24 JULY 2009 | GENEVA -- The number of human cases of pandemic (H1N1) 2009 is still increasing substantially in many countries, even in countries that have already been affected for some time.
Our understanding of the disease continues to evolve as new countries become affected, as community-level spread extends in already affected countries, and as information is shared globally. Many countries with widespread community transmission have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends. This shift has been recommended by WHO, because as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources. It remains a top priority to determine which groups of people are at highest risk of serious disease so steps to best to protect them can be taken.
In addition to surveillance information, WHO is relying on the results of special research and clinical studies and other data provided by countries directly through frequent expert teleconferences on clinical, virological and epidemiological aspects of the pandemic, to gain a global overview of the evolving situation.
Average age of cases increasing
In most countries the majority of pandemic (H1N1) 2009 cases are still occurring in younger people, with the median age reported to be 12 to 17 years (based on data from Canada, Chile, Japan, UK and the United States of America). Some reports suggest that persons requiring hospitalization and patients with fatal illness may be slightly older.
As the disease expands broadly into communities, the average age of the cases is appearing to increase slightly. This may reflect the situation in many countries where the earliest cases often occurred as school outbreaks but later cases were occurring in the community. Some of the pandemic disease patterns differ from seasonal influenza, where fatal disease occurs most often in the elderly (>65 years old). However, the full picture of the pandemic's epidemiology is not yet fully clear because in many countries, seasonal influenza viruses and pandemic (H1N1) 2009 viruses are both circulating and the pandemic remains relatively early in its development.
Although the risk factors for serious pandemic disease are not know definitively, risk factors such as existing cardiovascular disease, respiratory disease, diabetes and cancer currently are considered risk factors for serious pandemic (H1N1) 2009 disease. Asthma and other forms of respiratory disease have been consistently reported as underlying conditions associated with an augmented risk of severe pandemic disease in several countries.
A recent report suggests obesity may be another risk factor for severe disease. Similarly, there is accumulating evidence suggesting pregnant women are at higher risk for more severe disease. A few preliminary reports also suggest increased risk of severe disease may be elevated in some minority populations, but the potential contributions of cultural, economic and social risk factors are not clear.
The development of new candidate vaccine viruses by the WHO network is continuing to improve yields (currently 25% to 50 % of the normal yields for seasonal influenza for some manufacturers). WHO will be able to revise its estimate of pandemic vaccine supply once it has the new yield information. Other important information will also be provided by results of ongoing and soon-to be-initiated vaccine clinical trials. These trials will give a better idea of the number of doses required for a person to be immunized, as well as of the quantity on active principle (antigen) needed in each vaccine dose.
Manufacturers are expected to have vaccines for use around September. A number of companies are working on the pandemic vaccine production and have different timelines.
H1N1 flu (swine flu) — Comprehensive overview covers symptoms, tests, treatment and prevention.
Novel H1N1 flu, popularly known as swine flu, is a respiratory infection caused by an influenza virus first recognized in spring 2009. The new virus, which is officially called swine influenza A (H1N1), contains genetic material from human, swine and avian flu viruses.
Technically, the term "swine flu" refers to influenza in pigs. Occasionally, pigs transmit influenza viruses to people, mainly hog farm workers and veterinarians. Less often, someone infected occupationally passes the infection to others. You can't catch swine flu from eating pork.
Unlike typical swine flu, H1N1 flu spreads quickly and easily. In June 2009, when the infection's spread had been verified worldwide, the World Health Organization declared H1N1 flu a global pandemic.
An H1N1 vaccine has been developed for the 2009-10 flu season.
Swine flu symptoms in humans are similar to those of infection with other flu strains:
- Sore throat
- Body aches
Swine flu symptoms develop three to five days after you're exposed to the virus and continue for about eight days, starting one day before you get sick and continuing until you've recovered.
When to see a doctor
It's not necessary to call a doctor if you're generally healthy and you develop swine flu symptoms, such as fever, cough and body aches. Do call your doctor, however, if you have flu symptoms and you're pregnant or you have a chronic disease, such as emphysema or a heart condition.
