EMERGING BIOLOGICAL THREATS This page intentionally left blank EMERGING BIOLOGICAL THREATS A Reference Guide JOAN R. CALLAHAN GREENWOOD PRESS An Imprint of ABC-CLIO, LLC Copyright 2010 by Joan R. Callahan All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher. Library of Congress Cataloging-in-Publication Data Callahan, Joan R. Emerging biological threats : a reference guide / Joan R. Callahan. p. ; cm. Includes bibliographical references and index. ISBN 978-0-313-37209-4 (alk. paper) 1. Emerging infectious diseases. 2. Health risk assessment. 3. Food security. I. Title. [DNLM: 1. Disease Outbreaks—prevention & control. 2. Food Contamination—prevention & control. 3. Hazardous Substances—adverse effects. 4. Public Health—history. WA 105 C156e 2010] RA643.C263 2010 362.196'9—dc22 2009046252 14 13 12 11 10 12345 This book is also available on the World Wide Web as an eBook. Visit www.abc-clio.com for details. ISBN: 978-0-313-37209-4 EISBN: 978-0-313-37210-0 ABC-CLIO, LLC 130 Cremona Drive, P.O. Box 1911 Santa Barbara, California 93116-1911 This book is printed on acid-free paper Manufactured in the United States of America Dedicated to my great-grandfather MICHAEL FOLEY (1849–1897) Born during the Irish Famine Died from an experimental tuberculosis treatment This page intentionally left blank Contents Preface xi 1. Introduction 1 Public Health: A Short History 2 Koch and His Postulates 2 Hazard, Threat, and Risk 2 Outbreaks, Epidemics, and Pandemics 6 What Is Popular Culture? 6 More Definitions 6 So How Bad Is It? 6 2. Five Big Ones 9 HIV Disease and AIDS 9 Malaria 18 Tuberculosis 25 Influenza 32 Hepatitis B and C 40 3. Five More (and Complications) 49 Measles 49 Dysenteries and Enteric Fevers 55 Dengue and Dengue Hemorrhagic Fever 63 Bad Bugs and Miracle Drugs 69 Emerging Diseases 76 What about Pneumonia? 86 What about Meningitis and Encephalitis? 92 Conclusion 101 4. Food Insecurity 103 What about Bees? 103 viii CONTENTS Mad Cow Disease 104 Foot-and-Mouth Disease 109 Anthrax 113 Rinderpest 117 Heartwater 120 Classical Swine Fever 124 Blue-Ear Pig Disease 128 Newcastle Disease 132 Avian Influenza 136 Honeybee Colony Collapse Disorder 141 Conclusion 146 5. Food Insecurity, Continued 147 Citrus Tristeza Virus 147 Bacterial Wilt 156 Southern Corn Leaf Blight 160 Citrus Canker 163 Late Blight of Potato 167 Soybean Rust 171 Witches’ Broom Disease 174 Phoma Stem Canker 178 Asian Soybean Aphid 182 Locusts 186 Conclusion: One to Grow On 190 6. Making Things Worse 193 Too Many Babies: Overpopulation 193 Too Much Carbon: Global Climate Change 199 Not Enough Food: Famine, Pestilence, Destruction, and Death 204 Too Much Food: Metabolic Syndrome and Type 2 Diabetes 208 Too Many Sick People: The Healthcare Crisis 212 Too Many Angry People: Bioterrorism 217 Too Many Experts: The Bogus Health Industry 222 Too Many Drugs: Substance Abuse 227 Too Much UV: Stratospheric Ozone Depletion Revisited 231 Too Many Cooks: Environmental Management Issues 235 Conclusion 241 7. Fighting Back 243 Part 1: Balking the Enemy’s Plans 244 Health Education 244 Better Food 246 A Higher Power 250 Basic Research 252 Water, Toilets, and Garbage 254 Part 2: Preventing the Junction of the Enemy’s Forces 256 Lookouts: Surveillance and Screening 257 Arming the People: Vaccination 260 Holding the Line: Convenient Barriers 265 The Fifth Column: Ringers and Decoys 268 A Clean Camp: Home, School, and Workplace 269 CONTENTS ix Part 3: Attacking the Enemy’s Army in the Field 272 Killing the Enemy: Snipers and WMDs 273 Disabling the Enemy’s Transportation: Inconvenient Barriers 275 Destroying the Enemy’s Resources: Habitat Modification 278 Enlisting Allies: Biological Controls 280 Bugout: Postexposure Prophylaxis 282 Part 4: Besieging Walled Cities 284 Mopping Up: Disease Eradication and Elimination 284 Occupation: Public Health Enforcement 290 Recruitment: Help Wanted 292 Who’s Going to Pay for This? 293 Tuberculosis: The Million-Year War 295 Postscript: Making Friends 297 Index 299 This page intentionally left blank Preface It is my aspiration that health will finally be seen not as a blessing to be wished for, but as a human right to be fought for. —Attributed to Kofi Annan (1938–) In the last week of April 2009, the manuscript for this book was nearly finished when reports of the Mexico City swine flu outbreak exploded onto computer and television screens worldwide. Two weeks later, the reported death toll of 150 had declined to 52—not because people came back to life, but because the cause of death was often hard to verify. It was an unusual flu strain that health departments had not seen before, but the news media treated