Notable outbreaks

This section needs expansion with: Dengue fever. You can help by adding to it. (June 2020)

In human history, it is generally zoonoses such as influenza and tuberculosis which constitute most of the widespread outbreaks, resulting from the domestication of animals. There have been a number of particularly significant epidemics that deserve mention above the "mere" destruction of cities:

• Plague of Athens (430 to 426 BC): During the Peloponnesian War, typhoid fever killed a quarter of the Athenian troops and a quarter of the population. This disease fatally weakened the dominance of Athens, but the sheer virulence of the disease prevented its wider spread; i.e. it killed off its hosts at a rate faster than they could spread it. The exact cause of the plague was unknown for many years. In January 2006, researchers from the University of Athens analyzed teeth recovered from a mass grave underneath the city and confirmed the presence of bacteria responsible for typhoid.

• Antonine Plague (165 to 180 AD): Possibly measles or smallpox brought to the Italian peninsula by soldiers returning from the Near East, it killed a quarter of those infected, up to five million in total.
• Plague of Cyprian (251–266 AD): A second outbreak of what may have been the same disease as the Antonine Plague killed (it was said) 5,000 people a day in Rome.
• Plague of Justinian (541 to 750 AD): The first recorded outbreak of bubonic plague started in Egypt and reached Constantinople the following spring, killing (according to the Byzantine chronicler Procopius) 10,000 a day at its height, and perhaps 40% of the city's inhabitants. The plague went on to eliminate a quarter to half the human population of the known world. It caused Europe's population to drop by around 50% between 550 AD and 700 AD.
• Black Death (1331 to 1353): The total number of deaths worldwide is estimated at 75 to 200 million. Eight hundred years after the last outbreak, the plague returned to Europe. Starting in Asia, the disease reached the Mediterranean and western Europe in 1348 (possibly from Italian merchants fleeing fighting in Crimea), and killed an estimated 20 to 30 million Europeans in six years; a third of the total population, and up to a half in the worst-affected urban areas. It was the first of a cycle of European plague epidemics that continued until the 18th century. There were more than 100 plague epidemics in Europe during this period. The disease recurred in England every two to five years from 1361 to 1480. By the 1370s, England's population was reduced by 50%. The Great Plague of London of 1665–66 was the last major outbreak of the plague in England and killed approximately 100,000 people, 20% of London's population.
• Third plague pandemic (1855): Starting in China, it spread into India, where 10 million people died. During this pandemic, the United States saw its first outbreak: the San Francisco plague of 1900–1904. Today, sporadic cases of plague still occur in the western United States.
• The 1918 flu pandemic infected half a billion people—around the world, including on remote Pacific islands and in the Arctic—killing 20 to 100 million. Most influenza outbreaks disproportionately kill the very young and the very old, with higher survival rates for those in between, but the 1918 pandemic had an unusually high mortality rate for young adults. (It killed more people in 25 weeks than AIDS did in its first 25 years.) Mass troop movements and close quarters during World War I caused it to spread and mutate faster, and the susceptibility of soldiers to the flu may have been increased by stress, malnourishment and chemical attacks. Improved transportation systems made it easier for soldiers, sailors and civilian travelers to spread the disease.

Encounters between European explorers and populations in the rest of the world often introduced epidemics of extraordinary virulence. Disease killed part of the native population of the Canary Islands in the 16th century (Guanches). Half the native population of Hispaniola in 1518 was killed by smallpox. Smallpox also ravaged Mexico in the 1520s, killing 150,000 in Tenochtitlán alone, including the emperor, and in Peru in the 1530s, aiding the European conquerors. Measles killed a further two million Mexican natives in the 17th century. In 1618–1619, smallpox wiped out 90% of the Massachusetts Bay Native Americans. During the 1770s, smallpox killed at least 30% of the Pacific Northwest Native Americans. Smallpox epidemics in 1780–1782 and 1837–1838 brought devastation and drastic depopulation among the Plains Indians. Some believe the death of up to 95% of the Native American population of the New World was caused by Europeans introducing Old World diseases such as smallpox, measles and influenza. Over the centuries, Europeans had developed high degrees of herd immunity to these diseases, while the indigenous peoples had no such immunity.