Influenza viruses infect the cells lining your nose, throat and lungs. The virus enters your body when you inhale contaminated droplets or transfer live virus from a contaminated surface to your eyes, nose or mouth on your hand.
Because novel H1N1 virus is new, everyone is at some risk. Health care workers who provide direct patient care are at particular risk of catching H1N1 flu. College students and children in school and child care are also at high risk. Children typically pick up the virus in the classroom and pass it to other members of the household.
Influenza complications include:
- Worsening of chronic conditions, such as heart disease, diabetes and asthma
- Respiratory failure
Severe complications of human swine flu H1N1 seem to develop and progress rapidly.
Treatments and drugs
Most cases of flu, including human swine flu, need no treatment other than symptom relief. If you have a chronic respiratory disease, your doctor may prescribe additional medication to decrease inflammation, open your airways and help clear lung secretions.
The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can reduce the severity of symptoms, but flu viruses can develop resistance to them. To make development of resistance less likely and maintain supplies of these drugs for those who need them most, antivirals are reserved for people at high risk of complications.
High-risk groups are those who:
- Are hospitalized
- Have shortness of breath along with other flu symptoms
- Are younger than 5 years of age
- Are 65 years and older
- Are pregnant
- Are younger than 19 years of age and are receiving long-term aspirin therapy, because of an increased risk for Reye's syndrome
- Have certain chronic medical conditions, including asthma, emphysema, heart disease, diabetes, neuromuscular disease, and kidney, liver or blood disease
- Are immunosuppressed due to medications or HIV
Lifestyle and home remedies
If you come down with any type of flu, these measures may help ease your symptoms:
- Drink plenty of liquids. Choose water, juice and clear broth to prevent dehydration. Drink enough to have clear or pale yellow urine.
- Rest. Get more sleep to help your immune system fight the infection.
- Take over-the-counter medication to reduce symptoms. Follow package directions for taking acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to reduce fever and aches. Read package labels to be sure any product you give to a child or adolescent does not contain aspirin. Children and teens should not take aspirin because of the risk of Reye's syndrome, a rare but potentially fatal disease.
A vaccine has been developed to prevent swine flu. In the United States, vaccination is recommended for:
- Pregnant women. The risk of swine flu complications is higher during pregnancy. Mothers can potentially provide protection to infants who cannot be vaccinated.
- Household contacts and caregivers for children younger than 6 months of age. Younger infants are at higher risk of flu complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might reduce the infants' risk of exposure to the virus.
- Health care and emergency medical services personnel. Infections have been reported among health care workers, who can be a potential source of infection for vulnerable patients. Also, increased absenteeism in health care workers could reduce health care system capacity.
- Babies, children and teens, from 6 months through 18 years of age. Many cases of novel H1N1 influenza have occurred in children. Influenza viruses spread easily in school and child care, and children infected in these settings carry the infection to their families.
- Young adults, from 19 through 24 years of age. Immunization is important for young adults because they tend to live, work, and study in close proximity, and they move and travel often.
- People ages 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza. These conditions include heart disease, lung disease and some types of cancer.
These measures also help prevent flu and limit its spread:
- Stay home if you're sick. If you do have swine flu, you can give it to others starting about 24 hours before you develop symptoms and ending about seven days later. As a courtesy to others, do your best to stay out of the emergency room, doctor's office or urgent-care center. You don't want to risk infecting anyone else — particularly in a medical facility, where others receiving care may be especially vulnerable to the flu.
- Wash your hands thoroughly and frequently. Use soap and water, or if they're unavailable, use an alcohol-based hand sanitizer. Flu viruses can survive for two hours or longer on surfaces, such as doorknobs and countertops.
- Avoid contact. Stay away from crowds if possible.
- Reduce exposure within your household. If a member of your household has swine flu, designate one other household member to be responsible for the ill person's close personal care.
CBS conducted a three-month long investigation that indicates that we have all been hoodwinked by the governmental “protection” agency, CDC.
