Sept. 3, 2025
War & Pathogens, How Combat Drives Contagion
Send us a text War is a vector of disease. The battlefield isn't just a place where bullets fly—it's where pathogens thrive and evolve. Throughout human history, war and disease have been inseparable companions, creating perfect storms of contagion that affect soldiers and civilians alike. Our journey begins in the Boer War concentration camps where measles swept through malnourished populations. We explore how the densely packed, unsanitary conditions created an environment where this highl...
War is a vector of disease. The battlefield isn't just a place where bullets fly—it's where pathogens thrive and evolve. Throughout human history, war and disease have been inseparable companions, creating perfect storms of contagion that affect soldiers and civilians alike.
Our journey begins in the Boer War concentration camps where measles swept through malnourished populations. We explore how the densely packed, unsanitary conditions created an environment where this highly contagious virus could spread with unprecedented severity, even among adults who typically have greater resistance.
The trenches of World War I became breeding grounds for tuberculosis—a disease that claimed millions of lives with no effective treatment available beyond isolation, nutrition, and exposure to fresh air and sunlight. It would be decades after the war ended before the first effective medications were developed in the 1940s.
War doesn't just spread existing diseases—it creates conditions for new ones to emerge. During World War II, when farming ceased in the occupied Crimean Peninsula, overgrown grasslands became habitats for wildlife and the ticks they carried. When Russian soldiers reclaimed the area in 1944, they encountered what would later be identified as Crimean-Congo hemorrhagic fever. Similarly, the Korean War saw the emergence of Hantavirus among US soldiers.
Perhaps most alarming is our exploration of the current Russia-Ukraine conflict, where overstretched medical systems have accelerated antimicrobial resistance to frightening levels. Klebsiella pneumoniae from Ukrainian wounds exhibits carbapenem resistance rates ten times higher than those observed anywhere else in Europe. These resistant strains are already crossing borders, detected in six European countries and as far away as Japan.
The displacement of populations, collapse of healthcare infrastructure, and ecological disruptions caused by conflict create ripple effects that extend far beyond the battlefield. As one expert reminds us, perhaps "more effective than any vaccine, is peace."
Subscribe, share, and join us next time as we continue exploring the intricate connections between human activity and disease emergence. The more we understand these relationships, the better prepared we'll be to face future health challenges.
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Thanks for listening to the Infectious Science Podcast. Be sure to visit infectiousscience.org to join the conversation, access the show notes, and don’t forget to sign up for our newsletter to receive our free materials.
We hope you enjoyed this new episode of Infectious Science, and if you did, please leave us a review on Apple Podcasts and Spotify. Please share this episode with others who may be interested in this topic!
Also, please don’t hesitate to ask questions or tell us which topics you want us to cover in future episodes. To get in touch, drop us a line in the comment section or send us a message on social media.
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00:00 - Introduction to War and Pathogens
01:31 - The Boer War and Measles Outbreaks
13:33 - Tuberculosis During World War I
23:55 - Crimean-Congo Hemorrhagic Fever Discovery
35:52 - Antibiotic Resistance in the Ukraine War
47:36 - Conflict as Driver of Disease Emergence
WEBVTT
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This is a podcast about One Health the idea that the health of humans, animals, plants and the environment that we all share are intrinsically linked.
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Coming to you from the University of Texas Medical Branch and the Galveston National Laboratory.
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This is Infectious Science.
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Where enthusiasm for science?
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is contagious infectious science, where enthusiasm for science is contagious.
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Hello everyone, and welcome back to Infectious Science.
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Today we are talking about war and pathogens.
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There are very few examples of prolonged peace in history, and the human penchant for war has in history, and continues today, to significantly exacerbate the spread of infectious diseases.
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We've previously talked about how globalization exposes us to diseases that previously were only endemic in a specific region or locale.
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Just like globalization, war also increases contagion, because wherever groups of people move, so too does disease.
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Whether masses of people are meeting on a battlefield or forcibly displaced by conflict, disease, the constant companion of humanity, tends to follow.
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In addition to this, war also increases disease by disrupting public health infrastructure and making resources scarce, which can result in malnutrition or the use of unclean water, all of which increase our vulnerability to pathogens.
