Monkeypox & Endemicity

WHO focuses less on endemicity as global monkeypox cases top 2,500

If we look at endemicity, it refers to the area where cases are developing [What does Endemic mean? A disease outbreak is endemic when it is consistently present but limited to a particular region. This makes the disease spread and rates predictable. Malaria, for example, is considered endemic in certain countries and regions.]

Today Our World in Data reported 2,580 confirmed global cases through Jun 19. The WHO report notes 2,103 confirmed cases worldwide, including 1 death, and 1 probable case through Jun 15. Cases have been reported in 42 countries in five global regions, but 84% have been in the WHO European Region.

MSM, Europe most affected

In an update late last week from the European Centre for Disease Prevention and Control (ECDC) and the WHO's European office, officials noted the high percentage of monkeypox cases that involve men who have sex with men (MSM).

The report provided details on 892 lab-confirmed European cases reported via The European Surveillance System (TESSy). Of 430 patients with available information, 423 (98.4%) identified as MSM. About 45% of patients were from 31 to 40 years old, and 99.4% of them were male. The earliest date of symptom onset was Apr 8. No deaths occurred.

The ECDC/WHO Europe report said 1,704 cases have been identified in Europe through Jun 15.

In its report, the WHO says, "The outbreak of monkeypox continues to primarily affect men who have sex with men who have reported recent sex with new or multiple partners…. The unexpected appearance of monkeypox in several regions in the initial absence of epidemiological links to areas that have historically reported monkeypox, suggests that there may have been undetected transmission for some time."

*Why is Monkeypox more concentrated in the MSM group?

And why are the overwhelming majority of those affected men who have sex with men (MSM)?

A long history of work on sexually transmitted infections and early studies of the current outbreak suggest the answers may be linked: The virus may have made its way into highly interconnected sexual networks within the MSM community, where it can spread in ways that it cannot in the general population.

Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto, says she “understands the hesitation” to focus on MSM, given the risk of stigma that could worsen discrimination and cause those who are affected to delay seeking care. “But based on the data that we have, and based on the contact tracing that’s been done, it’s very clear that this is an MSM-focused outbreak at this point,” she says. “Anyone can get monkeypox, but we’re seeing disease activity primarily among” MSM, confirms Demetre Daskalakis, an HIV prevention specialist at the U.S. Centers for Disease Control and Prevention.

Sexual encounters clearly play a role in transmission. Of the 152 people in the UKHSA data set, 82 were invited for additional interviews focusing on their sexual health. Among the 45 who participated, 44% reported more than 10 sexual partners in the previous 3 months, and 44% reported group sex during the incubation period. Exactly how the virus is passed on is less clear. Researchers have found viral DNA, and even infectious virus, in the semen of some patients, but they aren’t sure that is important for transmission; skin-to-skin contact may be enough. (Other sexually transmitted infections, including herpes and scabies, also primarily spread this way.)

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Another way to look at disease, something I learned 'not' in college, but from NBC's Dr. Bob Arnot [don't quote me though] when he his Mother-in-law was diagnosed with breast cancer. He stated that so far the medical community had not looked at epidemiology from the viewpoint; Who isn't getting the disease, in other words, where are the numbers low for prevalence and incidence?

[What is disease prevalence and incidence?

Prevalence: Number of people in a population who have a disease or other health outcome at one point in time. [ Source] Incidence: Number of people in a population who develop a disease or other health outcome over a period of time (i.e. new cases over a period of time).]

So, it was found that the Asian regions of the world, had very low numbers for women being diagnosed with breast cancer. Next question was why? Okay, public health looks at:

• genetics
• lifestyle
• where we live, work, and play

If we break down live, work, and play the elements of diet and exercise become important. It  was found that the Asian diet has more fish, ]omega], soy, etc & apparently this works to decrease the development of breast cancer. [The relatively higher soy intake may account for the low breast and prostate cancer mortality in Japan. Soy and isoflavone intake have also been inversely associated with risk of cardiovascular diseases, especially cerebral and myocardial infarctions.]

The lowest mortality rates for breast cancer are found in China and Japan, with rates of approximately 6% to 7%. By contrast, the mortality rate due to breast cancer tends to average around 20% to 25% in the developed nations of Europe and North America.

So, this information has now changed and the numbers are much higher: [Of course, their diets].

Dr. Kazuki Takabe explains why a strong relationship between American and Japanese oncologists is mutually beneficial to both Japanese and Asian-American Women

Two of the biggest factors that influence your cancer risk are genetics and lifestyle. While you have some control over your lifestyle, the culture and environment in which you live largely dictates your lifestyle choices. That’s part of the reason why studies have found a large difference in breast cancer rates among American and Japanese Women—American women are four to five times more likely to be diagnosed with breast cancer.

“In general, 1 out of 8 women in the U.S. will be diagnosed with breast cancer in their lifetime. In Japan, that is 1 out of every 38, but it was even less a decade ago,” says Kazuki Takabe, MD, Clinical Chief of Breast Surgery at Roswell Park Comprehensive Cancer Center.

Traditionally, American women have a higher intake of saturated fats and drink more alcohol compared to Japanese women, whose diets are largely soy-based. Japanese women also walk more and have children later in life. While these and other lifestyle factors have contributed to the stark difference in breast cancer rates between the two countries, the rate of breast cancer has been going up in Japan and is being attributed to the rise of Western influence on the Japanese culture.

“The fact is that three or four decades ago, there was less breast cancer in Japan, so there must be some environmental changes that are causing this,” says Dr. Takabe. “It's been said that the Western lifestyle and diet contribute to this high incidence rate. In Japan, as the younger generations are adopting the American culture, diet and habits, the breast cancer rate is increasing.”

