Pandemic Health Dictionary

A viral infection of the respiratory tract (air passages), typically causing fever, headache, muscle ache, and weakness. Popularly known as “flu”, it is spread by infected droplets from coughs or sneezes. Influenza usually occurs in small outbreaks or every few years in epidemics. There are 3 main types of influenza virus: A, B, and C. A person who has had an attack caused by the type C virus acquires antibodies that provide immunity against type C for life. Infection with a strain of type A or B virus produces immunity to that particular strain. However, type A and B viruses are capable of altering to produce new

strains: type A has been the cause of pandemics in the last century.

Types A and B produce classic flu symptoms; type C causes a mild illness that is indistinguishable from a common cold. The illness usually clears up completely within 7–10 days. Rarely, flu takes a severe form, causing acute pneumonia that may be fatal within a day or 2 even in healthy young adults. Type B infections in children sometimes mimic appendicitis, and they have been implicated in Reye’s syndrome. In the elderly and those with lung or heart disease, influenza may be followed by a bacterial infection such as bronchitis or pneumonia. Analgesic drugs (painkillers) help to relieve aches and pains and reduce fever. The antiviral drug amantadine may be given if the person is elderly or has another lung condition. Antibiotic drugs may be used to combat secondary bacterial infection.

Flu vaccines, containing killed strains of the types A and B virus currently in circulation, are available, but have only a 60–70 per cent success rate.

Immunity is short-lived, and vaccination (recommended for older people and anyone suffering from respiratory or circulatory disease) must be repeated annually.... influenza

Bacterial infection caused by Vibrio cholerae. The patient suffers profuse watery DIARRHOEA, and resultant dehydration and electrolyte imbalance. Formerly known as the Asiatic cholera, the disease has occurred in epidemics and pandemics for many centuries. When it entered Europe in 1853, Dr John Snow, a London anaesthetist, carried out seminal epidemiological work in Soho, London, which established that the source of infection was contaminated drinking water derived from the Broad Street pump. Several smaller epidemics involved Europe in the latter years of the 19th century, but none has arisen in Britain or the United States for many years. In 1971, the El Tor biotype of V. cholerae emerged, replacing much of the classical infection in Asia and, to a much lesser extent, Europe; parts of Africa were seriously affected. Recently a non-01 strain has arisen and is causing much disease in Asia. Cholera remains a major health problem (this is technically the seventh pandemic) in many countries of Asia, Africa and South America. It is one of three quarantinable infections.

Incubation period varies from a few hours to ?ve days. Watery diarrhoea may be torrential and the resultant dehydration and electrolyte imbalance, complicated by cardiac failure, commonly causes death. The victim’s skin elasticity is lost, the eyes are sunken, and the radial pulse may be barely perceptible. Urine production may be completely suppressed. Diagnosis is by detection of V. cholerae in a faecal sample. Treatment consists of rapid rehydration. Whereas the intravenous route may be required in a severe case, in the vast majority of patients oral rehydration (using an appropriate solution containing sodium chloride, glucose, sodium bicarbonate, and potassium) gives satisfactory results. Proprietary rehydration ?uids do not always contain adequate sodium for rehydration in a severe case. ANTIBIOTICS, for example, tetracycline and doxycycline, reduce the period during which V. cholerae is excreted (in children and pregnant women, furazolidone is safer); in an epidemic, rapid resistance to these, and other antibiotics, has been clearly demonstrated. Prevention consists of improving public health infrastructure – in particular, the quality of drinking water. When supplies of the latter are satisfactory, the infection fails to thrive. Though there have recently been large epidemics of cholera in much of South America and parts of central Africa and the Indian subcontinent, the risk of tourists and travellers contracting the disease is low if they take simple precautions. These include eating safe food (avoid raw or undercooked seafood, and wash vegetables in clean water) and drinking clean water. There is no cholera vaccine at present available in the UK as it provides little protection and cannot control spread of the disease. Those travelling to countries where it exists should pay scrupulous attention to food and water cleanliness and to personal hygiene.... cholera

This infection – also known as bubonic plague

– is caused by the bacterium Yersinis pestis. Plague remains a major infection in many tropical countries.

The reservoir for the bacillus in urban infection lies in the black rat (Rattus rattus), and less importantly the brown (sewer) rat (Rattus norvegicus). It is conveyed to humans by the rat ?ea, usually Xenopsylla cheopis: Y. pestis multiplies in the gastrointestinal tract of the ?ea, which may remain infectious for up to six weeks. In the pneumonic form (see below), human-to-human transmission can occur by droplet infection. Many lower mammals (apart from the rat) can also act as a reservoir in sylvatic transmission which remains a major problem in the US (mostly in the south-western States); ground-squirrels, rock-squirrels, prairie dogs, bobcats, chipmunks, etc. can be affected.