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We have selected some historic and modern examples of how war has shaped the spread and nature pathogens.
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So let's dive in.
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Alex, you had the first war in our chronological history.
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Do you want to start?
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My name is Alexander Alvarado, for today's episode of the Infectious Science Podcast, talking about war and disease.
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I'm going to be talking about the Boer War and about measles outbreaks in British-run concentration camps during the later phase of the war, and so I'm going to give some background as far as some of the underlying tensions that led to the war, talk a bit more about the Boer War itself and then talk more about measles virus and how the war ultimately changed the spread of measles itself and the course of disease that measles is able to cause.
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So the United Kingdom formally annexed the Cape Colony, which is an area that encompasses much of the western coast of South Africa, following the signing of the Convention of London in 1814 with the Netherlands, in the aftermath of one of the last of the Napoleonic Wars, the War of the Sixth Coalition, and so the British ended up in possession of a territory which had a population of Dutch and Huguenot settlers that came over as a result of Dutch activities in the colony over the past two centuries and the indigenous peoples that had long been on the land, and there were significant political disagreements between the British were curtailing the practice of slavery and the unwillingness of the British administration to go and expand the colony to enable these semi-nomadic boar cattle herders to expand their range.
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And ultimately this led for some of these settlers, some of these boars, to opt, over the course of largely the 1830s through the 1850s, to settle in the interior of South Africa in order to live beyond the course of largely the 1830s through the 1850s, to settle in the interior of South Africa in order to live beyond the jurisdiction of the British, to live outside of the boundaries of the Cape Colony.
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In time, these settlements coalesced into some of these Dutch settler republics, these Boer republics, including states like the Orange Free State and the South African Republic.
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And these states, they were hit by an influx of foreigners as a result of the discovery of gold in 1884, the Whitwater Strand Gold Rush, and largely British nationals ended up emerging into the South African Republic looking for gold.
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And there were fears, ultimately, among a number of these Boer residents in the Republic that the amount of British residents, which in time came to outnumber the Boers, that these British nationals would amass enough political clout to push for the absorbance of the independent state into the British Empire.
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And there were continued disputes regarding what the rights of these foreign residents should be and upon the duration required for them to attain citizenship, etc.
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In order for the Boers to find some ways to dilute the political power of these British nationals and these foreigners who had come seeking for gold, pushing back on that.
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And so the British attempted to negotiate with the South African Republic regarding the nature of the rights of these foreigners who had come seeking for gold.
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But the collapse of negotiations between the British and the Boer states ultimately led to the Orange Free State and the South African Republic to both declare war against the United Kingdom.
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Initial Boer victories in 1899, a mobilization by the British, one of the largest at the time, enabled ultimately the capture of both states in 1900 and of large swaths of territory.
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And so, with the collapse of the central states that initially started to wage the war, with continued, though, civilian support and the nature of the decentralized structure of command for the Boer armies and local knowledge of the land, the climate was ripe for Boer guerrilla warfare to continue the struggle for longer against the British.
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And the British ultimately decided, in order to go about suppressing the spate of guerrilla warfare and to enable the end of this war, tried to essentially detach the Boer military forces that were continuing to battle against them, from the civilian population and from the resources that they relied upon from the civilian population, like food, and so they destroyed Boer farmsteads and settlements, they burned crops and they displaced the population, both Boers and the indigenous peoples of that land.
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They displaced them into these specially constructed concentration camps, and so thus this enabled the Boer guerrillas to be deprived of civilian cover that they could otherwise blend into, as well as of civilian support and the material resources that they could use in order to further continue their campaign against the British.
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And these camps were rather densely populated and were known for having poor sanitation and had limited food rations, both as a result of the limitations of the time as well as British policy that exacerbated the situation.
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So relations of known guerrillas received smaller rations than others, and the indigenous African detainees lacked a guaranteed food ration, unlike some of the Boers, and were thus forced to work for food, unlike Boer detainees, and received nutritionally imbalanced rations when they did receive rations, as a result of pseudoscientific misconceptions of dieting at the time, and as a result, this was a population that, between the stresses of war, which is known to negatively affect the immune system, and the widespread nature of malnutrition in a densely populated area.