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WHAT IS AN EPIDEMIC?

The Centers for Disease Control and Prevention (CDC) describes an epidemic as an unexpected increase in the number of disease cases in a specific geographical area. Yellow fever, smallpox, measles, and polio are prime examples of epidemics. An epidemic disease doesn't necessarily have to be contagious. West Nile fever and the rapid increase in obesity rates are also considered epidemics. Epidemics can refer to a disease or other specific health-related behavior (e.g., smoking) with rates that are clearly above the expected occurrence in a community or region.

GLOBAL HEALTH, INFECTIOUS DISEASE, PUBLIC HEALTH EDUCATION Feb. 19 2021

Epidemic, Endemic, Pandemic: What are the Differences?

The novel coronavirus pandemic is the perfect model for understanding what exactly a pandemic is and how it impacts life on a global scale. Since the emergence of COVID-19 in 2020, the public has been bombarded with new language to understand the virus and the subsequent global public health response. This article will uncover the factors that make a pandemic and how it differs from epidemics and when a disease is endemic.

WHAT IS AN EPIDEMIC?

The Centers for Disease Control and Prevention (CDC) describes an epidemic as an unexpected increase in the number of disease cases in a specific geographical area. Yellow fever, smallpox, measles, and polio are prime examples of epidemics. An epidemic disease doesn't necessarily have to be contagious. West Nile fever and the rapid increase in obesity rates are also considered epidemics. Epidemics can refer to a disease or other specific health-related behavior (e.g., smoking) with rates that are clearly above the expected occurrence in a community or region.

WHAT IS A PANDEMIC?

The World Health Organization (WHO) declares a pandemic when a disease’s growth is exponential. This means the growth rate skyrockets, and each day cases grow more than the day prior. In being declared a pandemic, the virus has nothing to do with virology, population immunity, or disease severity. It means a virus covers a wide area, affecting several countries and populations.

WHAT ARE THE DIFFERENCES BETWEEN PANDEMICS AND EPIDEMICS?

The WHO defines pandemics, epidemics, and endemic diseases based on a disease's rate of spread. Thus, the difference between an epidemic and a pandemic isn't in the severity of the disease, but the degree to which it has spread.

A pandemic cuts across international boundaries, as opposed to regional epidemics. This wide geographical reach is what makes pandemics lead to large-scale social disruption, economic loss, and general hardship. It's important to note that a once-declared epidemic can progress into pandemic status. While an epidemic is large, it is also generally contained or expected in its spread, while a pandemic is international and out of control.

CAUSES OF DISEASE OUTBREAKS

Several factors contribute to the outbreak of infectious diseases. Contraction can occur as a result of transmission from people, animals, or even the environment. For example:

Weather conditions. 

For example, whooping cough occurs in spring, whereas measles tend to appear in the winter season.

Exposure to chemicals or radioactive materials. 

For example, Minamata is a disease contracted after exposure to mercury.

The social aftermath of disasters such as storms, earthquakes, and droughts can lead to high disease transmission. [Hurricane Katrina]

A number of environmental factors such as water supply, food, air quality, and sanitation facilities can catalyze the spread of infectious diseases.

Disease origins can also be unknown. These kinds of diseases could be caused by a variety of factors, including:

A new or newly modified pathogen

Natural toxins

Undetected chemical releases

Unknown ionizing radiation over-exposure

The field of epidemiology works to trace these unidentified outbreaks to the source in an effort to protect public health and safety.

NOTABLE PAST PANDEMICS

The current COVID-19 outbreak is not the only disease to have impacted the world on a global scale. Here are just a few examples of past pandemics that have shaped the evolution of outbreaks and human immunity: 

The Black Death (1346 - 1353): The Black Death caused an estimated death of 25 million people across the world in the 14th century. According to scientists, the outbreak was caused by a bacteria called Yersinia pestis. This Bubonic Plague lasted for about four years.

American Plagues (16th Century): A cluster of Eurasian diseases brought to the Americas by European explorers, smallpox was one of the chief illnesses of the American Plagues, which contributed to the collapse of the Inca and Aztec civilizations. Some estimates suggest that 90 percent of the indigenous population in the Western Hemisphere was killed off as a result. 

The Flu Pandemic (1889-1890): New transportation routes made possible in the Industrial Age made it easier for influenza viruses to spread widely in the U.S. and beyond. In the span of months, influenza traveled around the globe, with the earliest cases reported in Russia. The virus spread rapidly throughout St. Petersburg before quickly making its way through Europe and the rest of the world, despite the fact that air travel didn't exist yet, leaving 1 million people dead in its wake. 

Spanish Flu (1918-1920): Another massive disease outbreak was the influenza pandemic, popularly called Spanish flu. This viral pandemic began in 1918, immediately following World War I. Over 50 million deaths were recorded during this outbreak, with the disease lasting only two years.

The Asian Flu (1957-1958): The Asian Flu pandemic, which was a blend of avian flu viruses, began in China and eventually claimed more than 1 million lives. The CDC notes that the rapidly-spreading disease was reported in Singapore in February 1957, Hong Kong in April 1957, and the coastal cities of the U.S. in the summer of 1957. The total death toll was more than 1.1 million worldwide, with 116,000 deaths nationally.

AIDS Pandemic and Epidemic (1981-present): Since it was first identified, AIDS has claimed an estimated 35 million lives. Scientists believe that HIV, the virus that causes AIDS, is likely to have evolved from a virus found in chimpanzees that was transferred to humans in West Africa in the 1920s. By the late 20th century, the virus had made its way around the world. For decades, the disease had no known cure, but medication developed in the 1990s now allows people with the disease to experience a normal life span with regular treatment.