What they tried to learn from the CDC was just what percentage of the “flu cases” were in fact H1N1. The CDC did all they could to protect this information and only after filing a Freedom of Information request and waiting 2 months did they finally release the data. Now we know why they wanted it protected and why they stopped testing for the H1N1 virus in late July.
The data revealed that in fact very few cases reported as swine flu were in fact H1N1 variant virus. CBS examined the data in all 50 states. What they found, for example, was that in Georgia only 2% of reported cases were H1N1 (97% negative for H1N1); in Alaska only 1% of reported cases were H1N1 (93% negative for flu and 5% seasonal flu) and in California only 2% of reported cases were H1N1 with 12% being other flu viruses and 86% negative for flu.
A recent release from the CDC found that their survey reported that of 12,943 specimens tested from around the country, only 26.3% of cases tested positive for H1N1 variant virus, but that 99.8% of the specimens tested positive for some type of other flu virus, most of which were regular seasonal flu.
The CDC has now changed all data reporting on the flu effects. They did this by stopping viral typing and subtyping and rolled back all previous numbers based on prior data. The new system for collecting data now started on August 30th, 2009.
The only reason I can imagine they did this is that the prior data was clearly demonstrating that the H1N1 variant virus was causing a very mild illness in most people (99.99%) with fewer hospitalizations, fewer cases of pneumonia and fewer deaths for all ages and groups than the prior seasonal flu in past years. This was true for the United States and the Southern Hemisphere, which has gone though the worst of its flu season.
Now that they are no longer typing the virus, they can attribute all cases of pneumonia, hospitalizations and deaths to H1N1, even though the majority of cases appear to be from a long list of other causes. In fact, they can classify many cases of primary pneumonia as caused by H1N1.
Actually LESS Flu Deaths this Year
One must always keep in mind that the CDC has told us that 36,000 people die every year from influenza and influenza-related complications. Thus far, we have seen (accepting their data) about 900 deaths and 21,829 cases of pneumonia.
This is far below the 36,000 figure. In fact, perhaps we should be breathing a sigh of relief that 35,000 fewer people have died this year from flu-related disorders. This would go down on record as the fewest flu-related deaths in recorded history.
In fact, worldwide, according to CDC and WHO data, far fewer people have died form H1N1 than any seasonal flu in the past. This graph from the CDC showing the "Pneumonia and Influenza Mortality for 122 US Cities" also show that, so far, this year's flu mortality is far below that of 2008.
In fact, worldwide, according to CDC and WHO data, far fewer people have died form H1N1 than any seasonal flu in the past. So, one must ask, why is the government and their handmaidens, the media, fueling this panic mentality? Why are we once again talking about mandatory vaccination for every man woman and child in the nation?
And I can assure you that soon we will hear an announcement that the adjuvant MF-59 or ASO3 (squalene) will be needed to save lives.
Now, if the CBS data forced from the files of the CDC is correct, why are so many people dying from this flu? The answer is that no greater number are dying now, for any age group, sex or state of pregnancy than have died in any previous flu outbreak.
By statistical slight of hand they have created this pandemic and continue to do so. One cannot foretell the future, but based on the data now available from the United States, Canada, Europe and the Southern hemisphere, there is no justification for the fear mongering by the media and government agencies.
It is accepted that the cognitive portions of the human brain work less well under two conditions -- fear and anger. Those who have survived deadly situations or who make their living surviving such situations tell us that controlling our fear is the most important thing in survival. More people have died from making poor decisions while overwhelmed by fear than have died as a result of the situation itself.
I am reminded of the poor elderly person who died several years back waiting in a very long line for a flu vaccine in the sweltering heat. It seems she passed out and struck her head on the hard asphalt.
She was standing in that line for hours because the CDC announced that that year’s flu was going to be especially deadly for the elderly and there was a shortage of vaccine. As it turned out, that year they picked the wrong virus to make the vaccine -- so it was not only a dangerous vaccine, it would have given her no protection. But then, the vaccine manufactures got their blood money.