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This gives you an immunocompromised population in an area where infectious diseases can easily spread, and in many ways this was almost the perfect storm for a measles outbreak.
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And so measles virus itself is a paramyxovirus that has a non-segmented RNA viral genome which is capable of causing the disease of measles in humans, and so viral infection is largely caused through aerosol transmission, be it through direct contact or in contact with infected surfaces.
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And so measles virus itself, it tends to infect these airway epithelial cells and specialized lung immune cells, the latter of which may include, say, these alveolar macrophages, and alveolar macrophages, by becoming infected, may end up trafficking measles virus to local lymph tissue, enabling subsequent infection of more specialized immune cells, some naive B cells as well as memory T and B cells.
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And this is mediated through the measles virus interaction with the SLAM receptor, otherwise known as CD150, which is this surface receptor that's conserved among some of these cell types.
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And as a result of the infection of some of these specialized immune cells, and particularly these memory B and T cells, and the necessary cell deaths caused by the immune system, this response to go and kill the measles virus cells that were targeted to other organisms and, essentially, their replacement by these populations of BNT cells that are specific to measles virus specifically, it enables an increasing amount of susceptibility to other pathogens and this immunosuppression can last for some time, even after the full resolution of the course of disease of measles itself.
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It can prove to be quite problematic, but in terms of measles disease itself.
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So basically, after a 7 to 14 incubation period you start to experience some of the signs of a nonspecific febrile illness.
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So a fever, cough, rhinitis.
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These are some of the things that may start to emerge, and, in conjunction with some of these prodromal symptoms, conjunctivitis, coplic spot and a maculopapular rash are rather characteristic of measles virus.
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Infection and the spread of the virus to further within the lungs and into the brain may lead to pneumonia and encephalitis respectively, and so pneumonia can be caused by other pathogens as a result of measles-induced immunosuppression, or directly by measles, due to the sort of damage that measles can cause to the lung itself.
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And pneumonia is often the primary cause of measles death, be it indirectly or directly as a result of measles virus infection.
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And it's worth noting that measles virus is highly contagious.
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It has an R0 value of about 12 to 18, which really points to the contagiousness of measles virus itself, as a number of otherwise naive, uninfected, susceptible individuals can ultimately become infected by just one case.
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And so, in a densely populated area, in the absence of modern day vaccines for measles virus and in a population that was highly immunosuppressed, these British-built concentration camps for the Boers and for the indigenous people of the Boer republics really enabled a rapid spread of measles virus, and it enabled further these high degrees of mortality to it, higher even in adult cases than normal, because the measles virus largely tends to be a disease of the youth right.
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Once infected with it you may have lifelong immunity, but it is particularly hard on younger people.
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These outbreaks were somewhat unique, though, with relatively higher case fatality rates in adults, which was a new development that in many ways could probably be attributed to the stressors of the camp and the nature of the concentration camps in general in terms of the dense degree of the population and the malnutrition that they were experiencing.
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And so, over the course of the 1900 to 1902 period in which these camps were still operable, there were about 47,000 civilians, be they Boer settlers or the indigenous peoples, that died in these British camps.
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Roughly about 30% of these deaths are estimated to have been as a result of measles.
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In some of these camps, over 50% of children's deaths were due to measles and over 10% of adult deaths were due to that same disease.
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And I think that really speaks to the nature of how these specially constructed environments, these temporary environments, and the nature of war can significantly affect the spread of infectious disease, and it's something to be cognizant of in modern conflicts.
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Even to this day, there are certainly still issues with that, with a number of wars that are fought and with the breakdown of sanitation systems and of the emergence of, in some cases, hastily constructed, densely packed refugee camps and further this outbreak, I think, is a bit of a cautionary tale.
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This points to the destructive capacity of measles virus when it's not being mitigated by things like widespread vaccine uptake and antivirals and the resources that we have today, and I think it certainly points to how, when we have infectious diseases that can't be controlled by some of these therapeutics, or if there's some reluctance to go about using some of these therapeutics, the consequences can be rather disastrous for the population.
