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Terms in this set (49)
-Virulence: high
-Yes reservoir
-Fecal oral rt, contaminated water, contaminated food
-Repro: Upon ingestion, pathogen replicates in gastrointestinal tract. Diarrhea that results can cause the release of a large number of bacteria in the stools.
-Resist: no previous exposure means bacteria is highly infectious. Somebody who recovers develops immunity, but can be reinfected at later times in life, though not as severe
-No vaccine
-Morbidity and mortality results from an induced severe diarrhea that causes massive fluid and electrolyte loss in the patient in just a day or 2.
-Yes reservoir
-Fecal oral rt, contaminated water, contaminated food
-Repro: Upon ingestion, pathogen replicates in gastrointestinal tract. Diarrhea that results can cause the release of a large number of bacteria in the stools.
-Resist: no previous exposure means bacteria is highly infectious. Somebody who recovers develops immunity, but can be reinfected at later times in life, though not as severe
-No vaccine
-Morbidity and mortality results from an induced severe diarrhea that causes massive fluid and electrolyte loss in the patient in just a day or 2.
-Vir: high
-Yes reservoir
-Close contact aerosols
-Repro: Pathogen is inhaled and replicates very rapidly in the lung epithelium. Significant amounts of virus are released in the airways and lungs. These virions are spread by cough, sneeze, nasal drainage, etc.
-Resist: No human immunity bc not enough time to develop. Very infectious and spreads rapidly by aersols.
-No vaccine
-Virus replicates in lungs and kills epithelial cells and induces an inflammatory response that results in fluid accumulation in lungs. Patients die of a virally induced pneumonia
-Yes reservoir
-Close contact aerosols
-Repro: Pathogen is inhaled and replicates very rapidly in the lung epithelium. Significant amounts of virus are released in the airways and lungs. These virions are spread by cough, sneeze, nasal drainage, etc.
-Resist: No human immunity bc not enough time to develop. Very infectious and spreads rapidly by aersols.
-No vaccine
-Virus replicates in lungs and kills epithelial cells and induces an inflammatory response that results in fluid accumulation in lungs. Patients die of a virally induced pneumonia
-High RO 5-7
-No reservoir
-Close contact aersols
-Initial replication in lung epithelium with subsequent viremia throughout the body. High levels of virus in tissues and in skin rash papules. Virus can be released when skin lesions erupt by aersols when coughing and sneezing
-Very efficient pathogen, that very likely infects somebody that hasnt been vaccinated. Virus makes many proteins which have the ability to limit a protective immune response
-Not in present day
-Virus replicates at a high level in tissues during viremia phase that many organs do not function properly and many cells are killed. individuals can die of multiple organ failure or from systemic destructive inflammation
-No reservoir
-Close contact aersols
-Initial replication in lung epithelium with subsequent viremia throughout the body. High levels of virus in tissues and in skin rash papules. Virus can be released when skin lesions erupt by aersols when coughing and sneezing
-Very efficient pathogen, that very likely infects somebody that hasnt been vaccinated. Virus makes many proteins which have the ability to limit a protective immune response
-Not in present day
-Virus replicates at a high level in tissues during viremia phase that many organs do not function properly and many cells are killed. individuals can die of multiple organ failure or from systemic destructive inflammation
-Individual who has a higher level of pathogen replication in vivo than is usual
-Individual who excretes more infectious agent into the environment than is usual.
-Individual who remains infectious for a longer period of time than is usual.
-Individual who does not become incapacitated by disease as is usual, but continues to interact with susceptible individuals while being very ill.
-Individual who interacts with large groups of susceptible individuals while infectious (e.g. an individual in a health care setting with a lot of patients who may have lowered immunity)
-Individual who excretes more infectious agent into the environment than is usual.
-Individual who remains infectious for a longer period of time than is usual.
-Individual who does not become incapacitated by disease as is usual, but continues to interact with susceptible individuals while being very ill.
-Individual who interacts with large groups of susceptible individuals while infectious (e.g. an individual in a health care setting with a lot of patients who may have lowered immunity)
-Only one experimental patient (N=1, James Phipps).
-Phipps was a child and was the son of his poor gardener. (Employee exploitation?)
-Challenge of Phipps with smallpox virus was human experimentation that had a high probability of adverse effects based on current knowledge.
-No control patients (mock vaccination, then challenge with smallpox) for comparison, though this would also have been unethical.
-Drew conclusions from this single experiment (N=1, Controls=0) that were unfounded (i.e. no statistical analysis possible) based on the design of this "clinical" trial.
-Phipps was a child and was the son of his poor gardener. (Employee exploitation?)
-Challenge of Phipps with smallpox virus was human experimentation that had a high probability of adverse effects based on current knowledge.
-No control patients (mock vaccination, then challenge with smallpox) for comparison, though this would also have been unethical.
-Drew conclusions from this single experiment (N=1, Controls=0) that were unfounded (i.e. no statistical analysis possible) based on the design of this "clinical" trial.
-Had a clear hypothesis, even though he was not sure of the mechanism of cross-protection.
-Had a clear experimental design, with a definitive outcome (i.e. no detectable smallpox).
-Had all the materials he needed to complete the experiment [i.e. a source of fresh cowpox from his milkmaid, a willing experimental subject (victim?) thanks to his gardener, and a source of smallpox from his infected patients).
-Collected the results from this first experiment, and performed additional, similar experiments.
-Published his work.
-Had a clear experimental design, with a definitive outcome (i.e. no detectable smallpox).
