Road to the Viral Superhighway

1
Road to the Viral Superhighway

• George Armelagos

Emory University Anthropology
2
The Plagues

• So the lord sent a pestilence upon Israel from
  the morning until the appointed time and there
  died of people from Dan to Beer-sheba seventy
  thousand men

2 Samuel24
3
The Plagues

• Bible
• blood
• frogs
• gnats
• flies
• cattle disease
• boils
• hail
• locust
• darkness
• death to first born

• Hollywood
• Outbreak- imported monkey infected with organ
  liquefying virus becomes a threat to human kind

4
The Plagues

• Bible
• blood
• frogs
• gnats
• flies
• cattle disease
• boils
• hail
• locust
• darkness
• death to first born

• Hollywood
• Outbreak- imported monkey infected with organ
  liquefying virus becomes a threat to human kind

5
The Plagues

• Bible
• blood
• frogs
• gnats
• flies
• cattle disease
• boils
• hail
• locust
• darkness
• death to first born

6
Objectives

• Emerging disease is an evolutionary trend
  beginning in the Neolithic
• Neolithic as engine that changes the pattern of
  diet and disease in prehistory
• Examine the relationship of health and inequality
  from an evolutionary perspective
• Incorporating the evolutionary concept of
  pathogens as microparasites and structures of
  inequality as macroparasitism

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Time Frame

• 99.75 of human existence has been as
  gatherer-hunters
• .0025 as agriculturist
• .00125 as urban agriculturist
• .00005 living in an industrial age

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Epidemiological Transition

• A. R. Omran (1971) The control of infectious
  disease and the rise of chronic and degenerative
  diseases
• Broaden the concept of epidemiological transition
  to include dramatic shifts in disease patterns

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Epidemiological Transition

• The first epidemiological transition primary
  food production
• The second epidemiological transition The
  decline in infectious disease and the rise of
  chronic diseases
• The third epidemiological transition reemerging
  disease

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The Paleolithic

• The gathering and hunting stage (c.a. 4,000,000
  year)
• Distribution of populations
• Low density
• Small population size
• Semi-nomadic existence

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Paleolithic Baseline

• Those that had adapted to the prehominids and
  persisted in hominids
• Lice and pinworms
• Salmonella typhi
• Staphylococci

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Paleolithic Baseline

• Zoonoses (pathogens adapted to another host and
  accidentally transmitted to humans)
• Insect bites
• Eating infected meat

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Whats Missing?

• Smallpox
• Measles
• Influenza
• Mumps

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The First Epidemiological Transition
Transformation to Primary Food Production

• Sedentary settlements, increase population size
  and density, and animal domestication increases
  infectious and nutritional disease

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Emerging Disease in the Neolithic

• Pathogens that jump their species barriers and
  escape their geographic barriers
• Animals as vectors for disease
• Salmonella
• Ascaris carried by pigs, sheep, cattle
• Trypanosome and domestication
• Unwanted self domesticated animals
• Sparrows and rodents

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Macroparasitism

• A concept from McNeil (Plagues and Peoples)
  refers to human groups who extract energy and
  food from less powerful people.
• Macroparasitism is an evolutionary strategy
• Macroparasitism began with the evolution of
  social stratification associated with state
  societies it is characteristic most modern
  states.

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Macroparasitism

• Social power can insulate elites from food
  shortages and unhygienic living conditions
• Better access to resources has health benefits
  for wealthy, and it also has adverse health
  effects on the poor -- for both material and
  psychological reasons.
• Part of the macroparasitic strategy is
  ideological -- blaming outside entities (genes,
  miasma or germs) for the poors misery

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Preindustrial City

• Magnifies trends which began in settled village
• Increase in population size and density
• Increase in pollution-cholera
• Deterioration of the environment

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Preindustrial City

• Contagious disease
• Typhus
• Plague
• Viral diseases measles, mumps, chicken pox,
  smallpox
• Syphilis
• Disease endemicity
• Class inequalities
• Colonial expansion

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Industrial Cities

• Population size and density
• Environmental change
• Industrial wastes
• Economic inequalities
• Epidemic disease
• Typhoid and typhus
• Smallpox
• Diphtheria
• Yellow fever
• Spread of disease to virgin populations

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The Second Epidemiological Transition

• The control of infectious disease
• The role of medicine
• Public health measure
• The role of nutrition

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SET Effectiveness

• 50,000,000 deaths each year
• 17,500,000 from infectious and parasitic
  disease.
• Two billion people in the world are infected with
  hepatitis B virus
• 1.7 million have tuberculosis
• 30 million people are infected with HIV

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What Was The Extent of the Second Epidemiological
Transition ?

