To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This chapter delineates a crisis of public health that occurred throughout the Revolutionary and Napoleonic Wars. It shows how it was in response to this crisis that the modern system of universal quarantine took shape. The chapter investigates the series of plague and yellow fever epidemics that breached the defenses of a string of Mediterranean islands and considers the response of European governments. The frequency with which armies and navies crossed the Mediterranean created a massive augmentation of quarantine traffic just as new epidemic threats emerged. Authorities recommitted to a robust approach to quarantine in light of these challenges. Despite wartime debacles that suggested the system might break down, Chapter 1 shows that it emerged stronger than ever. In this way, we see how a brutal series of wars and epidemics counterintuitively fostered transnational sanitary cooperation.
The introduction sets out the main themes of the book and establishes the context from which the West India Regiments emerged in the late eighteenth century. The British had successfully expanded their control in the Caribbean during the eighteenth century even though mortality in the army remained stubbornly high. On some campaigns enslaved people had been used in short-term auxiliary military roles, setting a precedent that would be followed to its logical conclusion after 1795. Slavery remained the bedrock of Caribbean society, and while racial concepts remained somewhat in flux during the eighteenth century, they were gradually hardening. West Indian physicians, however, generally agreed that black and white bodies were fundamentally the same.
While Darwin effectively undermined the idea of any kind of genesis with the publication of On the Origin of Species in 1859, the damage to the medical reputation of black people generally, and black soldiers in particular, had been done. Attention in the 1860s and 1870s turned to the performance of the West India Regiments in West Africa in campaigns against the Asante people. Military surgeons, steeped in the now-established medical orthodoxy of black vulnerability to a variety of diseases (particularly lung complaints), constantly grumbled that the West India Regiments were no longer medically fit for purpose. After the 1850s most West India Regiment soldiers were born in the West Indies, rather than in Africa, reducing the rates of acquired immunity to yellow fever. And while the men of the West India Regiments had never been immune to all forms of malaria, surgeons only now began to notice how many of them succumbed to tropical fevers. By the 1870s there was a growing belief that white soldiers should be preferred for campaigns in West Africa, as West India Regiment troops were not thought physically capable of withstanding the climate. Blackness had been transformed from conferring a medical advantage to being a medical liability.
Chapter 5 shows just how influential Tulloch’s work was by analysing its effect on the American School of ethnologists. Debates about the origins of man, and specifically about the unity of the human species, had been ongoing since the middle of the eighteenth century, but crystallised in the 1840s and 1850s into a debate between monogenists and polygenists. In their attempt to prove that black and white people were fundamentally and innately different, the polygenists turned to the publications of British military surgeons and particularly to those of Alexander Tulloch. His work proved, they thought, that races could not become assimilated to different climates and that black people had been made for the African climate, not shaped by it. As a publication of the British army, American polygenists asserted that Tulloch’s work offered vital and impartial support for their claim that Africans and Caucasians were of different species.
This chapter analyses the rationale behind the founding of the West India Regiments in 1795. It argues that, while various trial runs with black soldiers during the eighteenth century had created a fertile ground for the idea, what forced Britain’s hand was an outbreak of a new strain of yellow fever in 1793. Only those of African descent were believed to be resistant to the disease (many West Africans had experienced a childhood form of the disease and were therefore immune), and when faced with the French arming large numbers of black soldiers in St. Domingue, the British determined to do the same. The decision, however, was principally a medical one rather than simply a military one. European troops would be replaced by Africans – the only men whom physicians had stated were immune to yellow fever in the West Indies.