Smallpox devastated the native population of Australia, killing around 50% of Indigenous Australians in the early years of British colonisation. It also killed many New Zealand Māori. In 1848–49, as many as 40,000 out of 150,000 Hawaiians are estimated to have died of measles, whooping cough and influenza. Introduced diseases, notably smallpox, nearly wiped out the native population of Easter Island. Measles killed more than 40,000 Fijians, approximately one-third of the population, in 1875, and in the early 19th century devastated the Andamanese population. The Ainu population decreased drastically in the 19th century, due in large part to infectious diseases brought by Japanese settlers pouring into Hokkaido.

Researchers concluded that syphilis was carried from the New World to Europe after Columbus's voyages. The findings suggested Europeans could have carried the nonvenereal tropical bacteria home, where the organisms may have mutated into a more deadly form in the different conditions of Europe. The disease was more frequently fatal than it is today. Syphilis was a major killer in Europe during the Renaissance. Between 1602 and 1796, the Dutch East India Company sent almost a million Europeans to work in Asia. Ultimately, fewer than a third made their way back to Europe. The majority died of diseases. Disease killed more British soldiers in India and South Africa than war.

As early as 1803, the Spanish Crown organized a mission (the Balmis expedition) to transport the smallpox vaccine to the Spanish colonies, and establish mass vaccination programs there. By 1832, the federal government of the United States established a smallpox vaccination program for Native Americans. From the beginning of the 20th century onwards, the elimination or control of disease in tropical countries became a driving force for all colonial powers. The sleeping sickness epidemic in Africa was arrested due to mobile teams systematically screening millions of people at risk. In the 20th century, the world saw the biggest increase in its population in human history due to a drop in the mortality rate in many countries as a result of medical advances. The world population has grown from 1.6 billion in 1900 to an estimated 6.8 billion in 2011. Dengue Fever: Dengue is spread by several species of female mosquitoes of the Aedes type, principally A. aegypti. The virus has five types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. A number of tests are available to confirm the diagnosis including detecting antibodies to the virus or its RNA.

Choleraedit

Since it became widespread in the 19th century, cholera has killed tens of millions of people.

• 1817–1824 cholera pandemic. Previously restricted to the Indian subcontinent, the pandemic began in Bengal, then spread across India by 1820. 10,000 British troops and countless Indians died during this pandemic. It extended as far as China, Indonesia (where more than 100,000 people succumbed on the island of Java alone) and the Caspian Sea before receding. Deaths in the Indian subcontinent between 1817 and 1860 are estimated to have exceeded 15 million. Another 23 million died between 1865 and 1917. Russian deaths during a similar period exceeded 2 million.
• 1826–1837 cholera pandemic. Reached Russia (see Cholera Riots), Hungary (about 100,000 deaths) and Germany in 1831, London in 1832 (more than 55,000 persons died in the United Kingdom), France, Canada (Ontario), and United States (New York City) in the same year, and the Pacific coast of North America by 1834. It is believed that more than 150,000 Americans died of cholera between 1832 and 1849.
• 1846–1860 cholera pandemic. Deeply affected Russia, with more than a million deaths. A two-year outbreak began in England and Wales in 1848 and claimed 52,000 lives. Throughout Spain, cholera caused more than 236,000 deaths in 1854–55. It claimed 200,000 lives in Mexico.
• 1863–75 cholera pandemic. Spread mostly in Europe and Africa. At least 30,000 of the 90,000 Mecca pilgrims fell victim to the disease. Cholera claimed 90,000 lives in Russia in 1866.
• In 1866, there was an outbreak in North America. It killed some 50,000 Americans.
• 1881–96 cholera pandemic. The 1883–1887 epidemic cost 250,000 lives in Europe and at least 50,000 in the Americas. Cholera claimed 267,890 lives in Russia (1892); 120,000 in Spain; 90,000 in Japan and 60,000 in Persia.
• In 1892, cholera contaminated the water supply of Hamburg, and caused 8,606 deaths.
• 1899–1923 cholera pandemic. Had little effect in Europe because of advances in public health, but Russia was badly affected again (more than 500,000 people dying of cholera during the first quarter of the 20th century). The sixth pandemic killed more than 800,000 in India. The 1902–1904 cholera epidemic claimed more than 200,000 lives in the Philippines.
• 1961–75 cholera pandemic. Began in Indonesia, called El Tor after the new biotype responsible for the pandemic, and reached Bangladesh in 1963, India in 1964, and the Soviet Union in 1966. Since then the pandemic has reached Africa, South America, and Central America.

