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Which viruses still present today caused a deadly pandemic/epidemic in the past?

Which viruses still present today caused a deadly pandemic/epidemic in the past?



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The current Covid-19 pandemic and its virus Sars-Cov-2 can be dangerous, especially for vulnerable groups like the elders. But however, I have seen studies that this virus become less dangerous in the future, when human population has built some immunity against it.

There are many other viruses still present and most of them produce only harmless diseases like the cold. But were some of such viruses really dangerous in the past and cause only mild symptoms on infected persons in present day (due to immunity)? Perhaps thousands of years they caused a bad epidemic?


There are a few viruses which are around for a long time and have caused recurring episodes of disease. Most of these where not pandemic, which is probably more of a problem for modern times due to fast travel/exchange of people and are also a problem of "modern" cities where many people come together in a limited space.

Among theses viruses are:

  • Measles: This virus is around since at least 400 BC, profiting from the first big cities. (see reference 1 and 2 for more details)

  • Polio: This virus has been described already in ancient Egypt, although major outbreaks didn't happen before the early 20th century. There is a nice article in Wikipedia about it, see reference 3.

  • Smallpox: These are only not threat anymore because mankind successfully eradicated them. They have been described first around 1500BC in India, later also in China and Egypt. See reference 4 and 5.

Not viruses but also pathogens which caused historic epidemics: Typhoid fever, Cholera and the Yersinia Pestis (also known as The Plague or the Black Death).

References:

  1. The history of measles: from a 1912 genome to an antique origin
  2. Measles may have emerged when large cities rose, 1500 years earlier than thought
  3. History of Polio
  4. Emergence and reemergence of smallpox: the need for development of a new generation smallpox vaccine
  5. History of Smallpox

The 1890 "Russian Flu" pandemic is now believed to have been caused by one of the common cold Coronaviruses, HCoV-OC43. At the time of historical pandemics, there was no way to identify the infectious agent, though. So connecting the pandemic to the virus is based on descriptions of symptoms, and patterns of which demographic groups were most affected; as well as genetic analysis to estimate when the virus jumped from animals to humans.

Accounting for expected mutation rates and working backwards, they calculated that the jump into humans occurred around 1890.

That date isn't the only thing linking OC43 with Russian flu. Many patients of that pandemic had pronounced symptoms affecting their central nervous system. Today, although mostly associated with mild colds, OC43 is also known to infect nervous tissue.

It's likely that all of the common cold Coronaviruses caused pandemics when they first started infecting humans. For the others, that happened much longer ago than OC43, so the historical record is less detailed, and there is more uncertainty in the genetic analysis.

In fact, it's possible that many or even all of the viruses that currently circulate among humans without problems were much less benign when they first emerged. Another example is the outbreak of severe symptoms from Zika infections in the Americas when the virus arrived there, after circulating in humans for (at least) decades in Africa with only mild symptoms:

In the outbreaks reported up to 2013, most of the infected patients were asymptomatic and only 20% of them had mild symptoms such as fever, arthralgia, maculopapular rash, and conjunctivitis.

So it's suspected that many "harmless" viruses were worse when they first emerged into humans, but with the tools that are currently available, there is no way to establish definitively whether any particular virus caused major pathogenic outbreaks in the past.


10 Deadly Diseases Making A Comeback

With modern medicine, we often become overconfident, believing we can conquer any ailment. Recent outbreaks indicate that we are not as secure as we believe. Diseases once thought conquered are making a comeback.

Their spread is due to many factors: globalization, technology, and the anti-vaccine movement. These outbreaks are not just found in remote jungle corners. Deadly diseases are also popping up in developed countries&mdasheven the United States. These outbreaks indicate that no one is safe from disease.


Spanish flu: the killer that still stalks us, 100 years on

O ne hundred years ago this month, just as the first world war was drawing to a fitful close, an influenza virus unlike any before or since swept across the British Isles, felling soldiers and civilians alike. One of the first casualties was the British prime minister and war leader, David Lloyd George.

On 11 September 1918, Lloyd George, riding high on news of recent Allied successes, arrived in Manchester to be presented with the keys to the city. Female munitions workers and soldiers home on furlough cheered his passage from Piccadilly train station to Albert Square. But later that evening, he developed a sore throat and fever and collapsed.

He spent the next 10 days confined to a sickbed in Manchester town hall, too ill to move and with a respirator to aid his breathing. Newspapers, including the Manchester Guardian, underplayed the severity of his condition for fear of presenting the Germans with a propaganda coup. But, according to his valet, it had been “touch and go”.

Lloyd George, then aged 55, survived, but others were not so lucky. In an era before antibiotics and vaccines, the “Spanish influenza” – so-called because neutral Spain was one of the few countries in 1918 where correspondents were free to report on the outbreak – claimed the lives of nearly 250,000 Britons. Cruelly for a nation that had seen the flower of British male youth mown down by German guns, the majority were adults aged 20 to 40. The mortality was the inverse of most flu seasons, when deaths fall most heavily on the elderly and the under-fives.

The global death toll was inconceivable: according to the most recent estimates, between 50 million and 100 million people worldwide perished in the three pandemic waves between the spring of 1918 and the winter of 1919. Adjusting for population growth, that is equivalent to between 200 million and 425 million today.

Unlike now, when reports of new bird flu outbreaks in south-east Asia are closely monitored by the World Health Organisation, there was no early warning system. Consequently, when it was reported in May 1918 that King Alfonso XIII was ill in Madrid, most people dismissed the Spanish flu as a joke. The main advice was to gargle with salt water and to isolate yourself until the fever had passed. However, these rules did not apply to munitions workers who were urged to “carry on” for the sake of the war effort.

As in other 20th-century epidemics and pandemics, such as HIV/Aids, Africans and Asians suffered proportionately more than Europeans and north Americans. Thus, while the average case mortality in the developed world was about 2%, in India, where 18.5 million perished, it was 6%, and in Egypt, where 138,000 died, it was 10%. In isolated regions with “virgin” populations with no immunity to flu, the impact was truly astonishing – in Western Samoa, for example, a quarter of the population was wiped out. By contrast, American Samoa recorded no casualties.

The severity of the pandemic and the peculiar death pattern puzzle scientists to this day. Few epidemiologists believe the pandemic began in Spain, pointing instead to pre-pandemic waves in Copenhagen and other northern European cities in the summer of 1918. Where the virus first leapt from birds to humans or some other mammal is even more perplexing, with some scientists favouring a Kansas point of origin and others northern France or China.

Earlier this year, in search of answers for a new podcast series, I travelled to Washington DC to interview one of the world’s leading experts on the 1918 pandemic. Jeffrey Taubenberger, a molecular pathologist at the National Institute of Allergy and Infectious Diseases, has been studying the Spanish flu virus for more than 30 years. In the late 1990s he succeeded in retrieving fragments of viral RNA from stored pathology specimens taken from American soldiers who had died of flu at US army camps in 1918 and an Inuit woman who been buried on a beach in Alaska, where the permafrost had preserved her lung tissue from decay.

US Army Camp Hospital at Aix-les-Bains, France. Photograph: Alamy

Using modern molecular techniques, Taubenberger and his colleague, Anne Reid, amplified the fragments and, in 2005, published the virus’s genetic sequence. Their findings were a shock. Previously, epidemiologists had observed that flu pandemics were preceded or followed by outbreaks of influenza-like illnesses in dogs, cats, and horses. It was also known that from time to time flu viruses could infect pigs and, of course, humans, and that wild flu viruses circulated in migratory waterfowl. However, when Taubenberger analysed the genome of the Spanish flu, he found that most of its genes were derived from a bird flu virus. Indeed, Taubenberger considered the H1N1 virus so “avian-like’” he could not discount the possibility that it had transmitted directly from birds to humans shortly before 1918 – and perhaps as early as 1916.

Taubenberger’s discovery raised the terrifying possibility that, in the future, some other avian influenza virus – like the H5N1 bird flu then circulating in south-east Asia or the H7N9 flu currently causing sporadic human infections in China – might suddenly acquire the ability to trigger a similarly devastating pandemic. It also begged the question, why bring the Spanish flu back to life, and what if the virus escaped the laboratory and fell into the hands of terrorists?

To prevent that happening, Taubenberger and other scientists with access to the freezer containing the virus are screened by the FBI and must wear double-gloves, a respirator and a full body suit – like the ones worn by medical workers during the west African Ebola epidemic. They must also submit to an iris scan. “It’s really the equivalent to top secret clearance,” he says.

Continued experimentation is necessary for the development of vaccines and other medical interventions. In mice, the H1N1 Spanish flu is extremely virulent, generating 39,000 times more virus particles than a modern flu strain. By targeting the inflammatory response, Taubenberger has shown that mice can be protected. But scientists are a long way from finding a cure for flu, much less a universal vaccine against seasonal and future pandemic strains.

