performed to follow the spread of pathogenic organisms within the hospital (nosocomial infections), from the actions of the physician (iatrogenic infections), and in the community. Molecular epidemiology is the study of causative genetic and environmental factors at the molecular level. Results of epidemiological studies ascertain the origin, distribution, and best strategies for prevention of disease. In infectious disease, these efforts are facilitated by the ability to determine the genetic similarities and differences among microbiological isolates.

Evolution of RTcontaining viruses

RT can rapidly evolve and increase the diversity of genetic populations via error-prone replication. Homologous elements of RTs are encoded in the genomes of many retroviruses1 such as human immunodeficiency virus (HIV) hepadnaviruses such as hepatitis B virus (HBV)4,5 plant and animal DNA viruses such as cauliflower mosaic viruses4 retrotransposons6-8 and mitochondrial group II introns.9 Retroviral and hepadnaviral RTs have been the main focus of RT research because HIV and HBV cause worldwide pandemic diseases spread through transfusion of blood and or body fluid.

Grid Activities In Asia And Japan

Other international grid projects in the area of drug discovery are the Cancer Biomedical Informatics Grid (caBIG), which is created by the NCI and other American cancer centers in July 2003, to form a worldwide web of cancer research that helps in understanding of cancer disease and accelerates early detection and treatment 105 . In addition, the Sudden Acute Respiratory Syndrome (SARS) Grid is an international grid sponsored by many research centers and institutions based on the Access Grid technology to include a database of patients to track the infected people a user interface part that provides a platform for enabling radiologists and doctors to review daily X-rays of SARS patients without risk of infection 114 .

Summary and conclusions

Infections with dengue viruses continue to present a major and escalating global public health problem. Vector control programmes are expensive, largely unsuccessful or of only short-term benefit, and thus vaccine development continues to be the most effective strategy for tackling this problem. The complex pathogenesis of dengue infections and the apparent involvement of the immune response in severe disease has raised questions over the safety and efficacy of every vaccine design strategy developed so far. However, when industrialised nations have been faced with theoretical threats of the same magnitude as dengue much less risk-averse policies have been adopted. Following the terrorist attack on September 11th 2001 in New York, many countries became fearful of a terrorist attack using smallpox. Consequently large stocks of vaccine were ordered and administration policies developed, even though the vaccine had not gone through the normal regulatory pathway and the incidence of...

Classification of Disease

Epidemiologists measure the frequency of diseases within a given population in regards to the geographical size of the area and the amount of damage the disease inflicts on the population. Diseases can be classified as endemic, sporadic, epidemic, or pandemic. A disease becomes pandemic when it is distributed throughout the world. For example, in 1918 the swine flu (influenza) reached pandemic proportions. Some experts consider the HIV virus to be pandemic.

Avian influenza virus

Breaks in commercial poultry flocks in recent years, with major economic consequences 21-23 . Avian influenza viruses carry novel HA types such as H5, H7 and H9 but generally do not replicate efficiently in humans. Part of this species barrier is due to the distinct preferences for HA binding to mammalian or avian sialic acids, as mentioned above. However, reassort-ment with human strains could allow a recombinant virus to emerge that is both highly pathogenic and highly infectious for human hosts. This reassort-ment between human and avian strains is thought to occur primarily in pigs, which are susceptible to infection by both strains 6 . The close proximity of humans, swine and birds in areas with endemic HPAI is of major concern as a potential source of a pandemic strain.

Prevention And Education

Road traffic accidents are the major cause of TBIs on a global scale. Although their mortality rates have decreased substantially in many industrialized countries during the past two decades, there is increasing concern about a rising epidemic of RTA injuries in developing countries. By 2020, it is estimated that road traffic crashes will have moved from ninth to third place in the world ranking of the burden of disease and will be in second place in developing countries. To quote an article in the British Medical Journal sleepiness among drivers may account for nearly a fifth of road traffic crashes. Similarly, if the international public health community continues to sleep through the global road trauma pandemic it will be accountable for many millions of avoidable deaths and injuries (12).

Case Presentation

This patient could well have had HIV disease AIDS because of her persistent generalized lymphadenopa-thy and very low CD4+ cell count. Her HIV strain might have differed enough from the pandemic group M HIV-1 strains so that the usual laboratory tests did not detect antibody to it. Education about how HIV is transmitted can be a very effective tool in helping to bring the worldwide epidemic of HIV disease under control. Education of schoolchildren has been shown effective in decreasing risky sexual behavior among teenagers. Videotapes and written material developed for one group of people, however, can be completely ineffective and even offensive to another group.