After the mass campaign of Measles and Rubella vaccination in 2003 in Iran, the cases of measles and rubella infection decreased but still, the cases of rash and fever were reported. It is worth noting that some other viral infections show signs similar to measles and rubella such as some arboviruses. Considering the epidemic outbreak of arbovirus infections in countries neighbouring Iran, we performed this study to estimate the possibility of chikungunya and dengue fever among measles and rubella IgM negative patients presenting with rash and fever from December 2016 to November 2017 in the National Measles Laboratory at Tehran University of Medical Sciences. Serum samples were selected at random from patients from eight provinces. The presence of DENV IgM and CHIKV IgM was examined by enzyme-linked immunosorbent assay. Of the 1306 sera tested, 210 were CHIKV seropositive and 82 were dengue seropositive. Statistical analysis demonstrated a significant increase in the CHIKV IgM antibody seropositivity rate in Kerman (OR = 2.07, 95% CI: 1.10–3.92; P = 0.024) and Fars (OR = 1.77, 95% CI: 1.06–2.93; P = 0.027). The DENV and CHIKV seropositivity rate in summer is higher than in other seasons (P < 0.01). Our seropositive samples suggest possible CHIKV and DENV infection in Iran. It is likely that these viruses are circulating in Iran and there is a need to study vector carriage of these two viruses.
Q fever (caused by Coxiella burnetii) is thought to have an almost world-wide distribution, but few countries have conducted national serosurveys. We measured Q fever seroprevalence using residual sera from diagnostic laboratories across Australia. Individuals aged 1–79 years in 2012–2013 were sampled to be proportional to the population distribution by region, distance from metropolitan areas and gender. A 1/50 serum dilution was tested for the Phase II IgG antibody against C. burnetii by indirect immunofluorescence. We calculated crude seroprevalence estimates by age group and gender, as well as age standardised national and metropolitan/non-metropolitan seroprevalence estimates. Of 2785 sera, 99 tested positive. Age standardised seroprevalence was 5.6% (95% confidence interval (CI 4.5%–6.8%), and similar in metropolitan (5.5%; 95% CI 4.1%–6.9%) and non-metropolitan regions (6.0%; 95%CI 4.0%–8.0%). More males were seropositive (6.9%; 95% CI 5.2%–8.6%) than females (4.2%; 95% CI 2.9%–5.5%) with peak seroprevalence at 50–59 years (9.2%; 95% CI 5.2%–13.3%). Q fever seroprevalence for Australia was higher than expected (especially in metropolitan regions) and higher than estimates from the Netherlands (2.4%; pre-outbreak) and US (3.1%), but lower than for Northern Ireland (12.8%). Robust country-specific seroprevalence estimates, with detailed exposure data, are required to better understand who is at risk and the need for preventive measures.
Coxiella burnetii, the causative agent of Q fever, is widely present in dairy products around the world. It has been isolated from unpasteurised milk and cheese and can survive for extended periods of time under typical storage conditions for these products. Although consumption of contaminated dairy products has been suggested as a potential route for transmission, it remains controversial. Given the high prevalence of C. burnetii in dairy products, we sought to examine the feasibility of transmitting the major sequence types (ST16, ST8 and ST20) of C. burnetii circulating in the United States. We delivered three strains of C. burnetii, comprising each sequence type, directly into the stomachs of immunocompetent BALB/c mice via oral gavage (OG) and assessed them for clinical symptoms, serological response and bacterial dissemination. We found that mice receiving C. burnetii by OG had notable splenomegaly only after infection with ST16. A robust immune response and persistence in the stomach and mesenteric lymph nodes were observed in mice receiving ST16 and ST20 by OG, and dissemination of C. burnetii to peripheral tissues was observed in all OG infected mice. These findings support the oral route as a mode of transmission for C. burnetii.