Influenzaedit

• The Greek physician Hippocrates, the "Father of Medicine", first described influenza in 412 BC.
• The first influenza pandemic to be pathologically described occurred in 1510. Since the pandemic of 1580, influenza pandemics have occurred every 10 to 30 years.
• The 1889–1890 flu pandemic, also known as Russian Flu or Asiatic Flu, was first reported in May 1889 in Bukhara, Uzbekistan. By October, it had reached Tomsk and the Caucasus. It rapidly spread west and hit North America in December 1889, South America in February–April 1890, India in February–March 1890, and Australia in March–April 1890. The H3N8 and H2N2 subtypes of the Influenza A virus have each been identified as possible causes. It had a very high attack and mortality rate, causing around a million fatalities.
• The "Spanish flu", 1918–1919. First identified early in March 1918 in U.S. troops training at Camp Funston, Kansas. By October 1918, it had spread to become a worldwide pandemic on all continents, and eventually infected about one-third of the world's population (or ≈500 million persons). Unusually deadly and virulent, it ended almost as quickly as it began, vanishing completely within 18 months. Within six months, some 50 million people were dead; some estimates put the total number of fatalities worldwide at over twice that number. About 17 million died in India, 675,000 in the United States, and 200,000 in the United Kingdom. The virus that caused Spanish flu was also implicated as a cause of encephalitis lethargica in children. The virus was recently reconstructed by scientists at the CDC studying remains preserved by the Alaskan permafrost. The H1N1 virus has a small but crucial structure that is similar to the Spanish flu.
• The "Asian Flu", 1957–58. A H2N2 virus first identified in China in late February 1957. It caused about two million deaths globally.
• The "Hong Kong Flu", 1968–69. A H3N2 virus first detected in Hong Kong in early 1968 and spread across the world, lasting until 1972. This pandemic killed approximately one million people worldwide.
• The "Swine Flu", 2009–10. An H1N1 virus first detected in Mexico in early 2009. Estimates for the mortality of this pandemic range from 150 to 500 thousand.

Typhusedit

Typhus is sometimes called "camp fever" because of its pattern of flaring up in times of strife. (It is also known as "gaol fever" and "ship fever", for its habits of spreading wildly in cramped quarters, such as jails and ships.) Emerging during the Crusades, it had its first impact in Europe in 1489, in Spain. During fighting between the Christian Spaniards and the Muslims in Granada, the Spanish lost 3,000 to war casualties, and 20,000 to typhus. In 1528, the French lost 18,000 troops in Italy, and lost supremacy in Italy to the Spanish. In 1542, 30,000 soldiers died of typhus while fighting the Ottomans in the Balkans.

During the Thirty Years' War (1618–1648), about eight million Germans were killed by bubonic plague and typhus. The disease also played a major role in the destruction of Napoleon's Grande Armée in Russia in 1812. During the retreat from Moscow, more French military personnel died of typhus than were killed by the Russians. Of the 450,000 soldiers who crossed the Neman on 25 June 1812, fewer than 40,000 returned. More military personnel were killed from 1500 to 1914 by typhus than from military action. In early 1813, Napoleon raised a new army of 500,000 to replace his Russian losses. In the campaign of that year, more than 219,000 of Napoleon's soldiers died of typhus. Typhus played a major factor in the Great Famine of Ireland. During World War I, typhus epidemics killed more than 150,000 in Serbia. There were about 25 million infections and 3 million deaths from epidemic typhus in Russia from 1918 to 1922. Typhus also killed numerous prisoners in the Nazi concentration camps and Soviet prisoner of war camps during World War II. More than 3.5 million Soviet POWs died out of the 5.7 million in Nazi custody.