Clinically, symptoms usually begin 2–8 days after infection; disease begins with fever, headache, lassitude, and aching limbs. In over two-thirds of patients, enlarged glands (buboes) appear – usually in the groin, but also in the axillae and cervical neck; this constitutes bubonic plague. Haemorrhages may be present beneath the skin causing gangrenous patches and occasionally ulcers; these lesions led to the epithet ‘Black Death’. In a favourable case, fever abates after about a week, and the buboes discharge foul-smelling pus. In a rapidly fatal form (septicaemic plague), haematogenous transmission produces mortality in a high percentage of cases. Pneumonic plague is associated with pneumonic consolidation (person-to-person transmission) and death often ensues on the fourth or ?fth day. (The nursery rhyme ‘Ringo-ring o’ roses, a pocketful o’ posies, atishoo! atishoo!, we all fall down’ is considered to have originated in the 17th century and refers to this form of the disease.) In addition, meningitic and pharyngeal forms of the disease can occur; these are unusual. Diagnosis consists of demonstration of the causative organism.

Treatment is with tetracycline or doxycycline; a range of other antibiotics is also e?ective. Plague remains (together with CHOLERA and YELLOW FEVER) a quarantinable disease. Contacts should be disinfected with insecticide powder; clothes, skins, soft merchandise, etc. which have been in contact with the infection can remain infectious for several months; suspect items should be destroyed or disinfected with an insecticide. Ships must be carefully checked for presence of rats; the rationale of anchoring a distance from the quay prevents access of vermin. (See also EPIDEMIC; PANDEMIC; NOTIFIABLE DISEASES.)... plague

adj. occurring frequently in a particular region or population: applied to diseases that are generally or constantly found among people in a particular area. Compare ecdemic; epidemic; pandemic.... endemic

n. a sudden outbreak of infectious disease that spreads rapidly through the population, affecting a large proportion of people. The commonest epidemics today are of influenza. Compare endemic; pandemic. —epidemic adj.... epidemic

a disease of domesticated pigs, first seen in humans in early 2009, caused by H1N1, a strain of *influenza A virus. Very contagious, the World Health Organization has now declared it to be a pandemic strain in humans. Swine influenza is currently believed not to be as virulent as *avian influenza and it seems to be less severe than the virulent 1918 pandemic, with which it shares antigenic features.... swine influenza

In?uenza is an acute infectious disease, characterised by a sudden onset, fever and generalised aches and pains. It usually occurs in epidemics and pandemics (see EPIDEMIC; PANDEMIC).

Cause The disease is caused by a VIRUS of the in?uenza group. There are at least three types of in?uenza virus, known respectively as A, B and

C. One of their most characteristic features is that infection with one type provides no protection against another. Equally important is the ease with which the in?uenza virus can change its character. It is these two characteristics which explain why one attack of in?uenza provides little, if any, protection against a subsequent attack, and why it is so di?cult to prepare an e?ective vaccine against the disease.

Epidemics of in?uenza due to virus A occur in Britain at two- to four-year intervals, and outbreaks of virus B in?uenza in less frequent cycles. Virus A in?uenza, for instance, was the prevalent infection in 1949, 1951, 1955 and 1956, whilst virus B in?uenza was epidemic in 1946, 1950, 1954 and, along with virus A, in 1958–59. The pandemic of 1957, which swept most of the world, although fortunately not in a severe form, was due to a new variant of virus A

– the so-called Asian virus – and it has been suggested that it was this variant that was responsible for the pandemics of 1889 and 1918. Since 1957, variants of virus A have been the predominating causes of in?uenza, accompanied on occasions by virus B.

In 1997 and 2004, outbreaks of Chinese avian in?uenza caused alarm. The in?uenza virus had apparently jumped species from birds

– probably chickens – to infect some people. Because no vaccine is available, there was a risk that this might start an epidemic.

Symptoms The incubation period of in?uenza A and B is 2–3 three days, and the disease is characterised by a sudden onset. In most cases this is followed by a short, sharp febrile illness of 2–4 days’ duration, associated with headache, prostration, generalised aching, and respiratory symptoms. In many cases the respiratory symptoms are restricted to the upper respiratory tract, and consist of signs of irritation of the nose, pharynx and larynx. There may be nosebleeds, and a dry, hacking cough is often a prominent and troublesome symptom. The fever is usually remittent and the temperature seldom exceeds 39·4 °C (103 °F), tending to ?uctuate between 38·3 and 39·4 °C (101 and 103 °F).

The most serious complication is infection of the lungs. This infection is usually due to organisms other than the in?uenza virus, and is a complication which can have serious results in elderly people.

The very severe form of ’?u which tends to occur during pandemics – and which was so common during the 1918–19 pandemic – is characterised by the rapid onset of bronchopneumonia and severe prostration. Because of the toxic e?ect on the heart, there is a particularly marked form of CYANOSIS, known as heliotrope cyanosis.

Convalescence following in?uenza tends to be prolonged. Even after an attack of average severity there tends to be a period of weakness and depression.

Treatment Expert opinion is still divided as to the real value of in?uenza vaccine in preventing the disease. Part of the trouble is that there is little value in giving any vaccine until it is known which particular virus is causing the infection. As this varies from winter to winter, and as the protection given by vaccine does not exceed one year, it is obviously not worthwhile attempting to vaccinate the whole community. The general rule therefore is that, unless there is any evidence that a particularly virulent type of virus is responsible, only the most vulnerable should be immunised – such as children in boarding schools, elderly people, and people who suffer from chronic bronchitis or asthma, chronic heart disease, renal failure, diabetes mellitus or immunosuppression (see under separate entries). In the face of an epidemic, people in key positions, such as doctors, nurses and those concerned with public safety, transport and other public utilities, should be vaccinated.