• Primarily restricted to developed nations
• Effectively eradicated smallpox and decline of
  polio suggests impact a global impact
• Technology of the SET created the TET
• Technological disruption of the environment on a
  global scale
• Antibiotic resistance

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The Third Epidemiological Transition and the
Viral Superhighway

• Reemerging infectious diseases
• Reemerging infectious disease that are antibiotic
  resistant
• Multiple antibiotic resistant diseases
• Emerging infectious diseases
• Globalization of the disease process

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Emerging Disease in the Third Epidemiological
Transition

• Satcher (1995) lists 22 disease that have emerged
  in the last 22 years.
• Rotovirus Paravovirus B19 Cryptosporidium parvum
• HIV
• Legionella pneumophila
• Hantaan Virus
• Campylobacter sp.

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Emerging Disease in the Third Epidemiological
Transition

• HTLV I
• Staphylococcus toxin
• Escherichia coli 0157h7
• HTLV II
• Borrelia burgdorferi
• Ebola
• Helicobacter pylori
• Human Herpes Virus

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Emerging Disease in the Third Epidemiological
Transition

• Ehrlichia chaffeensis
• Hepatitis C
• Guarnarito virus
• Vibrio Cholera 0139
• Bartonella (Rochalimaea) henselea
• Hantavirus isolates
• Sabia virus

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Why?

• The Institute of Medicine (IOM) (1992) reports
  that the emergence of disease is the result of an
  interaction of social, demographic, environmental
  changes in a global ecology and in the adaptation
  and genetics of the microbe.

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Emerging Disease in the Third Epidemiological
Transition

• Morse (1995) categorized the factors affecting
  the emergence of disease.
• Ecological factors
• Demographic changes
• International commerce and travel
• Technological change
• Breakdown in public health measures
• Microbial adaptation

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Health and Inequality

• The Worlds biggest killer and greatest cause of
  ill-health and suffering across the globe is
  listed almost at the end of the International
  Classification of Disease. It is given in code
  Z59.5--.

WHO World Report (1995)
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Health and Inequality

• The Worlds biggest killer and greatest cause of
  ill-health and suffering across the globe is
  listed almost at the end of the International
  Classification of Disease. It is given in code
  Z59.5--extreme poverty.

WHO World Report (1995)
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Rising Together and Drifting Apart
Sources 1947-79 Analysis of U.S. Census Bureau
data in Economic Policy Institute, The State of
Working America 1994-95, p. 37. 1979-98 U.S.
Census Bureau, Historical Income Tables, Table
F-3 http//www.census.gov/hhes/income/histinc/f03
.html.
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Bloom and Canning Health, Wealth and the
Demographic Dividend

• Higher income provides
• Better nutrition
• Safer water
• Greater access to health care
• Better health means
• Increased productivity
• Education (human capital)
• Investment in physical capital
• Temporarily increased productivity with
  demographic growth

Income
Health
Health
Income
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The Increasing Inequality Gap is Cause for Worry

• The large gap in income between the rich and poor
  always increase health risks for the poor in the
  context of scarce resources
• Severe poverty is a major cause of the
  reemergence of infectious disease in the 3rd
  epidemiological transition
• economic conditions accelerate the evolution of
  antibiotic resistance
• The End of the Antibiotic Era

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Health and Inequality

• Once medicine is established as anthropology,
  and once the interests of the privileged no
  longer determine the course of public events, the
  physiologist and practitioner will be counted
  among the elder statesman who support the social
  structure. Medicine is a social science in its
  very bone and marrow.

R. Virchow
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Conclusion

• An evolutionary perspective suggests a common
  element in our adaptation for at least 10,000
  years.
• The acceleration of emerging disease in the urban
  and industrial
• Pattern continues in many parts of the world
• The second epidemiological transition was a short
  respite in selected areas of the developed world

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Conclusion

• The third epidemiological transition with the
  globalization of antibiotic diseases brings
  evolution back to us in dramatic fashion.
• What can we do?