Survey of Recombinant Viral Vaccines Currently under Development 6211 Herpes viruses

Viral haemorrhagic fevers (VHFs) represent a serious public health problem with recurrent outbreaks worldwide. The most widely distributed virus is dengue, causing 20 million infections per annum, and, despite the availability of an efficient live, attenuated vaccine, the spectre of yellow fever continues to haunt Africa and South America. In many cases, VHF control is primarily by elimination of the mosquito vector, but where the natural host is not known, as in the case of Ebola and Marburg virus, this is not feasible. Other important agents of VHF include Lassa virus and Japanese encephalitis virus (JEV), while a number of other agents (St Louis encephalitis virus, tick-borne encephalitis virus, Rift Valley fever virus, West Nile virus (WNV)) cause periodic localized epidemics. Unfortunately, with the exception of dengue, yellow fever and JEV, these diseases are a low commercial priority for vaccine manufacturers and comparatively little is known about their biology and...

Quinate Oxidation Membrane Bound Quinate Dehydrogenase QDH

Shikimate Pathway

SKA is a key intermediate for aromatic amino acids as well as for large numbers of antibiotics, alkaloids, and herbicides. Recently, another important role for SKA has emerged as a precursor for the synthesis of oseltamivir (Tamiflu), an antiviral drug designed to protect people from pandemic flu infection. In spite of warnings from the World Health Organization about the approach of a global flu pandemic, including avian influenza, there are insufficient stocks of oseltamivir around the world. One reason for this is the technical difficulties in preparing SKA, because two different metabolic pathways, glycolysis and pentose phosphate pathway, need to be combined before forming SKA. Furthermore the metabolic location of SKA is a long way from that for glucose and it is very difficult to lead the metabolic flow to SKA production through classic fermentation technology as well as through modern molecular biotechnology. Although resources are limited, SKA is also produced by extraction...

Multiplex Nested RTPCR

Sequence data for SARS CoV were obtained from the curated database in GenBank. The unique and conserved regions of SARS CoV were selected by aligning the released SARS CoV sequences and the latest nonredundant nucleic acid sequences in the NCBI database (ftp 2. To allow detection of SARS CoV, multiple regions from the open reading frame (ORF) of replicase 1a, spike glycoprotein, and nucleocapsid protein were selected as the targets for hybridization detection. 3. To amplify the four segments from these three ORFs in the genome of SARS CoV, four sets of outer and inner primers were designed, as listed in Table 1. The four outer primer sets were designed in the selected genes using Primer3 (39) by setting the optimal Tm to 67 C and the size of PCR product from 400 to 1200 bp. Two universal primers were allowed to bind to the 5' end of the designed inner primers for efficient labeling of the PCR product. 5. The primers were aligned using BLASTN with the latest...

A role of viral variation in determining the host response

We are developing a rapid and cost-effective mechanism for dengue resequenc-ing, utilizing an array platform approach that has already been developed to track the genetic diversity of the SARS CoV (Wong et al 2004), using high-density custom microarrays manufactured by Nimblegen Systems. For the pilot array, we first created reference consensus sequences to the four serotypes of dengue, derived from all available dengue genomes in GenBank. Resequencing probes were synthesized in situ onto the array using our previous bioinformatics approaches. While the probes were able to distinguish between the four serotypes of dengue, the resultant sequence was not complete, giving sequencing errors primarily in regions where there were multiple polymorphisms within the same resequencing probe. To overcome this problem, we generated a second consensus sequence derived from viruses isolated in Southeast Asia and conducted allelic association analysis of single nucleotide polymorphisms which occur...

Dynamics Of Disease Transmission

Diseases can be defined as endemic, epidemic, and pandemic. Endemic can be defined as either the habitual presence of a disease within a given geographical area, or as the usual occurrence of a given disease within such an area. Epidemic can be defined as the occurrence in a community or region of disease, clearly in excess of normal expectancy, and derived from a common source or from a propagated source. Pandemic refers to a worldwide epidemic. The usual or expected level of a disease is determined through ongoing surveillance. strategies devised by the microbe to survive prior to infecting a host such as sporulation or harboring in drought-resistant mosquito eggs, and by the various modes of transmission, e.g., direct contact (including large droplets) or indirect contact with fomites, or by insect vectors, and airborne via small particle droplets.3 Natural experiments, however, have highlighted the true diversity in the abilities of microorganisms to infect humans and animals...