Smallpoxedit

Smallpox was a contagious disease caused by the variola virus. The disease killed an estimated 400,000 Europeans per year during the closing years of the 18th century. During the 20th century, it is estimated that smallpox was responsible for 300–500 million deaths. As recently as the early 1950s, an estimated 50 million cases of smallpox occurred in the world each year. After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in December 1979. To this day, smallpox is the only human infectious disease to have been completely eradicated, and one of two infectious viruses ever to be eradicated, along with rinderpest.

Measlesedit

Historically, measles was prevalent throughout the world, as it is highly contagious. According to the U.S. National Immunization Program, by 1962 90% of people were infected with measles by age 15. Before the vaccine was introduced in 1963, there were an estimated three to four million cases in the U.S. each year. Measles killed around 200 million people worldwide over the last 150 years. In 2000 alone, measles killed some 777,000 worldwide out of 40 million cases globally.

Measles is an endemic disease, meaning it has been continually present in a community, and many people develop resistance. In populations that have not been exposed to measles, exposure to a new disease can be devastating. In 1529, a measles outbreak in Cuba killed two-thirds of the natives who had previously survived smallpox. The disease had ravaged Mexico, Central America, and the Inca civilization.

Tuberculosisedit

One-quarter of the world's current population has been infected with Mycobacterium tuberculosis, and new infections occur at a rate of one per second. About 5–10% of these latent infections will eventually progress to active disease, which, if left untreated, kills more than half its victims. Annually, eight million people become ill with tuberculosis, and two million die from the disease worldwide. In the 19th century, tuberculosis killed an estimated one-quarter of the adult population of Europe; by 1918, one in six deaths in France were still caused by tuberculosis. During the 20th century, tuberculosis killed approximately 100 million people. TB is still one of the most important health problems in the developing world. In 2018, Tuberculosis becomes the leading cause of death from an infectious disease, with roughly 1.5 million deaths worldwide.

Leprosyedit

Leprosy, also known as Hansen's disease, is caused by a bacillus, Mycobacterium leprae. It is a chronic disease with an incubation period of up to five years. Since 1985, 15 million people worldwide have been cured of leprosy.

Historically, leprosy has affected people since at least 600 BC. Leprosy outbreaks began to occur in Western Europe around 1000 AD. Numerous leprosoria, or leper hospitals, sprang up in the Middle Ages; Matthew Paris estimated that in the early 13th century, there were 19,000 of them across Europe.

Malariaedit

Malaria is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa. Each year, there are approximately 350–500 million cases of malaria. Drug resistance poses a growing problem in the treatment of malaria in the 21st century, since resistance is now common against all classes of antimalarial drugs, except for the artemisinins.

Malaria was once common in most of Europe and North America, where it is now for all purposes non-existent. Malaria may have contributed to the decline of the Roman Empire. The disease became known as "Roman fever". Plasmodium falciparum became a real threat to colonists and indigenous people alike when it was introduced into the Americas along with the slave trade. Malaria devastated the Jamestown colony and regularly ravaged the South and Midwest of the United States. By 1830, it had reached the Pacific Northwest. During the American Civil War, there were more than 1.2 million cases of malaria among soldiers of both sides. The southern U.S. continued to be afflicted with millions of cases of malaria into the 1930s.

Yellow feveredit

Yellow fever has been a source of several devastating epidemics. Cities as far north as New York, Philadelphia, and Boston were hit with epidemics. In 1793, one of the largest yellow fever epidemics in U.S. history killed as many as 5,000 people in Philadelphia—roughly 10% of the population. About half of the residents had fled the city, including President George Washington. Another major outbreak of the disease struck the Mississippi River Valley in 1878, with deaths estimated at around 20,000. Among the hardest hit places was Memphis, Tennessee, where 5,000 people were killed and over 20,000 fled, then representing over half the city's population, many of whom never returned. In colonial times, West Africa became known as "the white man's grave" because of malaria and yellow fever.