Frustratingly, it is still not known where and when the Spanish flu acquired its avian genes and first began spreading in humans. The genes map most closely to wild waterfowl from north America but, despite examining the Smithsonian Institute’s extensive bird collections, Taubenberger was unable to find viable autopsy remains from before 1918.

One theory is that the so-called “spillover” event occurred in early 1918, not far from an army camp in Kansas that supplied soldiers to the American Expeditionary Force. Certainly, there were explosive outbreaks of an influenza-like illness at Camp Funston, Fort Riley, in March 1918, followed by similar outbreaks along the eastern seaboard of the US and on the transatlantic troop carriers that ferried American troops to France. However, the earliest fragments of the pandemic virus obtained by Taubenberger date from May 1918, so there is no way of telling whether outbreaks prior to this were caused by the pandemic strain, as opposed to an ordinary seasonal influenza.

A nurse checking on a patient at the Walter Reed hospital flu ward during the influenza pandemic in 1918. Photograph: Underwood Archives/Getty Images

A rival theory, favoured by the British virologist John Oxford, is that the pandemic began at Étaples, a huge British military camp an hour south-west of Boulogne. With accommodation for up to 100,000 soldiers, Étaples lay on a migratory bird flyway close to the Somme estuary and had all the necessary conditions for a spillover event: wild waterfowl, plus chickens and pigs, living in close proximity to men packed into airless barracks. Étaples also had several hospitals where soldiers whose lungs had been compromised by mutagenic gases deployed on the battlefield were evacuated for treatment.

In the winter of 1917, several hundred British soldiers collapsed with influenza-like symptoms and medics at Étaples recorded 156 deaths. At the time, the epidemic was labelled “purulent bronchitis” because of the yellow pus that oozed from the larger airways of the lungs at autopsy (some medics thought it resembled the lung damage from phosgene gas).

Another prominent feature was cyanosis, a distinctive purple-blue discolouration of the lips, ears and cheeks, caused by the loss of oxygen to the heart. Cyanosis was also a hallmark of the pneumonias associated with the Spanish flu – an observation that persuaded doctors writing in the Lancet in 1919 that it and purulent bronchitis had been “fundamentally the same condition”.

Another puzzle is why, in some cases of pneumonia associated with the Spanish flu, the onset was rapid and the lung damage highly localised, while in others, the infection resembled an aggressive bronchopneumonia with extensive haemorrhaging and swelling throughout the lungs. These features have never been adequately explained, with some pathologists arguing that the virus triggered an unusual auto-immune response known as a cytokine storm and others that extensive lung damage is better explained by bacterial infections that followed the flu – a big danger in the days before antibiotics.

But perhaps the biggest unanswered question is why the Spanish flu proved so deadly to young adults. Here, present-day science has hypotheses but no good answers. One suggestion is that the elderly enjoyed greater immunity because, as children, they had been exposed to a pandemic virus with a similar genetic makeup to the H1N1 Spanish flu. Conversely, those aged 28 and over had an immunological blind spot because their first exposure had been to the 1890 “Russian flu”, an H3 virus with a completely different configuration of genes. Or it could be that the unusual mortality pattern seen in 1918 was the result of an as yet unidentified environmental exposure or stressor peculiar to young adults at the time.

Answering those questions is important because genes from the Spanish flu continue to circulate in human and pig populations to this day. Some of these genes are direct descendants of the 1918 virus others have reassorted with other pandemic viruses, such as the 1968 Hong Kong flu and the hybrid H1N1 virus responsible for the 2009 swine flu pandemic. As Taubenberger puts it: “[The outbreak of] 1918 set up a very successful introduction of a bird-like virus in humans that has never gone away in 100 years. It really was the mother of all pandemics.’

Mark Honigsbaum is the author of Living With Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918. His podcast, Going Viral: The Mother of all Pandemics, is available at Libsyn and other podcast providers. @GoingViral_pod.

Ada Darwin, photographed in 2005. She lost her mother, father and a brother in the outbreak of Spanish flu in 1918. Photograph: Christopher Thomond/The Guardian

The pandemic was especially hard on children, perhaps more than any other segment of the population. Take Ada Darwin, who was seven when the “Spanish Lady” called at the house in Manchester’s Moss Side she shared with her mother and five siblings.

“It was Sunday 17 November that I was put to bed,” Darwin recalled when I interviewed her at her home in Chester in 2005. “I remember this great big headache and telling my mother to ‘stop my sister Norah chattering, it’s making my head hurt’.”

The next to fall ill was Ada’s mother, Jane Berry, and her baby sister, Edith, followed by her younger brothers, Austin, two, and Noel, four. With the whole family stricken, Ada’s grandmother was summoned to their home. But by the time she arrived, Ada’s mother was covered in dark blue patches – an indication she had cyanosis – and the prognosis was hopeless. She died the next day – Wednesday 20 November – followed, three days later, by Noel. Jane Berry was just 34.

Then, on 25 November, Darwin learnt that her 38-year-old father, Frederick Berry, a member of the Royal Army Medical Corps, had also died, most likely after catching the flu at Salford military hospital, where he had stayed on after the Armistice to nurse wounded soldiers. He was buried with full military honours at Manchester Southern Cemetery on 29 November, along with Darwin’s mother and Noel. Aged 94, Darwin could still recall the triple funeral cortège as it passed her primary school.

“It’s like a film in my head,” she told me in 2005. “There were the black horses with the plumes made from ostrich feathers, then the gun carriage with my dad’s coffin covered with the union flag. My mother’s coffin was in a big glass hearse with Noel’s coffin under the driver’s seat. My grandma told us my mother had gone to Jesus, but I said, ‘Jesus has got plenty of people, I want my mummy’.”

Darwin was not the only child to be orphaned by the flu. In Cape Town, observed one eyewitness, the autumn wave “made orphans of between two to three thousand children”.

In London, meanwhile, it is estimated that 16,000 people perished between September and December 1918, the majority of them young men and women. The result was that 1919 would be the first year since records began that Britain’s death rate exceeded its birthrate.

Today, there are few people still alive to recall those dark days in November when, according to Manchester’s chief medical officer, James Niven, “it seemed as if it would not be possible to get coffins for the dead, or gravediggers to dig the graves”. All the more reason why, in the centenary year of the pandemic, it is worth recalling the experiences of Darwin and other survivors of the Spanish Lady.


Emerging viruses

The Emerging viruses section of Virology Journal includes studies covering all aspects of new and reemerging viruses that cause severe and/or lethal diseases in humans and animals. Examples of these viruses include filoviruses (Ebola, Marburg), henipaviruses (Nipah, Hendra), Lassa virus, Lujo virus, South American hemorrhagic fever viruses (Junin, Machupo, Guanarito, Chapare, Sabia), Crimean-Congo hemorrhagic fever virus, Rift Valley fever virus, hantaviruses, SARS coronavirus, MERS coronavirus, tick-borne encephalitis viruses, and Zika virus. Topics of interest include but are not limited to virus discovery, mechanisms of virus entry, assembly, protein translation, transcription and replication, pathogenesis, immunology, ecology, and epidemiology. Basic and translational research on the development of preventive vaccines and antiviral drugs and therapeutic interventions is particularly welcome.

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Intranasal exposure of African green monkeys to SARS-CoV-2 results in acute phase pneumonia with shedding and lung injury still present in the early convalescence phase

We recently reported the development of the first African green monkey (AGM) model for COVID-19 based on a combined liquid intranasal (i.n.) and intratracheal (i.t.) exposure to severe acute respiratory syndro.

Authors: Robert W. Cross, Krystle N. Agans, Abhishek N. Prasad, Viktoriya Borisevich, Courtney Woolsey, Daniel J. Deer, Natalie S. Dobias, Joan B. Geisbert, Karla A. Fenton and Thomas W. Geisbert

Citation: Virology Journal 2020 17 :125

Content type: Short report

Published on: 18 August 2020

Association of genotype III of dengue virus serotype 3 with disease outbreak in Eastern Sudan, 2019

Dengue fever (DF) is an arthropod-borne disease caused by dengue virus (DENV). DENV is a member of the genus Flavivirus in the family Flaviviridae. Recently, DENV has been reported as an important emerging infect.

Authors: Mawahib H. Eldigail, Hazem A. Abubaker, Fatima A. Khalid, Tajeldin M. Abdallah, Hassan H. Musa, Mohamed E. Ahmed, Gamal K. Adam, Mustafa I. Elbashir and Imadeldin E. Aradaib

Citation: Virology Journal 2020 17 :118

Published on: 30 July 2020

SARS-CoV-2: characteristics and current advances in research

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection has spread rapidly across the world and become an international public health emergency. Both SARS-CoV-2 and SARS-CoV belong to subfamily Coronav.