A cross-sectional survey was carried out to estimate the seroprevalence of Coxiella burnetii in extensively grazed cattle and sheep from central Italy and to identify the related risk factors. Data on notified human Q fever cases in the area were also collected and described. A two-stage cluster sampling was performed. A total of 5083 animals (2210 cattle; 2873 sheep) belonging to 186 farms (92 herds; 94 flocks) were tested for the presence of antibodies against C. burnetii using a commercial enzyme-linked immunosorbent assay kit. The prevalence at the animal-level resulted three times higher in sheep compared to cattle (37.8% vs. 12.0%; χ2 = 270.10, P < 0.001). The prevalence at the herd-level was also higher in sheep than in cattle (87.2% vs. 68.5%; χ2 = 9.52, P < 0.01). The multivariate analysis showed a higher risk of seropositivity for cattle aged 67–107 months (OR 2.79, 95% CI 1.86–4.18), cattle >107 months of age (OR 2.07, 95% CI 1.36–3.14) and mixed breed cattle (OR 1.74, 95% CI 1.11–2.72). A herd size >92 animals was recognized as herd-level risk factor in cattle (OR 6.88, 95% CI 1.67–28.37). The risk of being seropositive was double in sheep belonging to flocks >600 animals (odds ratio (OR) 2.04, 95% CI 1.63–2.56). Sheep were confirmed to be the most exposed species. Nevertheless, the prevalence observed in cattle also suggests the potential involvement of this species in the circulation of the pathogen in the area. Seven confirmed human Q fever cases were reported. In five out of seven cases there was at least one exposed herd within a 5 km buffer. Even though the source of the infection was not identified, the possibility of C. burnetii circulating in the livestock and human population in the study area cannot be overlooked. The integration between veterinary and human surveillance will be crucial to understand the spread of this zoonosis and to support the adoption of appropriate control measures.
Lassa fever (LF) is increasingly recognised as an important rodent-borne viral haemorrhagic fever presenting a severe public health threat to sub-Saharan West Africa. In 2017–18, LF caused an unprecedented epidemic in Nigeria and the situation was worsening in 2018–19. This work aims to study the epidemiological features of epidemics in different Nigerian regions and quantify the association between reproduction number (R) and state rainfall. We quantify the infectivity of LF by the reproduction numbers estimated from four different growth models: the Richards, three-parameter logistic, Gompertz and Weibull growth models. LF surveillance data are used to fit the growth models and estimate the Rs and epidemic turning points (τ) in different regions at different time periods. Cochran's Q test is further applied to test the spatial heterogeneity of the LF epidemics. A linear random-effect regression model is adopted to quantify the association between R and state rainfall with various lag terms. Our estimated Rs for 2017–18 (1.33 with 95% CI 1.29–1.37) was significantly higher than those for 2016–17 (1.23 with 95% CI: (1.22, 1.24)) and 2018–19 (ranged from 1.08 to 1.36). We report spatial heterogeneity in the Rs for epidemics in different Nigerian regions. We find that a one-unit (mm) increase in average monthly rainfall over the past 7 months could cause a 0.62% (95% CI 0.20%–1.05%)) rise in R. There is significant spatial heterogeneity in the LF epidemics in different Nigerian regions. We report clear evidence of rainfall impacts on LF epidemics in Nigeria and quantify the impact.
In present study, we aimed to evaluate the changes in valvular regurgitations in mid-term follow-up of children with first attack acute rheumatic fever diagnosed after updated Jones criteria.
Materials and methods:
The medical records of the children diagnosed with acute rheumatic fever between June 2015 and November 2018 were evaluated retrospectively. When compared to the findings during diagnosis, the changes in the degree of valvular regurgitation in the last visit were coded as same, regressed, or disappeared.
A total of 50 children were diagnosed with the first attack of acute rheumatic fever between the noted dates. Nine patients (18%) could be diagnosed depending on the new criteria. Eight patients did not have carditis, and 35 patients (49 valves) could be followed for a median follow-up period of 11.7 ± 3.3 months. In our study, the valvar lesions continued in 82% of patients with clinical carditis at the end of the first year and the degree of valvular regurgitation decreased in 39% of them. Despite this, in a significantly higher (p = 0.031) ratio of patients with silent carditis (41%), valvar lesions disappeared in the same follow-up period. In 18.4% of the involved valves, regurgitation regressed to physiological level.
Updated Jones criteria make it possible to diagnose a significant number of patients, and the ratio of complete recovery among patients with silent carditis is significantly higher. Also, it can be speculated that the normal children in whom a physiological mitral regurgitation is detected should be followed in terms of rheumatic heart disease.
