Transcript Infectious disease 感染病(cause)

医学史简论（7）
A Brief History of Medicine
浙江大学医学院 余 海
Zhejiang University School of Medicine
送瘟神
Send away the Good of Plague
人类与传染病的斗争
Battles to Infectious Diseases
History of Infectious Diseases

Infection 感染
the invasion of the body by any of
various infectious agents – including
bacteria, viruses, fungi, protozoan
and worms and the reaction of the
body to them or their toxins.
Definitions

Infectious disease 感染病 (cause)
The disease caused by infection and/or capable being communicable by
infection

Communicable disease 传染病 (transmission)
The disease capable of being transmitted from one person to another or
from animals (intermediate host) to human.

Epidemic disease 流行病 (incidence)
The occurrence of cases of disease in excess of what is usually expected for
a given period of time. (epidemic hysteria)
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Endemic disease 地方病 (location)
The disease that is constantly present in people living in a particular
location (endemic thyroid disease-goiter)
Human and Infectious Diseases

Epidemics 流行
Sudden outbreak of diseases in excess of
what is expected

Pandemics （全球）大流行
Sudden geographically widespread
outbreak of diseases
History of Infectious Disease

Prehistoric period：Infectious disease rare

Agriculture society：Increased transmission
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Urban civilization： Congestion of urban inhabitation, war
and travelling result to outbreak of infectious diseases
Three factors of
transmission of
infectious disease
•Source of infection
•Susceptible population
•Transmission routes
Direct
touch
Indirect
touch
Droplet
spittle
Air-borne
Indirect
utensils
insect
Routes of transmission
Speed of sneeze: 170km/h 47.2m/s
Victories over infectious
diseases
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Smallpox
plague
Influenza
Diphtheria
Measles
Tetanus
poliomyelitis
schistosomiasis
天花
smallpox
天花病毒
poxviridae
othopoxvirus
pockmarked face，from maculopapular rash to
raised fluid-filled blisters to pustules
天花
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smallpox
Egyptian Pharaoh
Ramses V died from
smallpox in1157 B.C
Frequent outbreak in
the history
300 million people died
from smallpox in 20th
century (100 million
died from wars)
Ramses V 1157 BC
Victims of
Smallpox
Louis XV 1777
Joseph I d1711
Elizabeth I 1533-1603
顺治 1638-1661
Marry II 1662-1694
天花
smallpox
Chinese invented
inoculation of human
smallpox (variolation)
in 10th century, 14-16
century widely used
Lady Montagu brought
back from Turkey to
Europe in 1721
Lady Montagu
variolation
Blow the scab of smallpox skin lesion
天花

smallpox
Inspired by the fact that
dairymaids infected with cowpox
were immune to small-pox,
Edward Jenner invented cowpox
vaccine against human smallpox.
variolation
(vaccinia vacca-cow)
vaccination
Edward Jenner
1749-1823
天花

smallpox
Jenner deliberately infected
James Phipps, an eight year
old boy, with cowpox in May
14, 1796. He then exposed
Phipps to smallpox–which
Phipps failed to contract. After
repeating the experiment on
other children, including his
own son, Jenner concluded
that vaccination provided
immunity to smallpox without
the risks of variolation.
Jenner’s findings were
published in 1798.
天花 smallpox
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
in 1840 Vaccination
Acts were passed,
the British
government banned
variolation and
provided vaccination,
free of charge.
In 1805 vaccination
was introduced to
China via Portugal
merchants in Macao
天花
smallpox

1840 British vaccination Acts
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1940 Smallpox was eradicated in Europe and North America
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1960 Last Chinese case occurred in a Yunnan-Burma border village

1967 WHO launched smallpox eradication movement
（At that time 30 million
patients,2million death every
year）
30 countries
1700 medical doctors
200,000 health worker
Mobilized in the movement
天花
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
smallpox
Last natural infected Somalia patient
cured in Oct 26 1977
A fatal incidence occurred in
Birmingham University in August 1978 a
woman lab photographer Janet Parker
became the last victim of smallpox, Prof
Henry Bedson committed suicide.
May 8, 1980 WHO announced:
Global eradication of smallpox
Ali Maali
天花 smallpox
Reasons for possible eradication
of smallpox

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There are no other virus reservoirs but man
Only acute infection exists, the outcome of
disease: die or life-long immunity
Virus is highly immunogenic, so vaccine has
been most effective
鼠疫
Plague
bacterium
Yersinia pestis
Prairie dog
Flea
Rat
Bubonic and Pneumonic Plague
伍连德和鼠疫
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Lien-Teh Wu 1879-1960