Sites for Virus isolation

Lesions and warts the perfuse spread of Ebola allows detection even in the skin. For respiratory infections, samples may include nasal and throat swabs as well as nasopharyngeal aspirates and bronchial lavage fluids. Urine and stool samples are collected for enteric disease, and cerebral spinal fluid is obtained when neurological symptoms are present. Viruses may be very labile, and care must be taken to avoid exposure to harsh treatments such as extreme pH, direct sunlight, and freezing temperatures in order to preserve the potential for identification and study. Generally, samples are transported on ice and evaluated in the lab as quickly as possible. If delays are expected, samples can be frozen, but the recovery of infectious virus may be reduced or eliminated.

Competing to be valued and loved and losing

As we emphasised, human relationships provide an array of valuable resources to individuals in the form of protection, care, support, and opportunities for reproduction (Buss, 1999 Gilbert, 1989). They are also physiologically powerful, including effects on the immune system (Cacioppo et al., 2000). It is worth remembering that viruses (and other pathogens) have played a large role in human evolution the mortality rate was often high in early hominids. The influenza epidemic of 1918, at the end of the First World War, killed more people than died in that war. If access to affectionate, supportive relationships aids the immune system, survival from illness, and disability, and offers advantages of cooperative activity and sharing, then abilities to secure these relationships will be key drivers in evolution. Hence, we would expect humans to be highly attuned and responsive to them (Cacioppo et al., 2000), to be affected by their presence or loss, and to compete for them.

Immunosuppression And Cancer

Despite the worldwide epidemic of HIV AIDS and the increased incidence of these cancers, there has been a relative paucity of cases of orbital non-Hodgkin's lymphoma. NHL in AIDS is typically higher grade, is extranodal, and has a poorer outcome. The first case of orbital involvement was reported in 19829 and the second as late as 1990.10 Since that time, a handful of other cases has been reported.11-13 Here then is a paradox. We have a worldwide epidemic of HIV AIDS. There has been a documented increase in the incidence of NHL and, in particular, NHL of the orbit but there have been very few cases of NHL of the orbit reported to be associated with AIDS. Our own experience has mirrored this. In a survey of 73 cases of orbital and ocular adnexal lymphoma from our institution, not one was known to be associated with HIV AIDS.14 Other large series also show no cases of HIV AIDS-associated NHL. NHL of the ocular adnexa typically occurs in the older population (median age 65 in our...

Environmental insults at the early developmental stages

In utero exposure to influenza has been implicated as a risk factor since a report that an increased proportion of adult schizophrenia in Helsinki was associated with presumed second-trimester in utero exposure to the 1957 A2 influenza epidemic.(88) Over 30 studies have subsequently attempted to replicate the putative link between maternal influenza and schizophrenia. While several studies have replicated the original Finnish findings, negative results have more recently been reported from an increasing number of studies based on large epidemiological samples in different parts of the world. (8 90) Two studies ,92) in which access to data on actually infected pregnant women was available found no increased risk of schizophrenia among their offspring.

Human Viral Diseases Are Common

Many common childhood diseases such as measles, mumps and chickenpox are caused by viruses, as are the common cold and flu. More dangerous viral diseases include polio, smallpox, herpes, Lassa fever, Ebola and AIDS. Do viruses ever do anything useful Yes infection by a mild virus can provide resistance against a related but more dangerous virus (see Ch. 17). Viruses may carry genes from one host organism to another, in a process known as transduction (see Ch. 18), and have thereby played a major role in molecular evolution (see Ch. 20). The ability of viruses to carry genes between organisms may be put to good use by genetic engineers. All the same, about the best that can be said for the natural role of viruses is that most of them do relatively little damage and only a few cause highly virulent diseases.


In both industrialized and developing countries, childhood immunization has become one of the most important and cost-effective public health interventions. National immunization programs have prevented millions of deaths since WHO initiated the 'Expanded Program on Immunization' in 1974. Smallpox was eradicated in 1979, poliomyelitis is on the verge of eradication, and two thirds of developing countries have eliminated neonatal tetanus. Global immunization coverage was at 78 in 2005. Through their impact on childhood morbidity and mortality, immunization programs are contributing to reaching the 'Millennium Development Goal 4' - a two-thirds reduction of under-five mortality by 2015. However, the failure to reach more than 20 of the world's children with existing vaccines was responsible for at least 2.5 million of an estimated 10.5 million deaths of children under 5 years, mainly in developing countries. Of these deaths, 1.4 million could have been prevented by vaccines currently...