Parasites live and interact in multi-species communities. As these interactions are often hidden, the extent to which they occur, their relative strength and consequences are poorly understood. We review work on parasite interactions occurring in free-living African buffalo, which are distributed across the African continent and host a diversity of parasites, from bacteria and viruses to helminths. Three case studies of pairwise interactions between some of the most common and economically important parasites of buffalo shed new light on the effects of parasite interactions for individual hosts and population-level disease dynamics. Work on interactions between macro- and microparasites (common gastrointestinal worm infections and bovine tuberculosis, TB) suggests that immune responses underlie complex interactions. At individual host level, worms enhance TB infection severity, but at population level they can limit TB spread. Analysis of interactions between TB and Rift Valley Fever virus (RVFV) shows that TB presence makes increases RVFV effects. Work into how two dominant members of the worm community living in the buffalo gastrointestinal tract reassemble after perturbation reveals that the processes driving interactions between parasites can be dynamic over time. We use combined approaches to bridge the gap between individual and population scales and show how studies of natural populations can advance understanding of parasite interactions.
Little information is available regarding the calcium (Ca) dynamics and how its concentration is influenced following the Ca treatment (injection or bolus) after calving in dairy cows. To evaluate the short- and long-term effects of different sources of Ca supplement to animals fed anionic diets during the pre-partum period, 36 multiparous Holstein cows were randomly assigned to 1 of 3 treatments: (1) control group without Ca supplement (CON); (2) subcutaneous injection of 500 ml of 40% w/v Ca borogluconate immediately post-calving (SUB) and (3) oral supplement of Ca bolus containing 45 g Ca immediately and 24 h post-calving (BOL). Serum concentrations of Ca, P and Mg were measured. Serum concentration of Ca was affected by treatments at 48 h of post-calving (P < 0.01). The mean Ca at 6 h was greater in SUB compared to CON group (2.34 v. 2.01 mmol/l; P < 0.002). The lowest Ca concentration at 12 h was related to CON cows compared with BOL and SUB cows (1.90, 2.16 and 2.14 mmol/l, respectively; P < 0.02); a similar trend was observed 24 h post-calving (P < 0.02). Serum concentrations of P and Mg were not influenced by treatments. Yield of milk, milk protein and fat-corrected milk were lowest (P < 0.05) in SUB cows within 3 weeks of lactation in comparison with CON and BOL cows. However, milk yield and milk composition did not show any difference among treatments throughout the first 3 months post-calving. In general, under conditions of this experiment, Ca supplements to fresh cows as an oral bolus are recommended in comparison with subcutaneous injection.
Spotted fever group rickettsiae (SFG) are a neglected group of bacteria, belonging to the genus Rickettsia, that represent a large number of new and emerging infectious diseases with a worldwide distribution. The diseases are zoonotic and are transmitted by arthropod vectors, mainly ticks, fleas and mites, to hosts such as wild animals. Domesticated animals and humans are accidental hosts. In Asia, local people in endemic areas as well as travellers to these regions are at high risk of infection. In this review we compare SFG molecular and serological diagnostic methods and discuss their limitations. While there is a large range of molecular diagnostics and serological assays, both approaches have limitations and a positive result is dependent on the timing of sample collection. There is an increasing need for less expensive and easy-to-use diagnostic tests. However, despite many tests being available, their lack of suitability for use in resource-limited regions is of concern, as many require technical expertise, expensive equipment and reagents. In addition, many existing diagnostic tests still require rigorous validation in the regions and populations where these tests may be used, in particular to establish coherent and worthwhile cut-offs. It is likely that the best strategy is to use a real-time quantitative polymerase chain reaction (qPCR) and immunofluorescence assay in tandem. If the specimen is collected early enough in the infection there will be no antibodies but there will be a greater chance of a PCR positive result. Conversely, when there are detectable antibodies it is less likely that there will be a positive PCR result. It is therefore extremely important that a complete medical history is provided especially the number of days of fever prior to sample collection. More effort is required to develop and validate SFG diagnostics and those of other rickettsial infections.