Authors: Yicheng Yang, Zhiqiang Xiao, Kaiyan Ye, Xiaoen He, Bo Sun, Zhiran Qin, Jianghai Yu, Jinxiu Yao, Qinghua Wu, Zhang Bao and Wei Zhao

Citation: Virology Journal 2020 17 :117

Published on: 29 July 2020

Relapsing viral keratoconjunctivitis in COVID-19: a case report

Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, many studies have reported the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the conjunctival sac of pa.

Authors: Dongyu Guo, Jianhua Xia, Yang Wang, Xuhong Zhang, Ye Shen and Jian-Ping Tong

Citation: Virology Journal 2020 17 :97

The newly emerged COVID-19 disease: a systemic review

Coronaviruses are large family-RNA viruses that belong to the order Nidovirales, family Coronaviridae, subfamily Coronavirinae. The novel COVID-19 infection, caused by a beta coronavirus called SARS-CoV-2, is a n.

Authors: Endeshaw Chekol Abebe, Tadesse Asmamaw Dejenie, Mestet Yibeltal Shiferaw and Tabarak Malik

Citation: Virology Journal 2020 17 :96

Evaluation of SARS-CoV-2 viral RNA in fecal samples

The need for timely establishment of a complete diagnostic protocol of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is demanded worldwide. We selected 15 positive novel coronavirus disease 19 (.

Authors: Alvaro Mesoraca, Katia Margiotti, Antonella Viola, Antonella Cima, Davide Sparacino and Claudio Giorlandino

Citation: Virology Journal 2020 17 :86

Content type: Short report

Published on: 30 June 2020

Non-optimal effectiveness of convalescent plasma transfusion and hydroxychloroquine in treating COVID-19: a case report

Convalescent plasma (CP) transfusion was reported to be effective in treating critically ill patients with COVID-19, and hydroxychloroquine could potently inhibit SARS-CoV-2 in vitro. Herein, we reported a cas.

Authors: Tian-min Xu, Bin Lin, Cong Chen, Long-gen Liu and Yuan Xue

Citation: Virology Journal 2020 17 :80

Published on: 19 June 2020

Challenge infection model for MERS-CoV based on naturally infected camels

Middle East Respiratory Syndrome coronavirus (MERS-CoV) is an emerging virus that infects humans and camels with no approved antiviral therapy or vaccine. Some vaccines are in development for camels as a one-h.

Authors: Naif Khalaf Alharbi, Osman H. Ibrahim, Ali Alhafufi, Samy Kasem, Ali Aldowerij, Raed Albrahim, Ali Abu-obaidah, Ali Alkarar, Faisal Altaib Bayoumi, Ali Mohammed Almansour, Musaad Aldubaib, Hail M. Al-Abdely, Hanan H. Balkhy and Ibrahim Qasim

Citation: Virology Journal 2020 17 :77

Published on: 17 June 2020

Investigation of the immunogenicity of Zika glycan loop

Zika virus (ZIKV) is a major human pathogen and member of the Flavivirus genus. Previous studies have identified neutralizing antibodies from Zika patients that bind to quaternary epitopes across neighboring enve.

Authors: Elizabeth A. Henderson, Christina C. Tam, Luisa W. Cheng, Annie Elong Ngono, Anh-Viet Nguyen, Sujan Shresta, Matt McGee, Hal Padgett, Laurence K. Grill and Mikhail Martchenko Shilman

Citation: Virology Journal 2020 17 :43

Published on: 31 March 2020

Recent sylvatic yellow fever virus transmission in Brazil: the news from an old disease

Yellow fever (YF) is an acute viral disease, affecting humans and non-human primates (NHP), caused by the yellow fever virus (YFV). Despite the existence of a safe vaccine, YF continues to cause morbidity and .

Authors: Natalia Ingrid Oliveira Silva, Lívia Sacchetto, Izabela Maurício de Rezende, Giliane de Souza Trindade, Angelle Desiree LaBeaud, Benoit de Thoisy and Betânia Paiva Drumond

Citation: Virology Journal 2020 17 :9

Published on: 23 January 2020

Marburg virus pathogenesis – differences and similarities in humans and animal models

Marburg virus (MARV) is a highly pathogenic virus associated with severe disease and mortality rates as high as 90%. Outbreaks of MARV are sporadic, deadly, and often characterized by a lack of resources and f.

Authors: Kyle Shifflett and Andrea Marzi

Citation: Virology Journal 2019 16 :165

Published on: 30 December 2019

A live-cell imaging system for visualizing the transport of Marburg virus nucleocapsid-like structures

Live-cell imaging is a powerful tool for visualization of the spatio-temporal dynamics of moving signals in living cells. Although this technique can be utilized to visualize nucleocapsid transport in Marburg .

Authors: Yuki Takamatsu, Olga Dolnik, Takeshi Noda and Stephan Becker

Citation: Virology Journal 2019 16 :159

Published on: 19 December 2019

Virology Downunder, a meeting commentary from the 2019 Lorne Infection and Immunity Conference, Australia

The aim of this article is to summarise the virology content presented at the 9th Lorne Infection and Immunity Conference, Australia, in February 2019. The broad program included virology as a key theme, and t.

Authors: Gregor Ebert, Prasad N. Paradkar and Sarah L. Londrigan

Citation: Virology Journal 2019 16 :109

Content type: Meeting report

Published on: 2 September 2019

Serological evidence of Flavivirus circulation in human populations in Northern Kenya: an assessment of disease risk 2016–2017

Yellow fever, Dengue, West Nile and Zika viruses are re-emerging mosquito-borne Flaviviruses of public health concern. However, the extent of human exposure to these viruses and associated disease burden in Kenya.

Authors: E. Chepkorir, D. P. Tchouassi, S. L. Konongoi, J. Lutomiah, C. Tigoi, Z. Irura, F. Eyase, M. Venter and R. Sang

Citation: Virology Journal 2019 16 :65

Optimization of Zika virus envelope protein production for ELISA and correlation of antibody titers with virus neutralization in Mexican patients from an arbovirus endemic region

Zika virus (ZIKV) has become a global threat with immediate need for accurate diagnostics, efficacious vaccines and therapeutics. Several ZIKV envelope (Env)-based vaccines have been developed recently. Howeve.

Authors: Young Chan Kim, Cesar Lopez-Camacho, Joanne E. Nettleship, Nahid Rahman, Michelle L. Hill, Laura Silva-Reyes, Georgina Ortiz-Martinez, Gloria Figueroa-Aguilar, María Antonieta Mar, Héctor Vivanco-Cid, Christine S. Rollier, Nicole Zitzmann, Martha Eva Viveros-Sandoval, Raymond J. Owens and Arturo Reyes-Sandoval

Citation: Virology Journal 2018 15 :193

Published on: 27 December 2018

Combination of ELISA screening and seroneutralisation tests to expedite Zika virus seroprevalence studies

Here we propose a strategy allowing implementing efficient and practicable large-scale seroepidemiological studies for Zika Virus (ZIKV). It combines screening by a commercial NS1 protein-based Zika IgG ELISA.

Authors: Elif Nurtop, Paola Mariela Saba Villarroel, Boris Pastorino, Laetitia Ninove, Jan Felix Drexler, Yelin Roca, Bouba Gake, Audrey Dubot-Peres, Gilda Grard, Christophe Peyrefitte, Stéphane Priet, Xavier de Lamballerie and Pierre Gallian

Citation: Virology Journal 2018 15 :192

Content type: Short report

Published on: 27 December 2018

The Correction to this article has been published in Virology Journal 2019 16:12

Intra-epidemic genome variation in highly pathogenic African swine fever virus (ASFV) from the country of Georgia

African swine fever virus (ASFV) causes an acute hemorrhagic infection in suids with a mortality rate of up to 100%. No vaccine is available and the potential for catastrophic disease in Europe remains elevate.

Authors: Jason Farlow, Marina Donduashvili, Maka Kokhreidze, Adam Kotorashvili, Nino G. Vepkhvadze, Nato Kotaria and Ana Gulbani

Citation: Virology Journal 2018 15 :190

Published on: 14 December 2018

Crystal structure of Usutu virus envelope protein in the pre-fusion state

Usutu virus (USUV) is a mosquito-born flavivirus that can infect multiple avian and mammalian species. The viral surface envelope (E) protein functions to initiate the viral infection by recognizing cellular r.

Authors: Zimin Chen, Fei Ye, Sheng Lin, Fanli Yang, Yanwei Cheng, Yu Cao, Zhujun Chen and Guangwen Lu

Citation: Virology Journal 2018 15 :183

Content type: Short report

Published on: 26 November 2018

RIG-I is responsible for activation of type I interferon pathway in Seneca Valley virus-infected porcine cells to suppress viral replication

Retinoic acid-inducible gene I (RIG-I) is a key cytosolic receptor of the innate immune system. Seneca valley virus (SVV) is a newly emerging RNA virus that infects pigs causing significant economic losses in .

