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2. Infectious diseases: an historical perspective
Infectious diseases have confronted humankind for as long as diseases have been documented or depicted in historical records, literature, art and scientific writing.
Between 1346 and 1350 there were 25 million deaths in Europe from the bubonic plague or 'Black Death' which reduced the population from 75 million to 50 million. One third of the four million population of England died.
Between 1685 and 1801 the annual incidence of smallpox in London peaked at 2,355 per 100,000 population and never fell below 313 per 100,000. In a three year period in the late 1830s a smallpox epidemic killed 42,000 people in Britain.
The epidemics which scarred Victorian England - such as diphtheria, typhus, cholera, tuberculosis - began to be brought under control by a series of major sanitary reforms directed at the cities and towns of the industrial revolution.
The importance of good sanitation, vaccines and antibiotics
Clean water, safe disposal of sewage, reduction of overcrowding and gradual improvement in the nutritional status of the population eventually cut death rates from these and other major infectious diseases.
The most dramatic reductions in mortality were amongst children. As a result more people survived into middle and later life and the foundations were laid for the greater longevity and better health which characterised much of the 20th century in England. The introduction of vaccines and antibiotics in the 20th century further contributed to the saving of lives which in the past would have been lost to infection.
The post-war development of powerful classes of drugs to treat infection led to a view in the 1960s and 1970s that it might be possible to conquer infectious diseases so that they would no longer pose a serious threat to human health.
Facing new challenges
This optimism proved to be unfounded. Gradually more and more of the micro-organisms that caused infection became resistant to the effects of antimicrobial drugs. The widespread use of treatments which weaken the immune system (like chemotherapy for cancer or immunosuppression for transplantation), and the emergence of a large frail elderly population, means that many more people are more susceptible to infection and fall victim to it.
On top of this, very serious previously unrecognised infectious diseases (such as HIV/AIDS) emerged whilst infections considered by many to have been consigned to the history books (such as tuberculosis), began to strike again on a major scale.
Looked at globally a range of key facts illustrates the scale of the problem of infection:
- HIV/AIDS, tuberculosis and malaria are now the world's major killers of children and young adults causing more than 13 million deaths a year;
- in some countries in sub-Saharan Africa up to one in four of the population is now living with HIV infection or full-blown AIDS; whilst nearly 42 million children in 27 countries will lose one or both parents to AIDS by 2010;
- up to one percentage point of a country's Gross Domestic Product (GDP) is lost when 10 per cent of the population is affected by HIV/AIDS;
- there are over 300 million episodes of acute malaria mainly affecting the world's poorest countries.
Understanding the significance of the international picture
In the last year of the 20th century, infectious diseases accounted for an estimated 25 per cent of deaths world-wide, 43 per cent of deaths in low income countries and 63 per cent of deaths among children under five years of age.
A great deal of effort and funding is being directed by Governments and international aid agencies at the major disease problems in the world. The prevention and control of infectious disease in England must be set in this wider context.
As a developed country, we have a role to play through funding, practical support and expertise in helping the developing world. More importantly, micro-organisms that spread these viruses know no boundaries. International travel, migration of populations, and the import and export of goods and foodstuffs make their spread inevitable.
The burden of infectious disease in England
Infectious disease issues that have made headline news in the last few years.
- 40 per cent of people consult their doctor every year because of an infection;
- infections account for 70,000 deaths each year;
- infections put over 150,000 people into hospital each year;
- one in 11 young sexually active women are infected with genital chlamydia;
- the number of people living with diagnosed HIV is estimated to rise to 29,000 by end of 2003, an increase of 40 per cent over the end of 1999 prevalence;
- serious infections with Staphylococcus aureus that involve bacteria resistant to infection have risen from less than five per cent a decade ago to over 40 per cent today.
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