Virus Order

The Mononegavirales order is comprised of viruses that have a single-stranded negative-sense RNA molecule as their genome. There are three families in the order Mononegavirales Filoviridae, Rhabdoviri-dae, and Paramyxoviridae. The Nidovirales order comprises the families Coro-naviridae and Arteriviridae. The virus that causes SARS is a member of the Coronaviridae. Virus order names are discerned from the other classification level names by ending with the suffix -virales.

Virus Genus

Pathogenesis, associated clinical symptoms, treatment, and level of required biocontainment can be quickly realized. This system also allows for classification and characterization of a new unknown virus. For example, SARS was a previously unknown virus that was quickly analyzed and placed into the Coronaviridae family.


The slave trade between West Africa and the Americas, and the resulting commerce, were responsible for the introduction and the widespread geographic distribution of an African mosquito, Aedes aegypti, in the New World during the 17th, 18th and 19th centuries. This species became highly adapted to humans and urban environments and was spread throughout the tropics of the world by sailing ships. The species first infested port cities and then moved inland as urbanization expanded. Because Ae. aegypti had evolved to become intimately associated with humans, preferring to feed on them and to share their dwellings, this species became a very efficient epidemic vector of dengue and yellow fever viruses (Gubler 1997). Therefore, when these viruses were introduced into port cities infested with Ae. aegypti, epidemics occurred. It was in this setting that major epidemics of dengue fever occurred during the 18th, 19th and early 20th centuries, as the global shipping industry developed and port...


Epidemiology involves the study of disease epidemics and factors that influence them over time. An epidemic is defined as a widespread and severe disease outbreak in a host population. An epidemic that occurs over a wide geographic region often for several years is referred to as a pandemic. Various disease epidemics caused by fungi or fungus-like organisms on plants have occurred throughout the world, including, chestnut blight (Cryphonectria parasitica), Dutch elm disease (Ophiostoma novo-ulmi), late blight Irish potato famine (Phytophthora infestans), southern corn leaf blight (Bipolaris may dis), and wheat rust (Puccinia graminis f.sp. tritici). Severe and widespread chestnut blight and Dutch elm disease epidemics were caused by plant pathogens introduced to geographic areas outside their naturalized range.

Primary CNS lymphoma

2 of NHL cases incidence increased partly by HIV pandemic non-HIV related aged 55-70 commonly involves frontal lobes, corpus callosum or deep periventricular structures cognitive or personality change common 10 seizures 40 evidence of leptomeningeal spread diagnosis by gadolinium-enhanced magnetic resonance and stereotactic needle biopsy systemic lymphoma uncommon poor prognosis improved by addition of systemic chemotherapy with high dose methotrexate to whole brain 206 radiotherapy improves survival with > 95 responses and median survival 30-60 months 50 relapse risk most relapses in CNS, others mainly leptomeningeal and ocular, < 10 systemic delayed neurotoxicity common, esp. > 60 years dementia, ataxia, urinary dysfunction.

Time Series Analysis

Although these examples may seem reasonable to a meteorologist or an economist, we rarely simply examine trends over time. More often, we are interested in somewhat different questions Did things change after some intervention Did the rate of automobile deaths fall after the speed limit was reduced Was there a higher incidence of Guillain-Barre syndrome after the swine flu vaccination program was begun Did the emptying of the psychiatric hospitals follow or precede the introduction of phenothiazines The


Viruses can be classified by whether they have RNA or DNA as their genome and whether their genome is single stranded or double stranded and linear or circular. Viruses are also classified based on the nature of their capsid and on the presence or absence of an envelope. Table 24-1 describes some viruses that affect human health. For example, the virus that causes severe acute respiratory syndrome (SARS) is a coronavirus. Corona is the Latin word for crown. The SARS virus has single-stranded, linear RNA and an envelope with lollipop-shaped proteins that make the envelope look like a crown.