马来亚华侨，英国学医
1907天津陆军军医学堂副监督
1910东三省防鼠疫全权总医官
1914奉天万国鼠疫大会主席，“医学进
士”
1915创办中华医学会和中华医学杂志
1918 北洋政府中央防疫处处长，北京
中央医院院长
1926创办哈尔滨医学专门学校校长
1930兼任上海海港检疫所所长
1935 提名诺贝尔医学奖
1937 返回马来亚，定居怡保市(Ipoh)
1960年1月21日病逝于马来亚槟榔屿
(Pulau Pinang）
伍连德和鼠疫
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
梁启超：“科学输入垂五十年，国
中能以学者资格与世界相见者，伍
星联（即伍连德）博士一人而已！”
1910年12月，鼠疫在东北大流行
死亡达39679人，占当时吉林黑
龙江人口的1．7％，1911年1月
，伍连德在哈尔滨建立了第一个
鼠疫研究所，采取了加强铁路检
疫、控制交通、隔离疫区、火化
鼠疫患者尸体、建立医院收容病
人等多种防治措施，不久便控制
了疫情。清政府为表彰其功绩，
授予陆军蓝翎军衔及医科进士。
1935年因首次发现肺鼠疫，并确
立旱獭为鼠疫传播的自然疫源而
被提名诺贝尔奖(Work on pneumonic
plaque and especially the discovery of the
role played by the Tarbagan in its
transmission.
– Folke Henschen)
Black death in 14th century
1346-1353 plague outbreak in Europe
（black death 黑死病）,claimed 2.5million,
1/3 of European population ( Threw bodies into
city using trebuchet to spread plague-first biological warfare
by Tartar troops)
Caffa
Crime
Learn from plaque：contagion gown
Beak fill of spices
Learn from plague:
quarantine
Quarantenaria （40天）
Quarantine （检疫）
Bacteriological
weapon

During the Sino-Japanese
War , plague was used as
a bacteriological weapon by
the Imperial Japanese Army.
These weapons were
provided by Shiro Ishii’
Units (石井, 731 部
队） and used in
experiments on humans
before being used on the
field.
Vivisection
One of
the survivors
Bacterial bomb
流感
Influenza
1918 flu pandemic (Spanish flu)
spreading to nearly every part of the
world.
Caused by Influenza virus strain
subtype H1N1.
From March 1918 to June 1920,
estimated 20 to 100 million people
were killed (mortality rate 2.5-5%)
The extreme virulence may be
associated with overreaction of
immune system-cytokine storm
Mittelmachte (Central Power 同盟国)
Entente Power (协约国）
流感
Influenza
The only protection was
wearing a mask
大学体育馆改建的流感病房
Gymnasium of Kansas University
the Oakland Municipal Auditorium
in use as a temporary hospital
血吸虫病
Schistosomiasis
Schistosoma heamatobium (Bilharzia)
Africa, Middle East
S. Japonicum China, Phillipines
S.mansoni Africa, Latin America
Paleopathology Findings
Schistosoma eggs discovered in a wellpreserved ancient lady’s body (in
Changsha Mawangdui of Hunan
Province, 165 BC) , and also found in
another well-preserved man’s body
(167 BC) in Jiangling of Hubei Province
血吸虫病
Schistosomiasis
Used be prevalent in 12 provinces,
400 counties, threatened 100
million people and 1 million
domestic animals (buffalo)
Mass Movement of Schistosomiasis
Prevention (血防Xuefang)in 1950s
Treatment of patients and animals
－eradication of the sources
Clearance of snails-intermediate
host
Water and feces control-cut the
transmission routes
七律二首 送瘟神
Send aw ay the G o d o f Plague
1958.07.01
绿水青山枉自多，华佗无奈小虫何！
千村薜荔人遗矢，万户萧疏鬼唱歌。
坐地日行八万里，巡天遥看一千河。
牛郎欲问瘟神事，一样悲欢逐逝波。
春风杨柳万千条，六亿神州尽舜尧。
红雨随心翻作浪，青山着意化为桥。
天连五岭银锄落，地动三河铁臂摇。
借问瘟君欲何往，纸船明烛照天烧。
The God of Plague
(Shistosomiasis) is back
Infection disease control-Long way to go
传染病控制 - 任重而道远

Eradicated: smallpox

Vaccine preventable: measles, poliomyelitis, diphtheria,
whooping cough, tetanus

Uncontrolled：plague, cholera, tuberculosis, viral
hepatitis

Re-emerging：sex-transmitted disease, Dengue fever,
schistosomiasis

Newly emerging：Legionnaires’ disease, Ebla fever, SARS,
bird flu, AIDS, Chikungunya Disease
Severe Acute Respiratory Syndrome (SARS）
•“Infectious Atypical Pneumonia ” (非典）
•January 2, 2003 first case in Heyuan County Guangdong, China
(super-spreading event, SSE)
•February 2003 became global
Pandemic
•Italian physician Carlo Urbani
who worked for WHO in Vietnam
first used the name SARS. He
Carlo Urbani
himself died at March 29 of SARS infection
传染性非典型性肺炎（SARS）
Etiology：冠状病毒 （Coronavirus)
Global SARS statistics
Country（region）
China中国
Hong Kong香港
Taiwan台湾
Canada加拿大
Singapore新加坡
Vietnam越南
Others其他
Total总计
Cases
5327
1755
671
250
206
63
165
8437
WHO 2003.7.11
Death
348
298
84
38
32
5
8
813
Who should be blamed？
Masked Palm Civet?
Bats found to carry SARS-related virus