Swine flu is a new strain of flu that started in Mexico in 2008. However, as it has not mutated at all as predicted by the drug industry "experts" it can be defeated the normal way. With this WHO may find itself in hot water. It appears that this pandemic is actually not pandemic at all and the evidence has started showing that this flu is no more dangerous that any of the annually occurring seasonal flus.
Some doctors are seriously questioning what is going on and especially the motives behind all this. See the video below:
Polish Prime Minister Donald Tusk has gone even further by refusing to buy vaccines for swine flu that are not properly tested or from producers who won't take responsibility for possible side effects.
Poland has had a few dozen swine flu cases that all have been mild and no deaths have been reported. Finland further in North has so far had two death cases, one being a young girl who did not get to see the doctor early eneough and in the other case the patiend had other underlaying causes.
Some independent health experts have been advising vaccination in Poland after a recent surge in flu cases in Ukraine saw more than 700,000 cases and 109 deaths of people with flu-like illness in recent weeks. Fourteen of the deaths were related to swine flu according to Ukraine's chief doctor Oleksandr Bilovol.
The World Health Organization tells now that the swine flu virus has become the predominant flu strain worldwide. In some countries, swine flu accounts for up to 70 per cent of the flu viruses according to Dr. Keiji Fukuda from WHO. While most people recover from the illness without needing medical treatment, officials are also continuing to see severe cases in people under 65 - people who are not usually at risk during regular flu seasons.
Smallpox (430 BC? - 1979): Killed more than 300 million people worldwide in the 20th century alone, and most of the native inhabitants of the Americas
Smallpox (also known by the Latin names Variola or Variola vera) is a contagious disease unique to humans. Smallpox is caused by either of two virus variants named Variola major and Variola minor. The deadlier form, V. major, has a mortality rate of 30–35%, while V. minor causes a milder form of disease called alastrim and kills ~1% of its victims. Long-term side-effects for survivors include the characteristic skin scars. Occasional side effects include blindness due to corneal ulcerations and infertility in male survivors.
Smallpox killed an estimated 60 million Europeans, including five reigning European monarchs, in the 18th century alone. Up to 30% of those infected, including 80% of the children under 5 years of age, died from the disease, and one third of the survivors became blind.
As for the Americas, after the first contacts with Europeans and Africans, some believe that the death of 90 to 95 percent of the native population of the New World was caused by Old World diseases. It is suspected that smallpox was the chief culprit and responsible for killing nearly all of the native inhabitants of the Americas. In Mexico, when the Aztecs rose up in rebellion against Cortés, outnumbered, the Spanish were forced to flee. In the fighting, a Spanish soldier carrying smallpox died. After the battle, the Aztecs contracted the virus from the invaders' bodies. When Cortes returned to the capital, smallpox had devastated the Aztec population. It killed most of the Aztec army, the emperor, and 25% of the overall population. Cortés then easily defeated the Aztecs and entered Tenochtitlán, where he found that smallpox had killed more Aztecs than had the cannons.
Smallpox was responsible for an estimated 300–500 million deaths in the 20th century. As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease and that two million died in that year. After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in 1979. To this day, smallpox is the only human infectious disease to have been completely eradicated from nature.
Spanish Flu (1918 - 1919): Killed 50 to 100 million people worldwide in less than 2 years
In 1918 and 1919, the Spanish Flu pandemic killed more people than Hitler, nuclear weapons and all the terrorists of history combined. (A pandemic is an epidemic that breaks out on a global scale.) Spanish influenza was a more severe version of your typical flu, with the usual sore throat, headaches and fever. However, in many patients, the disease quickly progressed to something much worse than the sniffles. Extreme chills and fatigue were often accompanied by fluid in the lungs. One doctor treating the infected described a grim scene: "The faces wear a bluish cast; a cough brings up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood."