Influenza virus

Influenza viruses are enveloped viruses, containing a segmented RNA genome, and are members of the family Orthomyxoviridae. Influenza viruses are divided into three types A, B, and C. Types A and B cause most human influenza in annual winter epidemics. Influenza A viruses are further divided into subtypes based on the hemagglutinin (HA) and neuraminidase (NA) genes. The WHO nomenclature for classification of influenza strains is as follows Type (A, B, or C) Geographic origin Isolate Year of isolation subtype (HA and NA) e.g. A Sydney 5 97 (H3N2). There are 16 HA subtypes and 9 NA subtypes HA 1, 2, and 3, and NA 1 and 2 typically circulate in humans. HA is the viral protein that binds to sialic acid on host cells and is a major determinant of species tropism. The HA proteins of the types that usually circulate in humans (H1, H2 and H3) preferentially bind to the particular sialic acid moieties present on human respiratory epithelial cells. Conversely, HA in viruses that circulate in...


More than 25 of all deaths world-wide are caused by infectious diseases (Morens et al. 2004) HIV AIDS, SARS, HPS (Hanta), Lyme, Ebola, BSE vCJD (Mad Cow), STDs, West Nile, Plague, to mention only a few to which humans are susceptible. The list lengthens dramatically if we include diseases attacking cherished and economically important plants and animals. It would seem that humans are not the ultimate predator, even though we can be extremely efficient when we set our minds to decimating populations. As the human population increases with the associated increase in crowding and dispersal rates, the dynamics of diseases is well-worth careful study. These dynamics are made all the more complicated by the rapid evolution of many of the causative agents.


The requirement for such high doses (45-135 g HA) compared to inactivated seasonal influenza vaccine (15 g HA) presents a barrier to producing sufficient vaccine for large populations in the event of a pandemic. Similar to the inactivated H5N1 vaccine trial described above, the reason for the decreased immunogenicity of the insect cell-expressed protein is not clear. It may be due to a lack of previous exposure to H5 subtype virus in the subjects, who therefore would have experienced a primary rather than a primed memory response. Alternative adjuvants may be more effective at inducing robust responses to novel antigens and clinical trials of the insect cell-expressed HA with alternative adjuvants are also ongoing.


The emergence of avian influenza viruses in the human population promotes high concern for a potential pandemic. Avian influenza viruses have extreme virulence in children, with multiorgan disease and high mortality. The majority of cases have exposure to domestic poultry and human-to-human transmission is rare. Most children present with fever, rhinorrhea and cough, and lymphopenia, thrombocytopenia and elevated transami-nases are common. Some children can present with GI disease alone. The complications of illness are severe, including respiratory failure, shock and death. Aggressive supportive care is the mainstay of treatment, although neuraminidase inhibitors may have some efficacy if used early. Suspicion for the presence of avian influenza relies heavily on epidemiological risk factors such as exposure to poultry or travel to endemic regions. The continued spread of these viruses in wild and domestic bird populations requires regular checking of institutional or governmental...


The next most important mode of transmission of HIV is through blood and blood products. Individuals infected with HIV who donated blood before a screening test became available in 1985 unknowingly infected thousands of transfusion recipients. One of the products from pooled donated blood, clotting factor VIII, was used to treat bleeding episodes among hemophiliacs. By 1984, over half of the hemophiliacs in the United States and 10 to 20 of their sexual partners were HIV positive. Fortunately, the risk of HIV transmission by factor VIII was eliminated in 1992 when recombinant factor VIII was licensed. Transmission by blood is still a major factor in the HIV disease pandemic, however, because of sharing of needles by those who abuse injected drugs. In the United States, the population of abusers of injected drugs is estimated to be 1.5 million. Many of them, both men and women, support their drug habits with prostitution. Because HIV is acquired and spread through sexual intercourse...

Microcheck 291

The signs and symptoms of persons with AIDS are mainly due to the opportunistic infections and tumors that complicate HIV disease. HIV is not highly contagious, and the AIDS worldwide epidemic could be stopped by changes in human behavior. Highly active antiretroviral therapy has given miraculous improvement in many patients with AIDS but is unlikely significantly to affect the advance of the AIDS epidemic. The largely silent spread of HIV continues.


Figure 25.20 The AIDS Pandemic Continues Without Letup During 1998 alone an estimated 5.8 million people became newly infected with the human immunodeficiency virus, and most of them will ultimately die of AIDS. Figure 25.20 The AIDS Pandemic Continues Without Letup During 1998 alone an estimated 5.8 million people became newly infected with the human immunodeficiency virus, and most of them will ultimately die of AIDS.