Authors: Pengfei Li, Xiangle Zhang, Weijun Cao, Fan Yang, Xiaoli Du, Zhengwang Shi, Miaotao Zhang, Xiangtao Liu, Zixiang Zhu and Haixue Zheng

Citation: Virology Journal 2018 15 :162

Published on: 23 October 2018

Seroprevalence of antibodies to enterovirus 71 and coxsackievirus A16 among people of various age groups in a northeast province of Thailand

Hand, foot and mouth disease (HFMD) is endemic among population of young children in Thailand. The disease is mostly caused by enterovirus 71 (EV71) and coxsackievirus A16 (CA16).

Authors: Hatairat Lerdsamran, Jarunee Prasertsopon, Anek Mungaomklang, Chompunuch Klinmalai, Pirom Noisumdaeng, Kantima Sangsiriwut, Boonrat Tassaneetrithep, Ratigorn Guntapong, Sopon Iamsirithaworn and Pilaipan Puthavathana

Citation: Virology Journal 2018 15 :158

Published on: 16 October 2018

Assessment of enteroviruses from sewage water and clinical samples during eradication phase of polio in North India

The Enterovirus (EV) surveillance system is inadequate in densely populated cities in India. EV can be shed in feces for several weeks these viruses are not easily inactivated and may persist in sewage for long .

Authors: Sarika Tiwari and Tapan N. Dhole

Citation: Virology Journal 2018 15 :157

Published on: 16 October 2018

Screening and identification of B-cell epitopes within envelope protein of tembusu virus

Tembusu virus is a newly emerging flavivirus that caused egg-drop syndrome in ducks in China. TMUV envelope protein is a major structural protein locates at the surface of tembusu virus particle. During tembus.

Authors: Dongmin Zhao, Kaikai Han, Xinmei Huang, Lijiao Zhang, Huili Wang, Na Liu, Yujie Tian, Qingtao Liu, Jing Yang, Yuzhuo Liu and Yin Li

Citation: Virology Journal 2018 15 :142

Published on: 17 September 2018

Heparan sulfate is an important mediator of Ebola virus infection in polarized epithelial cells

Currently, no FDA-approved vaccines or treatments are available for Ebola virus disease (EVD), and therapy remains largely supportive. Ebola virus (EBOV) has broad tissue tropism and can infect a variety of ce.

Authors: Manasi Tamhankar, Dawn M. Gerhardt, Richard S. Bennett, Nicole Murphy, Peter B. Jahrling and Jean L. Patterson


Historical Vaccine Safety Concerns

There is solid medical and scientific evidence that the benefits of vaccines far outweigh the risks. Despite this, there have been concerns about the safety of vaccines for as long as they have been available in the U.S. This page will explain past vaccine safety concerns, how they have been resolved, and what we have learned.

In 1955, some batches of polio vaccine given to the public contained live polio virus, even though they had passed required safety testing. Over 250 cases of polio were attributed to vaccines produced by one company: Cutter Laboratories. This case, which came to be known as the Cutter Incident, resulted in many cases of paralysis. The vaccine was recalled as soon as cases of polio were detected.

The Cutter Incident was a defining moment in the history of vaccine manufacturing and government oversight of vaccines, and led to the creation of a better system of regulating vaccines. After the government improved this process and increased oversight, polio vaccinations resumed in the fall of 1955.

At the time, there was no system in place to compensate people who might have been harmed by a vaccine. Today we have the National Vaccine Injury Compensation Program external icon (VICP), which uses scientific evidence to determine whether a vaccine might be the cause of an illness or injury, and provides compensation to individuals found to have been harmed by a vaccine. The VICP remains a model method for ensuring that all persons harmed by vaccines are compensated quickly and fairly, while also protecting companies that make lifesaving products from financially unsustainable liability claims through the tort system.

For more information, see Food and Drug Administration (FDA)&rsquos Science and the Regulation of Biological Products external icon page.

From 1955 to 1963, an estimated 10-30% of polio vaccines administered in the US were contaminated with simian virus 40 (SV40). The virus came from monkey kidney cell cultures used to make polio vaccines at that time. Most of the contamination was in the inactivated polio vaccine (IPV), but it was also found in oral polio vaccine (OPV). After the contamination was discovered, the U.S. government established testing requirements to verify that all new lots of polio vaccines were free of SV40.

Because of research done with SV40 in animal models, there has been some concern that the virus could cause cancer in humans. However, most studies looking at the relationship between SV40 and cancers are reassuring, finding no causal association between receipt of SV40-contaminated polio vaccine and development of cancer.

No vaccines used today contain SV40 virus.

Petricciani J, Sheets R, Griffiths E, Knezevic I. Adventitious agents in viral vaccines: Lessons learned from 4 case studies. Biologicals. 2014 Sep42(5):223-36. https://www.ncbi.nlm.nih.gov/pubmed/25135887 external icon

Mohammad-Taheri Z, Nadji SA, Raisi F, Mohammadi F, Bahadori M, Mark EJ. No association between simian virus 40 and diffuse malignant mesothelioma of the pleura in Iranian patients: a molecular and epidemiologic case-control study of 60 patients. Am J Ind Med. 2013 Oct56(10):1221-5. https://www.ncbi.nlm.nih.gov/pubmed/23828611 external icon

Eom M, Abdul-Ghafar J, Park SM, Han JH, Hong SW, Kwon KY, Ko ES, Kim L, Kim WS, Ha SY, Lee KY, Lee CH, Yoon HK, Choi YD, Chung MJ, Jung SH. No detection of simian virus 40 in malignant mesothelioma in Korea. Korean J Pathol. 2013 Apr47(2):124-9. https://www.ncbi.nlm.nih.gov/pubmed/23667371 external icon

Qi F, Carbone M, Yang H, Gaudino G. Simian virus 40 transformation, malignant mesothelioma and brain tumors. Expert Rev Respir Med. 2011 Oct5(5):683-97. https://www.ncbi.nlm.nih.gov/pubmed/21955238 external icon

Hmeljak J, Kern I, Cör A. No implication of Simian virus 40 in pathogenesis of malignant pleural mesothelioma in Slovenia. Tumori. 2010 Sep-Oct96(5):667-73.https://www.ncbi.nlm.nih.gov/pubmed/21302609 external icon

Lundstig A, Dejmek A, Eklund C, Filinic I, Dillner J. No detection of SV40 DNA in mesothelioma tissues from a high incidence area in Sweden. Anticancer Res. 2007 Nov-Dec27(6B):4159-61. https://www.ncbi.nlm.nih.gov/pubmed/18225586 external icon

Poulin DL, DeCaprio JA. Is there a role for SV40 in human cancer? J Clin Oncol. 2006 Sep 1024(26):4356-65. Review. https://www.ncbi.nlm.nih.gov/pubmed/16963733 external icon

Thu GO, Hem LY, Hansen S, Møller B, Norstein J, Nøkleby H, Grotmol T. Is there an association between SV40 contaminated polio vaccine and lymphoproliferative disorders? An age-period-cohort analysis on Norwegian data from 1953 to 1997. Int J Cancer. 2006 Apr 15118(8):2035-9. https://www.ncbi.nlm.nih.gov/pubmed/16287082 external icon

Dang-Tan T, Mahmud SM, Puntoni R, Franco EL. Polio vaccines, Simian Virus 40, and human cancer: the epidemiologic evidence for a causal association. Oncogene. 2004 Aug 2323(38):6535-40. https://www.ncbi.nlm.nih.gov/pubmed/15322523 external icon

In 1976 there was a small increased risk of a serious neurological disorder called Guillain-Barré Syndrome (GBS) following vaccination with a swine flu vaccine. The increased risk was approximately 1 additional case of GBS for every 100,000 people who got the swine flu vaccine. When over 40 million people were vaccinated against swine flu, federal health officials decided that the possibility of an association of GBS with the vaccine, however small, necessitated stopping immunization until the issue could be explored.

The Institute of Medicine (IOM) conducted a thorough scientific review external icon of this issue in 2003 and concluded that people who received the 1976 swine influenza vaccine had an increased risk for developing GBS. Scientists have multiple theories on why this increased risk may have occurred, but the exact reason for this association remains unknown.

Today, CDC continually monitors the safety of seasonal and pandemic flu vaccines, and any possible safety problems are discussed by the Advisory Committee on Immunization Practices. Vaccination is the best way to prevent flu infection and its complications, and having safe and effective flu vaccines is extremely important.

In 1998, some research caused concern that hepatitis B vaccination might be linked with multiple sclerosis (MS), a progressive nerve disease. However, this link has not been found in the large body of research that has been done since that time. In 2002, the Institute of Medicine thoroughly reviewed all available evidence and published a report external icon . In this thorough review, the IOM committee concluded that there is no link between hepatitis B vaccination and MS.