it like the Apocalypse. When revised numbers showed that the new strain was no more deadly than ordinary sea- sonal flu, the Monday-morning quarterbacking began. Was the public health response appropri- ate, or was it hype? Was it wrong for the Chinese to quarantine Mexican tourists, or for the Egyptians to slaughter their pigs? But just as public interest showed signs of fizzling, a new head- line appeared: “SWINE FLU–HIV COULD DEVASTATE HUMAN RACE.” Worse, the source was not the Weekly World News, but a major wire service1 quoting the head of the World Health Organization. The press release seemed to say that the new H1N1 swine flu strain could combine with the human immunodeficiency virus—the agent of AIDS—to create an airborne threat like nothing the world has ever seen. Many readers took this to mean that the two viruses might physically blend together and give rise to one ugly bug, but as far as we can tell, WHO said nothing of the sort. The original warning posted on the WHO website simply meant that the millions of people living with HIV would be at high risk for complications if they also caught the flu. At the time this book went to press, the H1N1 swine flu outbreak had recently achieved pan- demic status. In another year or two, the world will know whether the healthcare system has coped adequately with the result. At present, however, it seems unlikely that this is the long- awaited biological Big One. In May 2009, when the media breathlessly reported that N95 face masks were flying off the shelves as a result of high demand for flu protection, the author visited three hardware stores in a medium-sized city near San Diego. The shelves were well stocked with 1. United Press International, 4 May 2009. xii PREFACE N95 particulate respirators as usual, and nobody else seemed interested in them. In theaters and shopping malls and college campuses and buses, no one was wearing a mask. The next day, the top news story was no longer the swine flu, but the fact that a well-known actress had gained weight. These observations corroborated a Gallup poll, which showed that only 8 percent of Americans were worried about the swine flu. The virus was silent, but the people had spoken. And then the people spoke again, in June 2009, this time in the form of a distraught father in upstate New York whose son caught the flu. Blaming the school district for exposing his child to what he perceived as a serious health threat, he stormed the district office and threatened the superintendent with a gun. Fortunately, no one was hurt and the son recovered quickly, but the incident suggested that not everyone was interpreting media reports in the same way. Some peo- ple took the exaggerated warnings seriously, while many others ignored the outbreak altogether. Information overload can do that. By late June 2009, an estimated 1 million Americans had contracted the new H1N1 flu strain. Yet only about 3,000 had actually been hospitalized, and 127 had died. A vaccine was in produc- tion and would be available by October, but it was unclear how many people would request it, or what direction the pandemic would take. Most biological threats—potentially harmful things of biological origin—are infectious dis- eases, and influenza is just one of many such diseases that this book discusses in detail. After an introductory chapter that defines some terms and concepts, Chapters 2 and 3 describe ten major human diseases (or disease categories) and related conditions. Each section draws on sources ranging from popular culture and urban legends to the recent biomedical literature. Since biological entities that threaten the food supply are indirect threats to man, Chapters 4 and 5 explore this topic. Chapter 6 examines some human activities that have increased the level of risk associated with certain diseases, and Chapter 7 revisits the war on infectious disease from the perspective of the legendary (perhaps apocryphal) Chinese military strategist Sun Tzu. 1 Introduction All interest in disease and death is only another expression of interest in life. —Thomas Mann, The Magic Mountain Most people in the Chicago area (and many others worldwide) have heard about the Great Epidemic of 1885, which resulted from a rainstorm that swept raw sewage into Lake Michigan and contaminated the city’s water supply. For decades, historians have reported how an esti- mated 90,000 people, or one-eighth of the population of Chicago at that time, died of cholera or dysentery in the days that followed. The event has become nearly as famous as the Great Chicago Fire of 1871, and the players are as familiar as Mrs. O’Leary’s cow.