For an uncomplicated attack of in?uenza, treatment is symptomatic: that is, rest in bed, ANALGESICS to relieve the pain, sedatives, and a light diet. A linctus is useful to sooth a troublesome cough. The best analgesics are ASPIRIN or PARACETAMOL. None of the sulphonamides or the known antibiotics has any e?ect on the in?uenza virus; on the other hand, should the lungs become infected, antibiotics should be given immediately, because such an infection is usually due to other organisms. If possible, a sample of sputum should be examined to determine which organisms are responsible for the lung infection. The choice of antibiotic then depends upon which antibiotic the organism is most sensitive to.... influenza

(PD). Paralysis agitans. First described by James Parkinson, 1817. His description is as apt today as when it appeared in his book “Essay on the Shaking Palsy”. He wrote: “It is characterised by involuntary tremulous motion, with lessened muscular power in parts not in action and even when supported. There is a tendency to bend the trunk forward and to pass from a walking to a running pace. The senses and intellect are uninjured.”

Added to the above are:– muscular rigidity, loss of reflexes, drooling – escape of saliva from the mouth. Muscles of the face are stiff giving a fixed expression, the back presents a bowed posture. The skin is excessively greasy and the patient is unable to express emotional feelings. Loss of blinking. Pin- rolling movement of thumb and forefinger.

Causes: degeneration of groups of nerve cells deep within the brain which causes a lack of neurotransmitting chemical, dopamine. Chemicals such as sulphur used by agriculture, drugs and the food industry are suspected. Researchers have found an increase in the disease in patients born during influenza pandemics.

Treatment. While cure is not possible, a patient may be better able to combat the condition with the help of agents that strengthen the brain and nervous system.

Tea. Equal parts: Valerian, Passion flower, Mistletoe. 1 heaped teaspoon to each cup water; bring to boil; simmer 1 minute; dose: half-1 cup 2-3 times daily.

Gotu Kola tea. (CNS stimulant).

Tablets/capsules. Black Cohosh, Cramp bark, Ginseng, Prickly Ash, Valerian.

Formula. Ginkgo 2; Black Cohosh 1; Motherwort 2; Ginger 1. Mix. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-3 teaspoons in water or honey. Fava Bean Tea.

Case report. Two patients unresponsive to Levodopa treatment reported improvement following meals of fresh broad beans. (Vicia faba) The beans contain levodopa in large amounts. (Parkinson Disease Update Vol 8, No 66, p186, Medical Publications, PO Box 24622-H, Philadelphia, USA) See also: BROAD BEANS. L-DOPA.

Nacuna Pruriens. Appropriate. Essential active constituent: L-dopa. (Medicinal plants and Traditional Medicine in Africa, by Abayomi Sofowora, Pub: John Wiley)

Practitioner. To reduce tremor: Tincture Hyoscyamus BP. To reduce spasm: Tincture Belladonna BP. To arrest drooling: Tincture Stramonium BP.

Diet. It is known that people who work in manganese factories in Chile may develop Parkinson’s disease after the age of 30. Progress of the disease is arrested on leaving the factory. Two items of diet highest in manganese are wheat and liver which should be avoided, carbohydrates in place of wheat taking the form of rice and potatoes.

Supplements. Daily: B-complex, B2, B6, niacin. C 200mg to reduce side-effects of Levodopa. Vitamin E 400iu to possibly reduce rigidity, tremors and loss of balance.

Treatment of severe nerve conditions should be supervised by neurologists and practitioners whose training prepares them to recognise serious illness and to integrate herbal and supplementary intervention safely into the treatment plan.

Antioxidants. Evidence has been advanced showing how nutritional antioxidants, high doses of Vitamin C and E, can retard onset of the disease, delaying the use of Levodopa for an average of 2 and a half years. (Fahn S., High Dose Alpha-tocopherol and ascorbate in Early Parkinson’s Disease – Annals of Neurology, 32-S pp128-132 1992)

For support and advice: The Parkinson’s Disease Society, 22 Upper Woburn Place, London WC1H 0RA, UK. Send SAE. ... parkinson’s disease

a disease of poultry and other birds caused by strains of *influenza A virus. The severity of the disease depends on the strain of virus involved: H5N1 is particularly deadly (causing fowl plague (or pest), with a mortality approaching 100%) and very contagious, being spread between domestic flocks by wild birds. This virus is not easily transmissible to humans, requiring close contact with infected birds or their faeces. The first human cases of H5N1 infection (‘bird flu’) were reported in 1997 and restricted to Hong Kong: 18 people were infected, six of whom died. Since then half of the people infected with H5N1 in Asia, Europe, the Near East, and Africa have died. Most cases of avian influenza in humans have resulted from contact with infected poultry; human-to-human transmission has been extremely rare. However, if H5N1 should develop this ability, a serious pandemic could occur. See also swine influenza.... avian influenza