In 1998, the FDA approved RotaShield vaccine, the first vaccine to prevent rotavirus gastroenteritis. Shortly after it was licensed, some infants developed intussusception (rare type of bowel obstruction that occurs when the bowel folds in on itself) after being vaccinated. At first, it was not clear if the vaccine or some other factor was causing the bowel obstructions. CDC quickly recommended that use of the vaccine be suspended and immediately started two emergency investigations to find out if receiving RotaShield vaccine was causing some of the cases of intussusception.

The results of the investigations showed that RotaShield vaccine caused intussusception in some healthy infants younger than 12 months of age who normally would be at low risk for this condition.

The Advisory Committee on Immunization Practices (ACIP) withdrew its recommendation to vaccinate infants with RotaShield® vaccine, and the manufacturer voluntarily withdrew RotaShield from the market in October 1999.

There were concerns that the meningococcal vaccine Menactra caused a serious neurological disorder called Guillain-Barré Syndrome (GBS). Between 2005 and 2008, there were a number of youth who reported GBS after receiving Menactra. However, to investigate whether GBS was caused by the vaccine or was coincidental with vaccination, two large studies were conducted, with a combined total of over 2 million vaccinated adolescents. The results of these studies showed that there was no link between Menactra and GBS.

In 2007, Merck & Company, Inc. voluntarily recalled 1.2 million doses of Haemophilus influenzae type b (Hib) vaccines due to concerns about potential contamination with bacteria called B. cereus. The recall was a precaution, and after careful review, no evidence of B. cereus infection was found in recipients of recalled Hib vaccines.

An increased risk of narcolepsy (a chronic sleep disorder) was found following vaccination with Pandemrix, a monovalent 2009 H1N1 influenza vaccine that was used in several European countries during the H1N1 influenza pandemic. This risk was initially found in Finland, and then some other European countries also detected an association.

Pandemrix is manufactured by GlaxoSmithKline in Europe and was specifically produced for pandemic 2009 H1N1 influenza. Pandemrix was never licensed for use in the United States.

In 2014, CDC published a study on the association between 2009 H1N1 influenza vaccines, 2010/2011 seasonal influenza vaccines, and narcolepsy. The study found that vaccination was not associated with an increased risk for narcolepsy.

In 2018, a study team including CDC scientists analyzed and published vaccine safety data on adjuvanted pH1N1 vaccines (arenaprix-AS03, Focetria-MF59, and Pandemrix-AS03) from 10 global study sites. Researchers did not detect any associations between the vaccines and narcolepsy.

  • Incidence rate study data did not show a rise in the rate of narcolepsy following vaccination except in the one signaling country included (Sweden, which used Pandemrix).
  • Case-control analyses for Arepanrix-AS03 did not show evidence of an increased risk of narcolepsy.
  • Case-coverage analysis for Pandemrix-ASO3 in children in the Netherlands did not show evidence of an increased risk of narcolepsy, but the number of exposed cases was small (N=7).
  • Cases-control analysis for Focetria-MF59 did not show evidence of an increased risk of narcolepsy.

Porcine circovirus (PCV) is a common virus found in pigs. In 2010, it was discovered that both rotavirus vaccines licensed in the U.S.- Rotarix and RotaTeq- contained PCV type 1. PCV1 is not known to cause disease in animals or humans. In fact, PCV is common in healthy pigs, and humans are routinely exposed to the virus by eating pork. Safety monitoring of both vaccines has not shown any reason for concern about PCV.

In 2013, Merck & Company, Inc. recalled one batch of Gardasil, a human papillomavirus (HPV) vaccine. The recall was a precaution following an error in the manufacturing process. The company had concerns that a small number of vials might have contained glass particles due to breakage. No health problems were reported relating to this recall other than known side effects that can result from any vaccination, like arm redness and soreness where the shot was given.


Three areas of agreement: Some patients who are listed as having died of COVID-19 are categorized “without COVID-19 documented”

Second, Dr. Ioannidis is correct that some patients who are listed as having died of COVID-19 are categorized “without COVID-19 documented”. But this isn’t as a big a problem as it sounds. Though it soon became widely available in the US, early in the pandemic, testing was available for only a small fraction of patients. It was almost never available for people who died at home. It is still not widely available in many parts of the world. However, this does not necessarily mean doctors are wrong to categorize certain deaths as due COVID-19 without testing.

Like many viruses, SARS-CoV-2 produces a characteristic set of signs and symptoms. In the words of Dr. David Oliver, “Doctors treating patients with COVID-19 over the past 12 months recognise a very different clinical syndrome in the sickest patients and a tide of cases of a kind, severity, and clinical course that we have not seen before”. Indeed, this novelty is what allowed the heroic Chinese ophthalmologist Dr. Li Wenliang, who tragically died from the virus himself, to recognize a new disease in the first place.

Doctors are right to put COVID-19 as the cause of death when someone who lives where the virus is circulating, develops classic COVID-19 symptoms, and then dies while gasping for air. This is true even if that person was not tested for SARS-CoV-2, though of course confirming the diagnosis with a test is ideal. As the CDC stated in its death certificate guidelines, “Ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty”.

The argument that a positive test is required to diagnosis COVID-19 implies that the disease cannot exist without the test, which would be nice if it were true. It’s the same logic employed by Donald Trump when he said, “Cases are up because we have the best testing in the world and we have the most testing”. Of course, people contracted and died of viruses before testing was invented and even before people knew what viruses were.


6 Edgar Enrique Hernandez

&ldquoKid Zero&rdquo may sound like the name of a superhero sidekick, but it was actually the nickname of the first human infected with swine flu. Four-year-old Edgar Enrique Hernandez from Mexico tested positive for H1N1 swine flu in March 2009. Soon, photos of his smiling face were on the front page of every newspaper.

In Edgar&rsquos hometown, the rural town of La Gloria, several hundred people fell ill in a matter of weeks, and two children died. According to the World Health Organization, H1N1 has caused or contributed to the deaths of over 18,000 people as of January 2016. However, the CDC reports that the death count worldwide may actually be between 150,000 and 575,000.

Many residents of La Gloria blame nearby industrial hog farms for the outbreak, but the jury is still out on whether H1N1 originated in the pigpens. Also unconfirmed is whether little Edgar was actually the first human to contract the H1N1 swine flu. [6] Regardless, the local authorities of La Gloria recently erected a bronze statue of Edgar in an interesting attempt to bring tourists to the town famous for swine flu.


Major Epidemics of the Modern Era

For more than a century, countries have wrestled with how to improve international cooperation in the face of major outbreaks of infectious diseases. The COVID-19 pandemic, which killed more than 2.5 million people and brought the world to a near halt in 2020, underscores the urgency.

A new outbreak of cholera, a bacterial infection contracted through the consumption of contaminated food and water, begins in India at the turn of the century. It’s the latest wave of a disease that has caused pandemics intermittently since the early 1800s. The outbreak spreads to Russia, as well as to parts of the Middle East and North Africa, ultimately killing hundreds of thousands of people—with particularly high death tolls in India and Russia. Advancements in sanitation and public hygiene are credited with preventing the pandemic from taking hold in Europe and North America.

A new influenza virus begins to spread worldwide amid the upheavals of World War I. There is no consensus on the origin of the pandemic, but it is first publicly reported in Spain. It infects an estimated five hundred million people, roughly one-third of the world’s population at the time, and kills some fifty million, with an unusually high fatality rate among otherwise healthy young adults. Many governments look to isolation measures, quarantines, and disinfecting efforts, but the global movement of troops hinders containment. At the time, there is no flu vaccine and antibiotics have not yet been developed to treat secondary bacterial infections. In the United States alone, about 675,000 people die, lowering the country’s average life expectancy by more than twelve years.

Scottish scientist Alexander Fleming discovers penicillin, the first antibiotic—a class of drugs used to treat bacterial infections—marking a major milestone for global health. Widespread use of antibiotics takes off in the early 1940s during World War II. They soon become the go-to treatment for common illnesses, such as strep throat and urinary tract infections, and significantly reduce the death rates for many ailments, including syphilis and tuberculosis.

The World Health Organization’s (WHO) constitution, signed by more than sixty countries, enters into force in April 1948. The body, a part of the newly formed United Nations, sets out to coordinate international health policy, seeking to combat diseases such as malaria and tuberculosis and improve sanitation practices. The WHO builds on previous agencies including the League of Nations’ Health Organization (1920–1948), as well as earlier initiatives such as the International Sanitary Conferences, the Pan American Health Organization, and the International Office of Public Hygiene, which beginning in the nineteenth century issued regulations to improve health standards and prevent the spread of diseases such as cholera and yellow fever.