If the flu passed the stage of being a minor inconvenience, the patient was usually doomed. There is no cure for the influenza virus, even today. All doctors could do was try to make the patients comfortable, which was a good trick since their lungs filled with fluid and they were wracked with unbearable coughing. The "bluish cast" of victims' faces eventually turned brown or purple and their feet turned black. The lucky ones simply drowned in their own lungs. The unlucky ones developed bacterial pneumonia as an agonizing secondary infection. Since antibiotics hadn't been invented yet, this too was essentially untreatable. The pandemic came and went like a flash. Between the speed of the outbreak and military censorship of the news during World War I, hardly anyone in the United States knew that a quarter of the nation's population -- and a billion people worldwide -- had been infected with the deadly disease. More than half a million died in the U.S. alone; worldwide, more than 50 million.
Black Death (1340 - 1771): Killed 75 million people worldwide
The Black Death, or The Black Plague, was one of the most deadly pandemics in human history. It began in South-western or Central Asia and spread to Europe by the late 1340s. The total number of deaths worldwide from the pandemic is estimated at 75 million people; there were an estimated 20 million deaths in Europe alone. The Black Death is estimated to have killed between a third and two-thirds of Europe's population.
The three forms of plague brought an array of signs and symptoms to those infected. Bubonic plague refers to the painful lymph node swellings called buboes, mostly found around the base of the neck, and in the armpits and groin. The septicaemic plague is a form of blood poisoning, and pneumonic plague is an airborne plague that attacks the lungs before the rest of the body. The classic sign of bubonic plague was the appearance of buboes in the groin, the neck and armpits, which oozed pus and bled. Victims underwent damage to the skin and underlying tissue, until they were covered in dark blotches. Most victims died within four to seven days after infection. When the plague reached Europe, it first struck port cities and then followed the trade routes, both by sea and land. The bubonic plague was the most commonly seen form during the Black Death, with a mortality rate of thirty to seventy-five percent and symptoms including fever of 38 - 41 °C (101-105 °F), headaches, painful aching joints, nausea and vomiting, and a general feeling of malaise. Of those who contracted the bubonic plague, 4 out of 5 died within eight days. Pneumonic plague was the second most commonly seen form during the Black Death, with a mortality rate of ninety to ninety-five percent.
The same disease is thought to have returned to Europe every generation with varying virulence and mortalities until the 1700s. During this period, more than 100 plague epidemics swept across Europe. On its return in 1603, the plague killed 38,000 Londoners. Other notable 17th century outbreaks were the Italian Plague of 1629-1631, the Great Plague of Seville (1647-1652), the Great Plague of London (1665–1666), the Great Plague of Vienna (1679). There is some controversy over the identity of the disease, but in its virulent form, after the Great Plague of Marseille in 1720–1722 and the 1771 plague in Moscow it seems to have disappeared from Europe in the 18th century. The fourteenth-century eruption of the Black Death had a drastic effect on Europe's population, irrevocably changing Europe's social structure. It was a serious blow to the Roman Catholic Church and resulted in widespread persecution of minorities such as Jews, foreigners, beggars and lepers. The uncertainty of daily survival created a general mood of morbidity influencing people to "live for the moment", as illustrated by Giovanni Boccaccio in The Decameron (1353).
Malaria (1600 - today): Kills about 2 million people per year
Malaria causes about 400–900 million cases of fever and approximately one to three million deaths annually — this represents at least one death every 30 seconds. The vast majority of cases occur in children under the age of 5 years; pregnant women are also especially vulnerable. Despite efforts to reduce transmission and increase treatment, there has been little change in which areas are at risk of this disease since 1992. Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years. Precise statistics are unknown because many cases occur in rural areas where people do not have access to hospitals or the means to afford health care. Consequently, the majority of cases are undocumented.
Malaria is one of the most common infectious diseases and an enormous public-health problem. It's parasites are transmitted by female Anopheles mosquitoes. The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death. The disease is caused by protozoan parasites of the genus Plasmodium. It is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa.