Chinese and
American
scientist joint
study showed
bats may carry
the SARSrelated virus

Results
published in
Science Sep 29
2005
Avian Influenza

(Bird Flu)
Bird flu is influenza caused by viruses adapted to birds,
which belong to Influenza virus A
Influenza virus
with the
diameter of
80～120nm
Hemagglutinin,H:
H1～H15,
Neuraminidase, N:
N1～N9 ,
Theoretically there
could be 135 subtypes,
Treatment: Tamiflu
(Oseltamivir phosphate)
A neuraminidase inhibitor
Avian Influenza Virus
Updated: 38 cases 10 death
(7am April 12,2013)
Ecology of Avian Influenza Virus
Bird migration
Gene Resortment of H7N9 Avian Flu Virus
H7N8
H9N2
Zhejiang
Duck H7N9
Korean wild
birds H7N9
Gene resortmentNew H7N9
Yangtze delta
chicken H9N2
Source: Chinese Academy of Sciences
April 9 2013
Viet Nam
Cambodia
Thailand
Indonesia

Felines (tiger, leopard)
can be infected with
bird flue (60 tigers and
1 leopard in Thai zoo
died from bird flue )
Cumulative Number of Confirmed Human Cases of Avian
Influenza A/(H5N1) Reported to WHO
2003-2012
2003
Country
case death
2004
2005
2006
2007
2008
2009
2010
2011
2012
Total
case death case death case death case death case death case death case death case death case death case
death
Azerbaijan
Bangladesh
Cambodia
0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
0
0
4
8
0
2
5
0
2
0
0
1
0
0
1
0
1
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1
0
2
8
0
0
8
0
3
2
0
0
2
8
1
8
5
0
7
China
1
1
0
0
8
5
13
8
5
3
4
4
7
4
2
1
1
1
1
1
38
25
Djibouti
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
Egypt
0
0
0
0
0
0
18
10
25
9
8
4
17
0
29
13
39
15
9
5
68
23
Indonesia
0
0
0
0
20
13
55
45
42
37
24
20
0
0
9
7
12
10
6
6
141
115
Iraq
0
0
0
0
0
0
3
2
0
0
0
0
0
0
0
0
0
0
0
0
3
2
Laos
0
0
0
0
0
0
0
0
2
2
0
0
0
0
0
0
0
0
0
0
2
2
Myanmar
Nigeria
Pakistan
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
3
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
3
0
1
1
Thailand
0
0
17
12
5
2
3
3
0
0
0
0
0
0
0
0
0
0
0
0
25
17
Turkey
0
0
0
0
0
0
12
4
0
0
0
0
0
0
0
0
0
0
0
0
12
4
Viet Nam
3
3
29
20
61
19
0
0
8
5
6
5
4
4
7
2
0
0
4
2
111
56
Total
4
4
46
32
98
43
115
79
88
59
44
33
28
8
48
24
62
34
25
16
423
258
The overall case fatality rate 258/423=61.0%
禽流感和“猪流感”发病对比
Comparison of bird flu with “swine flu”
Cytokine storm “细胞因子风暴”
死亡率 ～60% vs ～1%
Antigenic drift
抗原漂移
Antigenic shift
抗原转移
Potential risk 潜在危险