A new strain of influenza virus, designated H2N2, is reported in Singapore in February 1957, and soon spreads to China, Hong Kong, the United Kingdom, and the United States. Though less severe than the Spanish Flu, the Asian Flu kills more than one million people worldwide. A second wave of cases beginning at the end of that year is particularly deadly, and young children, elderly people, and pregnant women are hardest hit. A vaccine is quickly developed in 1957, but its deployment is limited and it does little to mitigate the outbreak, experts later say.

A cholera pandemic originating in Indonesia spreads to other parts of Asia, the Middle East, and Africa over the course of a decade, and continues to this day. By the 1990s outbreaks also take hold in South America, the first on that continent in nearly a century. An outbreak in Zimbabwe in 2008–09 kills more than four thousand people, and major outbreaks in Haiti and Yemen each affect more than a half million people. Some three million people are infected with the bacteria that cause cholera each year, and it remains endemic in close to fifty countries. Health experts say oral cholera vaccines, introduced in the 1990s, are not a replacement for improved sanitation.

A decade after the Asian Flu, a new strain called H3N2 emerges. Commonly called the Hong Kong Flu, it emerges first in Hong Kong, then a British colony, in July 1968. It soon travels across East and South Asia, then to Australia, Europe, and North America, and on to Africa and South America by 1969. U.S. troops returning from the Vietnam War are believed to have brought the virus to the United States. An estimated one million people die in the pandemic, about half of them Hong Kongers and many of them people sixty-five years of age or older. Descendants of the H3N2 virus continue to circulate seasonally worldwide.

The last known case of smallpox, a viral disease that plagued humans for millennia, is diagnosed in 1977 in Somalia, following a nearly two-decade-long global vaccination campaign. Three years later the WHO formally declares it eradicated around the globe. The elimination of the disease, which was fatal in as many as one-third of patients, marks unusual U.S.-Soviet cooperation during the Cold War. It also highlights major advancements in the study and use of vaccines: polio vaccines introduced in the 1950s and 1960s lead to similar success globally, and vaccines are credited with reducing rates of illnesses such as measles, diphtheria, and whooping cough to all-time lows.

A 1981 report by what is now the U.S. Centers for Disease Control and Prevention (CDC) describes a rare form of pneumonia that is later identified as Acquired Immunodeficiency Syndrome, or AIDS. It is the most advanced stage of Human Immunodeficiency Virus (HIV). This marks the start of an explosive growth of cases, and by the early 1990s AIDS becomes the leading cause of death in men between the ages of twenty-five and forty-four in the United States. In 1996, the United Nations establishes UNAIDS to coordinate global action. The introduction of antiretroviral therapy helps to bring down the U.S. death toll, but the epidemic grows across Africa. The 2003 U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) boosts international funding, and between 2000 and 2018 HIV-related deaths decrease by 45 percent. Today, close to forty million people have HIV/AIDS, more than two-thirds of whom are in sub-Saharan Africa. Tens of millions of people have died from the disease.

The Severe Acute Respiratory Syndrome (SARS) coronavirus, part of a family of viruses that commonly cause respiratory symptoms such as coughing and shortness of breath, is first identified in late 2002 in southern China. SARS spreads to more than two dozen countries across four continents, infecting more than eight thousand people. In March 2003, the WHO triggers its Global Outbreak Alert and Response Network (GOARN) to coordinate research by teams of international experts and the deployment of supplies and health workers to affected countries. Health experts sharply criticize Beijing for covering up the initial spread of the virus. SARS kills close to eight hundred, most within China and Hong Kong, by the time the outbreak is quelled in mid-2003. The virus is thought to have been transmitted to humans via contact with civet cats.

The WHO rewrites its International Health Regulations, rules originally drawn up in 1969 that are binding on all WHO member states. The new rules aim to boost collective defenses against global health challenges and improve pandemic preparedness and response. Entering into force in June 2007, they require states to notify the WHO of potential global health emergencies. They also grant the WHO director-general the authority to declare a public health emergency of international concern, or PHEIC, in order to mobilize a global response. The changes are meant to build on the GOARN established in 2000.

A new influenza virus, labeled H1N1 and commonly referred to as the swine flu because of its links to influenza viruses that circulate in pigs, begins to spread in early 2009 in Mexico and the United States. Unlike other strains of influenza, H1N1 disproportionately affects children and younger people. The CDC calls it the “first global flu pandemic in forty years.” The WHO declares a PHEIC in April 2009, then designates the spread of H1N1 a pandemic in June, after the virus reaches more than seventy countries. In response, some countries advise against travel to North America, and China imposes mandatory quarantines for patients and their close contacts. The CDC estimates that between 151,700 and 575,400 people die worldwide—around 12,500 in the United States—in the first year after the virus is discovered. Around 80 percent of those who die are younger than sixty-five. The WHO announces the pandemic’s end in August 2010, though the strain continues to circulate seasonally.

A new coronavirus, named Middle East Respiratory Syndrome (MERS), is transmitted to humans from camels in 2012 in Saudi Arabia. The largest outbreak occurs on the Arabian Peninsula in the first half of 2014, with the Saudi city of Jeddah as its epicenter. In 2015, South Korea is home to the second-largest outbreak. More than two dozen countries report cases of the viral respiratory disease in the following years, though the majority of cases are in Saudi Arabia. The virus commonly causes pneumonia in those infected and has a relatively high fatality rate: of the roughly 2,500 people diagnosed with MERS since its discovery, more than 850 have died from the disease.

In May 2014, WHO Director-General Margaret Chan declares a PHEIC over a rise in polio cases in Africa and Asia. The virus, which paralyzed or killed a half million people yearly at its peak in the early 1950s, had been nearly eradicated after mass vaccination campaigns starting in the late 1950s. The disease, which disproportionately affects young people, proves hard to eliminate completely, particularly in conflict zones. Widespread mistrust of vaccination programs is a major challenge. As of early 2020, the PHEIC over the possible spread of polio remains in place, and the disease is still endemic in three countries: Afghanistan, Nigeria, and Pakistan.

In early 2014, cases of the Ebola virus, a rare and severe infectious disease that leads to death in roughly half of those who contract it, are detected in Guinea and soon after in Liberia and Sierra Leone. It is the first time the disease moves into densely populated urban areas, allowing for rapid transmission. The outbreak eventually spreads to seven other countries, including several European states and the United States, causing more than eleven thousand deaths in all. Mistrust of health workers and rumors again present challenges to containment. The WHO, which declares the outbreak a PHEIC in August 2014, is criticized for what many call a slow response. In September 2014, the UN Security Council adopts a resolution calling on member states to pool global resources to combat the crisis, and countries including the United States and United Kingdom deploy health workers and other aid. The hardest-hit countries declare themselves Ebola-free in June 2016.

The WHO reports in 2015 that malaria infections are down by more than one-third globally compared to 2000, as the United Nations and the Bill & Melinda Gates Foundation launch a major joint effort to eradicate the disease by 2040. Malaria still kills several hundred thousand people yearly, two-thirds of whom are children under five. Eradication efforts focus on the eleven countries where the large majority of malaria cases occur, all of which are in sub-Saharan Africa except for India. Meanwhile, cases of dengue, another mosquito-borne disease, spike between 2000 and 2015, partly due to increased reporting. Dengue is endemic in more than a hundred countries, with the majority of the 100–400 million yearly cases occurring in Asia. These diseases have proven difficult to eliminate, as researchers confront numerous challenges to developing successful vaccines.

An outbreak of the Zika virus, first discovered in Uganda in the 1940s and transmitted mainly by mosquitoes, takes off in Brazil in early 2015. In February 2016, the WHO declares the outbreak a PHEIC, and by the middle of the year more than sixty countries report cases of the virus, including the United States. Thousands of women infected with the virus while pregnant give birth to babies with microcephaly, a condition in which a child’s head is smaller than normal, and other congenital conditions. Some governments urge women to delay pregnancy amid the outbreak. Despite calls for cancellation, the 2016 Summer Olympics in Rio de Janeiro go ahead as planned. The WHO declares the end of the epidemic in November 2016.

In August 2018, the Democratic Republic of Congo (DRC) declares an outbreak of the Ebola virus in the country’s northeast. Several cases are later reported across the border in Uganda. Protracted conflict in the area hampers the response, as health workers face attacks by armed groups misinformation and mistrust among the local population are also challenges. By June 2019, the Ebola outbreak becomes the second largest in history, and in July the WHO declares a PHEIC, urging increased international support to end the crisis. More than 3,400 people are infected with the virus, and close to 2,300 die. In June 2020, nearly two years after the outbreak’s start, the WHO declares it over. However, new cases emerge afterward in the DRC and in Guinea, prompting international efforts to try to prevent the virus from spreading.