-Had all the materials he needed to complete the experiment [i.e. a source of fresh cowpox from his milkmaid, a willing experimental subject (victim?) thanks to his gardener, and a source of smallpox from his infected patients).
-Collected the results from this first experiment, and performed additional, similar experiments.
-Published his work.
Advantages: An attenuated infection that caused much less morbidity and mortality than did variolation (infecting with variola); Immunity against smallpox was quite good following vaccination; did not have to have a human with smallpox to inoculate others; during active infection with cowpox (from cow or arm to arm), individual was not very contagious to others, unlike variolation;
Disadvantages: If cowpox for immunization came from animals ("ungodly"), very difficult to keep such material sterile, so cow pathogen contamination was a problem; Cowpox arm to arm technique also caused some problems: If contributing individual also had other infections (e.g. hepatitis, etc.) then these infections could be transmitted to the receiver, Arm-to-arm technique was not always successful if transmitter did not have active lesions (e.g. where do you get live cowpox for vaccination?), No way to know amount of cowpox being transmitted to receiver; a few percent of individuals reacted poorly to cowpox infection; Not lifelong immunity.
Disadvantages: If cowpox for immunization came from animals ("ungodly"), very difficult to keep such material sterile, so cow pathogen contamination was a problem; Cowpox arm to arm technique also caused some problems: If contributing individual also had other infections (e.g. hepatitis, etc.) then these infections could be transmitted to the receiver, Arm-to-arm technique was not always successful if transmitter did not have active lesions (e.g. where do you get live cowpox for vaccination?), No way to know amount of cowpox being transmitted to receiver; a few percent of individuals reacted poorly to cowpox infection; Not lifelong immunity.
Snow did several things that were collectively unique for the 1850s: specifically
- General, accurate observations; used common sense
- Careful research of individual cases to determine what each had been exposed to in an effort to disprove or prove his hypothesis (forensic epidemiology)
- Careful data collection of cases in a geographical area (chartography)
- Statistics (mathematical analysis of the data)
- Drew conclusions based on data (i.e. evidence based conclusions) not beliefs or political correctness (the scientific method)
- General, accurate observations; used common sense
- Careful research of individual cases to determine what each had been exposed to in an effort to disprove or prove his hypothesis (forensic epidemiology)
- Careful data collection of cases in a geographical area (chartography)
- Statistics (mathematical analysis of the data)
- Drew conclusions based on data (i.e. evidence based conclusions) not beliefs or political correctness (the scientific method)
-Extremely well trained as a physician and as an epidemiologist (for his time)
-Functionally intelligent (i.e. high emotional intelligence)
-Infectious grin, entrepreneurial spirit, diversity of interests,
-Took a chance on the newly formed CDC in Atlanta
-Ability to overcome rules or obstacles that were in his way
-Could be an effective physician, as well as an effective administrator
-Had a desire to become an effective administrator
-Ability to stimulate trust in others that he could lead
-Ability to work with a diversity of researchers, physicians, epidemiologists, etc.
-Agreed to move self and family overseas (did what was necessary)
-Functionally intelligent (i.e. high emotional intelligence)
-Infectious grin, entrepreneurial spirit, diversity of interests,
-Took a chance on the newly formed CDC in Atlanta
-Ability to overcome rules or obstacles that were in his way
-Could be an effective physician, as well as an effective administrator
-Had a desire to become an effective administrator
-Ability to stimulate trust in others that he could lead
-Ability to work with a diversity of researchers, physicians, epidemiologists, etc.
-Agreed to move self and family overseas (did what was necessary)
The young: infants or children who had not been exposed to disease or vaccinated were very susceptible to smallpox. This is especially true for infants as their immune system is still developing. This less effective immune system makes the young generally more susceptible to diseases
The old: with aging, the immune system becomes less functional (immunosenescence). This less effective immune system makes the old generally more susceptible to diseases
Populations that never had smallpox in their geographic region: Such populations were essentially 100% susceptible to smallpox since no one had ever recovered from the disease. Such recovered individuals were immune to further smallpox infection. In the absence of any "herd immunity" the disease could spread rapidly from one person to another.
Immunosuppressed patients (an assumption): As with any infectious disease, the immunosuppressed are usually more susceptible (note: the degree of susceptibility depends upon the type of immunosuppression that the patient has and what the infectious disease is). However in the 1800s and early 1900s, we really did not have a good understanding of the immunosuppressed patient (either genetically or environmentally induced immunosuppression). So....we do not have any really good data on which type of immunosuppression resulted in high susceptibility to smallpox morbidity and/or mortality. So...we assume they were susceptible.
The old: with aging, the immune system becomes less functional (immunosenescence). This less effective immune system makes the old generally more susceptible to diseases
Populations that never had smallpox in their geographic region: Such populations were essentially 100% susceptible to smallpox since no one had ever recovered from the disease. Such recovered individuals were immune to further smallpox infection. In the absence of any "herd immunity" the disease could spread rapidly from one person to another.
Immunosuppressed patients (an assumption): As with any infectious disease, the immunosuppressed are usually more susceptible (note: the degree of susceptibility depends upon the type of immunosuppression that the patient has and what the infectious disease is). However in the 1800s and early 1900s, we really did not have a good understanding of the immunosuppressed patient (either genetically or environmentally induced immunosuppression). So....we do not have any really good data on which type of immunosuppression resulted in high susceptibility to smallpox morbidity and/or mortality. So...we assume they were susceptible.
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