Skip to 0 minutes and 11 seconds JIMMY WHITWORTH: Outbreaks of infectious diseases have always been with us; from descriptions from Rome and from Athens in classical time, through plague in the Middle Ages, and then in the 19th century epidemics of cholera, and in the 20th century of influenza. During this course, we’re going to use the terms “outbreak”, “epidemic”, and “pandemic” a great deal. So let me clarify what we mean when we use these terms. Outbreak simply means more cases than expected of a disease in a specific place or population, over a given period of time. So in fact, this could just be a single case if it’s something unexpected.
Skip to 1 minute and 0 seconds For example, if it was a case of cholera in the UK in somebody who had never travelled abroad. Epidemic has, really, the same meaning as outbreak, but we tend to reserve that term for the larger types of outbreaks. And then a pandemic is a large epidemic, where it has spread into several countries or several continents. Going back to the history, with increasing trade, and pilgrimage, and war, there was increasing international travel, and it was recognised that this could bring back cases of plague. And so it was that, in the 14th century, city authorities in places like Venice and Dubrovnik established quarantine.
Skip to 1 minute and 54 seconds This was the holding of ships in port, not allowing them to dock, and of people at land borders who were isolated for up to 40 days to allow the incubation of any plague to have passed on. These measures aimed to provide health protection and health security for the citizens of these cities. By the 19th century, four diseases, plague, cholera, yellow fever, and smallpox, were covered by international agreements, with mandatory reporting allowing for international surveillance and response. From these agreements developed the International Health Regulations that were first issued in 1969.
Skip to 2 minutes and 43 seconds Over time, it was recognised that with slow or limited reporting, with increasing rapid international travel, and with the emerging of other infectious diseases, there was a need to update these regulations.
Skip to 3 minutes and 2 seconds All of this time, it was recognised that outbreaks were causing major loss of life, severe social upheaval and great financial losses. This drove medical advances, in particular the development of vaccines against conditions such as measles, polio, yellow fever, rubella, and diphtheria, all of which had caused major outbreaks in the past. The International Health Regulations were revised in 2005, and the focus changed from stopping diseases at international borders to developing national capacity to be able to detect and respond to outbreaks within their borders. You will hear more about this later this week in the step on global architecture. Meanwhile, epidemics continue to happen all the time and all around the world.
Skip to 4 minutes and 1 second Just in the first two decades of the 21st century, we have had outbreaks of SARS (Severe Acute Respiratory Syndrome) meningitis, chikungunya, influenza, cholera, measles, MERS, which is Middle East Respiratory Syndrome, Ebola, Zika, and yellow fever. So, outbreaks have occurred throughout history and are still occurring today. You will learn more about this in the next step, which is about infectious disease outbreaks today.
History of disease outbreaks and their impact
In this step, Jimmy Whitworth (LSHTM) explains the history of outbreaks, which has been traced back to Ancient Rome and Greece. This step covers the diseases that caused outbreaks historically and the progress that was made to control them, including the critical development of vaccines. This step also explains the development of the International Health Regulations and its role as a framework for helping countries prepare and respond to outbreaks.
© London School of Hygiene and Tropical Medicine 2019