A new coronavirus emerges in China’s Hubei Province in late 2019, spreading rapidly to other parts of China and infecting tens of thousands of people. The disease soon travels throughout the rest of the world, and in March 2020, the WHO designates the outbreak a pandemic. Many governments impose restrictions to try to stop the virus’s spread, including lockdowns, mandates to wear face masks, limits on large gatherings, and quarantines for people who are infected. Within a year, more than 2.5 million people die, with a half million deaths in the United States alone. The economic toll is described as the worst decline since the Great Depression, with supply-chain disruptions and job losses reverberating worldwide. Meanwhile, efforts to develop a vaccine yield several highly effective options, the fastest-ever creation of a successful vaccine.


The Latest: India surpasses China in coronavirus cases

A truck carrying migrant workers leaves for Uttar Pradesh state, on the outskirts of Mumbai, India, Thursday, May 14, 2020. The pandemic has exposed India’s deep economic divide as millions of migrant workers have left Indian cities with luggage bags perched on their heads and children in their arms, walking down highways in desperate attempts to reach the countryside. (AP Photo/Rajanish Kakade)

The Latest on the coronavirus pandemic. The new coronavirus causes mild or moderate symptoms for most people. For some, especially older adults and people with existing health problems, it can cause more severe illness or death.

— India surpasses China in coronavirus infection cases.

— Democrats power massive $3 trillion response bill through House.

— Canada’s largest airline laying off at least 20,000 because of pandemic.

— Trump hopeful to have virus vaccine on market by end of year or shortly after.

NEW DELHI — India’s coronavirus infection cases have surpassed China’s with the health ministry on Saturday reporting the spike to 85,940 cases with 2,752 deaths.

In total, China has reported 4,633 deaths among 82,933 cases since the virus was first detected late last year in the central city of Wuhan.

The worst hit Indian states are Maharashtra with 29,100 cases, Tamil Nadu 10,108, Gujarat 9,931 and New Delhi 8,895.

Prime Minister Narendra Modi’s government is due to announce this weekend a decision whether to extend the 54-day-old lockdown. Early this month, it started gradually easing the restrictions to resume economic activity by allowing neighborhood shops to reopen and manufacturing and farming to resume. It also has resumed a limited train service across the country to help stranded migrant workers, students and tourists.

SEOUL, South Korea — South Korean officials say they so far confirmed 162 coronavirus cases linked to club goers in the densely populated Seoul metropolitan area, but also expressed cautious hope that infections are beginning to wane.

Health Ministry official Son Young-rae on Saturday said the country may have ducked a major surge in transmissions in a region where half of its 51 million people live, pointing out that the daily increase in infections have been within 30 over the past days despite a jump in tests.

Son said 46,000 have so far been tested after health workers earlier this month detected a slew of infections linked to clubs and other nightspots in Seoul’s Itaewon entertainment district.

“It’s notable there were no new transmissions in churches, call centers and gyms where virus carriers went to,” Son said.

He said this was a sign that facilities and businesses are properly practicing hygiene and enforcing distance between people, which he said would be crucial as the country explores a more sustainable form of social distancing.

Authorities had expanded what they call “anonymous testing,” which allows people to provide only their phone numbers and not their names for COVID-19 tests. Some South Korean media have described the Itaewon clubs linked to infections as catering to sexual minorities, which raised concern of discouraging sick people from coming forward in fear of homophobic backlash.

South Korea’s Centers for Disease Control and Prevention on Saturday reported 19 new cases of the coronavirus, but 10 were linked to passengers arriving from abroad.

WASHINGTON — Democrats have powered a massive $3 trillion coronavirus response bill through the House, over Republican opposition.

The 1,815-page measure is aimed at propping up a U.S. economy in freefall and a health care system overwhelmed by a pandemic that’s still ravaging the country. It’s also an election-year statement of priorities by Democrats.

The measure has no chance of passing the GOP-controlled Senate and has already drawn a White House veto threat. Passage sets up difficult negotiation with the White House and Senate Republicans over what’s likely to be the last major COVID-19 response bill before November’s presidential and congressional elections.

CANBERRA, Australia — Restrictions put in place to stop the coronavirus from spreading across Australia have eased, but the public was warned to take their new-found freedoms carefully in order to prevent a second wave of the pandemic.

States and territories have begun the first stage of a three-stage process to lift restrictions on outdoor and indoor gatherings and business operations. Australians will get to sit in pubs, cafes and restaurants for the first time in weeks after isolation and social distancing measures kept the lid on infections and COVID-19 deaths.

But Australian Medical Association president Tony Bartone urged people to remain vigilant because the virus is still present in the community and could flare up as hot spots or small outbreaks.

“If we do the wrong things, we risk undoing all the gains that we’ve made,” Batone said. “So, the message is, yes, appreciate all the efforts, appreciate the opportunity to release some of those measures, but let’s not have a party, let’s not go to town.”

He said people must still maintain social distancing, cough etiquette, washing hands regularly and staying away from others if they are not well.

“Those messages are really the backbone as we progressively lift those restrictions,” he said.

The number of active cases breached 7,000 on Friday, but the death toll from the pandemic remains at 98, extremely low by international standards.

JUNEAU, Alaska — An Alaska lawmaker on Friday defended asking whether stickers that individuals may be asked to wear as part of a Capitol coronavirus screening process will be “available as a yellow Star of David.”

Republican Rep. Ben Carpenter of Nikiski said he was serious in making the comment in an email chain with other legislators. He was responding to proposed protocols aimed at guarding against the virus as lawmakers prepare to reconvene Monday. The protocols suggest stickers be worn to confirm someone at the Capitol had been screened.

“The point is, tying it to the Star of David shows, who amongst the human population has lost their liberties more than the Jewish people?” he said in an interview. “And if there were more people standing up for the loss of liberties prior to World War II, maybe we wouldn’t have had the Holocaust.

“This is about the loss of liberties within our people, and we’re just turning a blind eye to it,” he said, adding that virus fears are “causing us to have policies that don’t make any sense.”

In his email, Carpenter asked about the screening process. “If my sticker falls off, do I get a new one or do I get a public shaming too? Are the stickers available as a yellow Star of David?”

Rep. Grier Hopkins, a Fairbanks Democrat, responded to Carpenter’s email by calling the remark “disgusting. Keep your Holocaust jokes to yourself.”

The state has reported 388 cases of COVID-19 involving Alaska residents and eight cases involving nonresidents. There have been 10 deaths related to COVID-19, the disease caused by the virus, according to the state health department.

HONOLULU — A tourist from New York who allegedly posted photos on Instagram of himself at the beach has been arrested for violating Hawaii’s traveler quarantine.

The state says 23-year-old Tarique Peters of the Bronx arrived in Honolulu on Monday. People who saw his social media posts reported him to authorities. He was arrested Friday. He couldn’t immediately be reached for comment.

Hawaii mandated a 14-day quarantine on travelers arriving to the islands in an attempt to curb the spread of the coronavirus. Authorities have been cracking down on travelers allegedly defying the quarantine.

TORONTO — Canada’s largest airline plans to lay off at least 20,000 employees because of the pandemic.

Air Canada says the layoffs will impact more than half of the company’s 38,000 employees. The airline says COVID-19 has forced it to reduce its schedule by 95% and it doesn’t expect normal traffic to return anytime soon.

The carrier says its workforce will be reduced by 50% to 60%. The move is effective June 7.

Air Canada announced in March it would lay off nearly half of its workforce under a cost reduction scheme. It proceeded to rehire some 16,500 laid-off flight attendants, mechanics and customer service agents in April under after the Canadian government announced a wage subsidy plan, but has not committed to maintain the program past June 6.

LOS ANGELES — A federal judge has ordered Los Angeles city and county to move thousands of homeless people who are living near freeways, saying their health is at risk from pollution and the coronavirus.

Judge David O. Carter issued a preliminary injunction Friday requiring relocation of an estimated 6,000 to 7,000 people camping near freeway ramps and under overpasses and bridges. The order would take effect on May 22.

Carter says those people are at risk from the coronavirus, lead and other pollutants, and from accidents and earthquakes.

DENVER — A man suspected of killing a woman in Denver was released from prison three weeks before the slaying due to concerns over the coronavirus.

The Denver Post reports Cornelius Haney was released April 15 under powers granted to the Colorado Department of Corrections by Gov. Jared Polis. The governor’s order aims to speed up certain releases from the prison system to lower the population amid the pandemic. Police arrested Haney on Monday in the fatal shooting of a 21-year-old woman in an alley in east Denver on May 9.

Haney had a mandatory release date of Aug. 22. States across the country are trying to reduce their prison populations to prevent outbreaks of the virus.

GAINESVILLE, Ga. — Community leaders say an effort to tamp down the spread of COVID-19 is succeeding in northeast Georgia, the site of a recent outbreak that threatened to level the state’s huge poultry processing industry.

Republican Gov. Brian Kemp visited Gainesville on Friday to highlight the effort, with local leaders saying they believed community outreach and infection-control efforts had begun to control the disease.