The mutation of virus may
cause the outbreak of
pandemics of avian influenza
(gene shift or draft, leading to
transmitted from human to
human)
Nature estimated：That may
cause one third of world
population infected , 30
million may need hospitalized,
one quarter of which would
die.
-世纪之疫
AIDS-the
plague for the century
AIDS
Plague in 21th century-AIDS
•1981 in US 5 cases reported and named
as Acquired Immunodeficiency
Syndrome (AIDS)
•1983 and 1984 Montagnier of Pasteur
Institute and Gallo of NIH isolated the
virus (lymphadenopathy-associated virus,
LAV; human T-lymphotropic virus type III,
HTLV-III)
•1986 naming as “Human
Immunodeficiency Virus HIV”
•1987 President Mitterrand of France and
President Reagan of the USA met that
the major issues were ironed out.
AIDS
virus
retrovirus
CCR 5
Multiplication of HIV
Clinical manifestation- cachexia
Clinical manifestation-Kaposi’s sarcoma
Clinical manifestation- Pneumocystis
carnii pneumonia
Pneumocystis
carnii pneumonia ）
非洲：现代瘟疫
Global HIV/AIDS estimates, end of 2007
UNAIDS 2008 Report of the global AIDS epidemic
Estimate
Range
People living with HIV/AIDS in 2007
33.0 million
30.3-36.1 million
Adults living with HIV/AIDS in 2007
30.8 million
28.2-34.0 million
Women living with HIV/AIDS in 2007
15.5 million
14.2-16.9 million
Children living with HIV/AIDS in 2007
2.0 million
1.9-2.3 million
People newly infected with HIV in 2007
2.7 million
2.2-3.2 million
Children newly infected with HIV in 2007
0.37 million
0.33-0.41 million
AIDS deaths in 2007
2.0 million
1.8-2.3 million
Child AIDS deaths in 2007
0.27 million
0.25-0.29 million
More than 25 million people have died of AIDS since 1981.
Africa has 11.6 million AIDS orphans.
In developing and transitional countries, 9.7 million people are in immediate need of life-saving AIDS
drugs; of these, only 2.99 million (31%) are receiving the drugs.
Regional statistics for HIV & AIDS, end of 2007
* Proportion of adults aged 15-49 who were living with HIV/AIDS
Region
Adults & children
living with HIV/AIDS
Region
Sub-Saharan Africa
North Africa &
Middle East
Asia
22.0 million
SubSaharan
Africa
380,000North
5
Africa &
Middle
millionEast
Asia
Oceania
74,000
1.9 million
1.9 million
5.0%
40,000
380,000
40,000
0.3%
27,000
380,000
0.3%
380,000
Oceania
74,000
13,000
0.4%
1,000
Latin
America
1.7 million
13,000
140,000
0.5%
63,000
20,000
1.1%
14,000
0.8%
58,000
230,000
Eastern
1.7 million
Europe &
1.5 million
230,000North
America,
140,000
110,000
20,000
Western & 2.0 million
Central
Europe
81,000
prevalence*
Deaths of
adults & children
5.0%
1.5 million
0.3%
27,000
0.3%
380,000
0.4%
1,000
0.5%
63,000
1.1%
14,000
0.8%
58,000
1.5 million
380,000
Central
Asia
Caribbean
22.0
million
5 million
Caribbean
Latin America
Adults & children
Adults & Adults &
Adult
Adult
Deaths of
newly
infected
children
children
prevalenc adults &
living with newly
e*
children
HIV/AIDS infected
0.4%
31,000
0.8%
2.0 million
Eastern Europe &
Central Asia
1.5 million
North America,
Western & Central
Europe
2.0 million
81,000
0.4%
31,000
33.0 million
2.7 million
0.8%
2.0 million
Global Total
Global
Total
33.0
million
110,000
2.7 million
中国爱滋病形势 AIDS in China
Reported:
HIV infection 492,191
（surviving 383,285）
（Dec, 2012）
Estimated ：
HIV infection 780,000,
AIDS patients 154,000
Ice burger
AIDS death 160,000
Mode of
Transmission：
18.7%
Between US and China
0.3%
18.7%
1.6%
8.4%
9.4%
61.6%
IDUs
blood tr
sexually
blood pr
MTCT
others
AIDS transmission:China
11.6%Sexually transmitted (1985-2005)
75.2% (2011) half of which via MSM
爱滋病的来源？
Origin of Aids?
The origin of HIV


HIV virus not detected in any
blood samples before 1959
It may transformed from simian
immunodeficiency virus (SIV) of
African primates (African Green
Monkey, Chimpanzee)
发达国家
艾滋病死
亡率下降
（美国）
艾滋病传布途径 AIDS transmission
control transmission

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


控制性传播
控制输受血传播
控制医源性传播
控制吸毒传播
控制母婴传播
Prevention from iv
drug use
Drug control
Detoxification
Provision of sterilized
syringes
两害相较取其轻
To choose the lesser
of two evils
Prevention of sexual
transmission
Abstinence
Be faithful
Condom
两害相较取其轻
To choose the
lesser of two evils
No condom
No sex
World Aids Day: 1 December (since 1988）
World AIDS Day, 1 December 2012
“GETTING TO ZERO.“
行动起来，向零艾滋迈进
全民参与，全力投入，全面预防
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

ZERO New HIV infections.
ZERO Discrimination and
ZERO AIDS-related deaths.
Essay writing
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Medicine: its past, present and future
You may choose any topics as long as follow the theme of
“history of medicine”
Should be ORIGINAL Using your own words, not “copy” and
“paste” “control-v””control-c”
No less than 2000 words, including title, abstract, full text,
references , with your name and student number
Word format, student number as file name
Electronic version only
Send to: [email protected], before April 25, 2013
谢
谢