Rheumatic fever, an immune sequela of untreated streptococcal infections, is an important contributor to global cardiovascular disease. The goal of this study was to describe trends, characteristics, and cost burden of children discharged from hospitals with a diagnosis of RF from 2000 to 2012 within the United States.
Using the Kids’ Inpatient Database, we examined characteristics of children discharged from hospitals with the diagnosis of rheumatic fever over time including: overall hospitalisation rates, age, gender, race/ethnicity, regional differences, payer type, length of stay, and charges.
The estimated national cumulative incidence of rheumatic fever in the United States between 2000 and 2012 was 0.61 cases per 100,000 children. The median age was 10 years, with hospitalisations significantly more common among children aged 6–11 years. Rheumatic fever hospitalisations among Asian/Pacific Islanders were significantly over-represented. The proportion of rheumatic fever hospitalisations was greater in the Northeast and less in the South, although the highest number of rheumatic fever admissions occurred in the South. Expected payer type was more likely to be private insurance, and the median total hospital charges (adjusted for inflation to 2012 dollars) were $16,000 (interquartile range: $8900–31,200). Median length of stay was 3 days, and the case fatality ratio for RF in the United States was 0.4%.
Rheumatic fever persists in the United States with an overall downwards trend between 2003 and 2012. Rheumatic fever admissions varied considerably based on age group, region, and origin.
Alice Dunbar Nelson’s early short stories about New Orleans’s downriver, working-class neighborhoods focus, in particular, on the way the men in this environment can suffer forms of alienation sufficiently extreme to constitute social death. In two of these stories, a literal death comes to highlight the ways the main characters are already, from the standpoint of social relations, dead, and as such highlight the problems faced by the working poor in the distinctive environment of the final years of the nineteenth century in New Orleans. These stories, however, gave Dunbar Nelson a means of escaping this world, as, soon after they were published, she left for New York and became a prominent figure in the Harlem Renaissance.
Recent research by climate scientists suggest that New Orleans, much of which is below sea level and protected from the sea only by a rapidly eroding marshland, may someday become uninhabitable. The city’s literature of the last few decades has been preoccupied with the theme of fatalism and apocalypse, and the deadly epidemics of the nineteenth century have provided rich symbolic terrain for figuring the troubles that “plague” the city and that will someday mean its end. Some recent work by women of color – notably Erna Brodber and Brenda Marie Osbey – delineates a different literary project, one appropriate to a post-apocalyptic diaspora, namely the work of remembering. Both the traditional fatalism and this emerging interest in memory will likely be central themes to watch for in the major literature associated with the New Orleans in coming decades.
First-degree heart block is a minor manifestation of acute rheumatic fever. Second and third degree heart block and junctional rhythms occur less commonly. We report patients presenting with these latter three electrocardiographic abnormalities and investigate their diagnostic utility.
Patients admitted to our centre meeting the 2014 New Zealand Rheumatic Fever Guideline Diagnostic Criteria for rheumatic fever over a 5-year period from January 2010 to December 2014 were identified. Clinical, haematologic, electrocardiographic, and echocardiographic records were reviewed. Electrocardiograms (ECG) were considered abnormal if there was second- or third-degree atrioventricular block or junctional rhythms. Comparative data from patients with advanced conduction abnormalities without a diagnosis of rheumatic fever during the same time period were reviewed.
A total of 201 patients met inclusion criteria for rheumatic fever. Of these, 17 (8.5%) had transient abnormalities of atrioventricular conduction, 5 (2.5%) with second or third-degree atrioventricular block, and 12 (6%) junctional rhythms. The remaining 173 (86%) patients had evidence of rheumatic valvulitis at presentation. Only one patient without rheumatic fever was found to have advanced conduction abnormalities over the study period, from a total of 3702 ECG.
This large contemporary cohort of acute rheumatic fever shows that 8.5% of cases had either advanced atrioventricular block or junctional rhythms both highly suggestive of the diagnosis in our population.