Norma Hernandez of the Northeast Georgia Latino Chamber of Commerce says that over the past two weeks, community leaders have worked to present a message from people that Spanish speakers will trust.

As poultry industry officials proudly noted Friday, Georgia is the nation’s largest chicken producer, a $41 billion industry that employs more than 45,000 people statewide and turns out 15% of U.S. production.

Kemp’s visit came as Georgia neared 37,000 overall infections and more than 1,550 deaths.

The state recently surpassed 300,000 tests, which Kemp hailed as a milestone in efforts to locate virus cases. The latest testing figure represents close to 3% of the state’s population.

FLAGSTAFF, Ariz. — Residents of the Navajo Nation will be under the strictest weekend lockdown yet. Grocery stores, gas stations and other businesses will be closed starting Friday night. Essential workers also are being told to stay home until Monday around dawn.

A frustrated Navajo Nation president made the announcement after a spike in deaths that he attributed to shifting traffic patterns in New Mexico. As of Thursday, the tribe reported 127 deaths and 3,632 positive cases since it first began tracking the figures. Tribal officials say more than 500 people have recovered.

The Navajo Nation has been hit harder by the coronavirus than any other Native American reservation.

LISBON, Portugal — Portugal will transition to its second phase of scaling back confinement measures following the positive government assessment of the evolution of its COVID-19 outbreak.

The first stage of the reopening process began with small shops and businesses such as hairdressers. Phase two starting Monday will include restaurants, bars, cafes and other shops opening under capacity limitations and social distancing restrictions.

Portuguese Prime Minister Antonio Costa also unveiled the plan for the reopening of beaches on June 6. Social distancing restrictions will have to be in place, with a maximum capacity for each beach.

The government announced that citizens will be able to check online or via a mobile phone application the current capacity of each beach .

Portugal has 20,583 confirmed cases and 1,190 deaths from the pandemic.

LAS VEGAS — The city of Las Vegas has announced that downtown restaurants and businesses operating under the first two phases of state reopening orders are allowed to extend operations to the sidewalk during regular business hours.

The Las Vegas Review-Journal reported that outdoor dining and sidewalk sales are now permitted. But each business must continue implementing social distancing measures by keeping tables, chairs and other furniture six feet from pedestrian paths. City spokesman Jace Radke says Las Vegas is currently in the first stage of reopening, which went into effect Saturday. The second phase will allow establishments to expand operations outside with additional restrictions.

Follow AP news coverage of the coronavirus pandemic at https://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak.

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‘The 1918 flu is still with us’: The deadliest pandemic ever is still causing problems today

In 1918, a novel strand of influenza killed more people than the 14th century’s Black Plague.

At least 50 million people died worldwide because of that H1N1 influenza outbreak. The dead were buried in mass graves. In Philadelphia, one of the hardest-hit cities in the country, priests collected bodies with horse-drawn carriages.

In the middle of today’s novel coronavirus outbreak, some are turning to the conclusion of past pandemics to discern how and when life might “return to normal.” The Washington Post has received a few dozen questions from readers who want historical context for our current epidemic. But how did the deadliest pandemic ever recorded come to an end?

Over time, those who contracted the virus developed an immunity to the novel strand of influenza, and life returned to normal by the early 1920s, according to historians and medical experts. Reports at the time suggest the virus became less lethal as the pandemic carried on in waves.

But the strand of the flu didn’t just disappear. The influenza virus continuously mutated, passing through humans, pigs and other mammals. The pandemic-level virus morphed into just another seasonal flu. Descendants of the 1918 H1N1 virus make up the influenza viruses we’re fighting today.

“The 1918 flu is still with us, in that sense,” said Ann Reid, the executive director of the National Center for Science Education who successfully sequenced the genetic makeup of the 1918 influenza virus in the 1990s. “It never went away.”

It’s not clear exactly how or where the 1918 influenza outbreak began, but, at some point, the novel H1N1 virus passed from birds to humans.

From start to finish, the flu could burn through a town or city in a matter of weeks. Very few people had ever contended with a concoction of influenza like this before, which is why it was so potent, Reid said.

Even President Woodrow Wilson contracted the virus while negotiating the end of World War I.

Seasonal influenza tends to kill the oldest and youngest in a society but in 1918, roughly half of those who died were men and women in their 20s and 30s. People were getting sick and dying in the prime of their lives.

“As many as 8 to 10 percent of all young adults then living may have been killed by the virus,” historian John M. Barry wrote in his best-selling book “The Great Influenza.”

All the while, World War I continued. The bloody trench warfare across Europe left 8.5 million or more soldiers dead. The tight quarters during the war only aided the spread of the virus, said Howard Markel, a physician and medical historian at the University of Michigan.

The 1918 outbreak has been called the Spanish flu because Spain, which remained neutral during World War I, was the first country to publicly report cases of the disease. China, France and the United States already had cases of the flu, but wartime censorship largely kept the outbreaks out of the newspapers.

Then, the king of Spain — Alfonso XIII — and several other members of his government contracted the flu. This series of unfortunate events left a permanent mark, tying the country to the deadly outbreak.

“There was a very common habit, which has persisted to this day, of blaming an epidemic on one country or one group of people,” Markel said. “It goes back centuries.”

The longer the influenza virus existed in a certain community, the less lethal the sickness was. An epidemiological study cited by Barry in “The Great Influenza” noted that “the virus was most virulent or most readily communicable when it first reached the state, and thereafter it became generally attenuated.”

Experts say there’s this natural progression where a virus often — but not always — becomes less lethal as time wears on. It’s in the best interest of the virus for it to spread before killing the host.

“The natural order of an influenza virus is to change,” Barry told The Post. “It seems most likely that it simply mutated in the direction of other influenza viruses, which is considerably milder.”

By 1920, the influenza virus was still a threat, but fewer people were dying from the disease. Some scientists at the time started to move on to other research. Barry wrote that William Henry Welch, a famous pathologist from Johns Hopkins who was studying the virus, found it “humiliating” that the outbreak was passing away without experts truly understanding the underlying cause of the disease.

What Welch didn’t predict was that the virus never truly went away. In 2009, David Morens and Jeffery Taubenberger — two influenza experts at the National Institutes of Health — co-authored an article with Anthony S. Fauci explaining how the descendants of the 1918 influenza virus have contributed to a “pandemic era” that has lasted the past hundred years. At the time the article was published, the H1N1 influenza virus in public circulation was a fourth-generation descendant of the novel virus from 1918.

“All those pandemics that have happened since — 1957, 1968, 2009 — all those pandemics are derivatives of the 1918 flu,” Taubenberger told The Post. “The flu viruses that people get this year, or last year, are all still directly related to the 1918 ancestor.”

Because of this, the 1918 influenza outbreak doesn’t come with a neat bookend. Society moved on, but the virus continued in some form or fashion.

“We are living in a pandemic era that began around 1918,” Taubenberger wrote with Fauci and Morens back in 2009 for the New England Journal of Medicine. “Ever since 1918, this tenacious virus has drawn on a bag of evolutionary tricks to survive.”

We continue to turn back to the 1918 outbreak as a point of comparison, said Jeremy Greene, a historian of medicine at Johns Hopkins. Some of the public health measures a hundred years ago are still put in place today. To “flatten the curve,” cities and towns have more or less shut down. That said, Greene cautions against drawing the parallels “too closely.”

There are similarities to draw between today’s pandemic and the influenza outbreak a hundred years ago. Both come from winged animals — one from birds and the other from bats. Both are respiratory viruses. Both led people to wear masks in public. Both forced cities and schools to shut down for periods of time. And, finally, in both cases, the country’s leaders exacerbated problems by ignoring the early warning signs.

Despite all that, influenza viruses and coronaviruses are not the same. There’s very little someone can draw from influenza to then provide treatment for the infectious disease named covid-19, said Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

“They’re really different viruses,” Offit added.

Influenza is consistent and relatively quick when compared with the novel coronavirus. If you get exposed to the flu, you’ll start showing symptoms in one to four days after the infection. According to the Centers for Disease Control and Prevention, it tends to take five days for those infected with SARS-CoV-2 to start showing symptoms of covid-19, but the timing can fluctuate from two days to two weeks.

The novel coronavirus is not moving on the same time frame as the 1918 influenza, Greene told The Post. Everything is longer with the novel coronavirus — the symptoms, the sickness and even the long-term complications. Doctors are concerned covid-19 can lead to lasting cardiovascular complications.

Then there are asymptomatic carriers of the disease. That one detail makes it harder to mitigate the spread of the virus by simply taking temperatures. Symptoms are not a be-all-end-all solution to tracking the disease. With that in mind, the novel coronavirus is acting more like polio, where those with mild cases don’t know they’re sick, Greene said.

“It immediately raises a different set of problems for managing a disease,” Greene said. “One needs to relearn the way to think about who is dangerous, and that becomes, basically, everybody.”