AIDS (1981 - today): Killed 25 million people worldwideAcquired Immune Deficiency Syndrome (AIDS) has led to the deaths of more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed approximately 3.1 million (between 2.8 and 3.6 million) lives in 2005 (an average of 8,500 per day), of which 570,000 were children. UNAIDS and the WHO estimate that the total number of people living with the human immunodeficiency virus (HIV) has reached its highest level. There are an estimated 40.3 million (estimated range between 36.7 and 45.3 million) people now living with HIV. Moreover, almost 5 million people have been estimated to have been infected with HIV in 2005 alone.
The pandemic is not homogeneous within regions with some countries more afflicted than others. Even at the country level there are wide variations in infection levels between different areas. The number of people living with HIV continues to rise in most parts of the world, despite strenuous prevention strategies. Sub-Saharan Africa remains by far the worst-affected region, with 23.8 million to 28.9 million people living with HIV at the end of 2005, 1 million more than in 2003. Sixty-four percent of all people living with HIV are in sub-Saharan Africa, as are more than 77% of all women living with HIV. South & South East Asia are second most affected with 15%.
The key facts surrounding this origin of AIDS are currently unknown, particularly where and when the pandemic began, though it is said that it originated from the apes in Africa.
Cholera (1817 - today): 8 pandemics; hundreds of thousands killed worldwide
In the 19th century, Cholera became the world's first truly global disease in a series of epidemics that proved to be a watershed for the history of plumbing. Festering along the Ganges River in India for centuries, the disease broke out in Calcutta in 1817 with grand - scale results. When the festival was over, they carried cholera back to their homes in other parts of India. There is no reliable evidence of how many Indians perished during that epidemic, but the British army counted 10,000 fatalities among its imperial troops. Based on those numbers,, it's almost certain that at least hundreds of thousands of natives must have fallen victim across that vast land. Cholera sailed from port to port, the germ making headway in contaminated kegs of water or in the excrement of infected victims, and transmitted by travelers. The world was getting smaller thanks to steam-powered trains and ships, but living conditions were slow to improve. By 1827 cholera had become the most feared disease of the century.
The major cholera pandemics are generally listed as: First: 1817-1823, Second: 1829-1851, Third: 1852-1859, Fourth: 1863-1879, Fifth: 1881-1896, Sixth: 1899-1923: Seventh: 1961- 1970, and some would argue that we are in the Eighth: 1991 to the present. Each pandemic, save the last, was accompanied by many thousands of deaths. As recently as 1947, 20,500 of 30,000 people infected in Egypt died. Despite modern medicine, cholera remains an efficient killer.
Typhus (430 BC? - today): Killed 3 million people between 1918 and 1922 alone, and most of Napoleon's soldiers on Russia
Typhus is any one of several similar diseases caused by louse-borne bacteria. The name comes from the Greek typhos, meaning smoky or lazy, describing the state of mind of those affected with typhus. Rickettsia is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field.
The first description of typhus was probably given in 1083 at a convent near Salerno, Italy. Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history. During the second year of the Peloponnesian War (430 BC), the city-state of Athens in ancient Greece was hit by a devastating epidemic, known as the Plague of Athens, which killed, among others, Pericles and his two elder sons. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is one of the strongest candidates for the cause of this disease outbreak, supported by both medical and scholarly opinions. Epidemics occurred throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. A major epidemic occurred in Ireland between 1816-19, and again in the late 1830s, and yet another major typhus epidemic occurred during the Great Irish Famine between 1846 and 1849.
In America, a typhus epidemic killed the son of Franklin Pierce in Concord, New Hampshire in 1843 and struck in Philadelphia in 1837. Several epidemics occurred in Baltimore, Memphis and Washington DC between 1865 and 1873. During World War I typhus caused three million deaths in Russia and more in Poland and Romania. De-lousing stations were established for troops on the Western front but the disease ravaged the armies of the Eastern front, with over 150,000 dying in Serbia alone. Fatalities were generally between 10 to 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. Following the development of a vaccine during World War II epidemics occur only in Eastern Europe, the Middle East and parts of Africa.