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Thankfully, there have been no lingering effects to this day of the measles epidemic in the British concentration camps, but the camps themselves and the degree of death that ultimately pervaded in them is still in many ways a cause of concern for what happened over the course of that war, and certainly a story is worth attention, and so I figured that I talk about it a bit more today in this segment.
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Back over to you.
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Awesome.
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Thanks, alex.
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It's always so good to learn and understand things that you really knew nothing about beforehand.
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I really like using these recordings and these sessions that we have to learn for myself and study things I was previously interested in but maybe didn't know too much about specifically, and the war and the disease process that I wanted to focus on for our recording session today was actually the relationship between tuberculosis and World War I, tuberculosis and World War I.
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So, as we here know, tuberculosis is caused by mycobacterium tuberculosis.
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It has two phases really, or three, I guess, if you want to consider latent phase as a phase.
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But primary tuberculosis is not so infectious for most people and most people's immune systems do fight off the infection at this stage.
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However, from primary tuberculosis can become latent.
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So it's basically your infection is held at bay, but it's still present in the body by your immune system.
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However, certain triggers that depress the immune system can cause that infection to become reactivated, and that's called secondary tuberculosis.
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Just want to make sure all that sounds right, matt, sound good on your end.
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Sounds very good on my end.
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Yeah, doing great.
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Awesome, okay, so actually in World War I, before the war, tuberculosis itself was a pretty rampant disease process and of course, with war bringing so many people into close quarters and of course with war bringing so many people into close quarters, it really caused a massive spike in tuberculosis cases.
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Specifically in World War I they didn't really use particularly great screening methods for tuberculosis.
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So, if I'm correct, matt, now of course we do our physical exam, we do certain tests to test whether or not a person has tuberculosis they're actually specific for testing for tuberculosis and of course also doing chest x-rays seemed as pretty routine for screening for the infection.
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But back then we didn't have x-rays used in the screening process for tuberculosis and we really just used physical exam and history to screen.
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For that Is it pretty difficult to actually diagnose primary tuberculosis just off a physical exam.
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Yeah, I mean it really depends on the context.
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I've seen a lot of people around the world with tuberculosis infection and it does have a very typical presentation A lot of people present with chronic.
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It's a chronic infectious disease, right Like something that's indolent, very slow moving, slow growing.
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Fever, chills, night sweats, weight loss are often very common and it was a reason that back in those days they called it consumption, because people looked as though they were being consumed by the pathogen.
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So clinicians of those days were pretty adept at diagnosing tuberculosis even without all the fancy diagnostic tools.
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Now they may have over-called some things tuberculosis because we didn't have the molecular tests and, dennis, I won't push you on when Robert Koch elaborated the first real diagnostics for tuberculosis and described the bacterium, but these were things that were being deployed at the time.
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But probably physical diagnosis and history, you know, obviously, palpating lymph nodes, assessing for the clinical signs and symptoms, listening to the lungs, these were probably as good as we got.
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But you know, because it tends to travel in populations, you would certainly see it in clusters, in people who are in close quarters.
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So I think you rightly mentioned war does tend to produce disruptions in a lot of the public health control measures that we typically rely on for peace and stability during peace and stability times.
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So you know it's not surprising spikes in infectious pathogens during those times of upheaval.
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Yeah, absolutely Completely agree.
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And speaking of how you see these increases and these spikes in the community in World War I and, as I'm sure, in all the other wars we're going to talk about today, it's important to note that these diseases didn't just infect and affect soldiers.
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Right, there were so many civilians that were at the other end of this infection and also died.
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And specifically in World War I, there's not a great count for how many people died from tuberculosis just in those years of the actual war, but estimates are in the millions, and so that just shows how horrible this disease was at that time.
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And specifically so because back then, in World War I's years, we didn't actually have a cure or treatment for tuberculosis.
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So back then the treatment really was just isolation, nutrition and sunlight, from what I could read.
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So fresh air, sunshine that was the best that we could do and pretty aggressive disease.
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So without an actual treatment, without an actual cure, it's clear to see why it took so many lives back then.
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From what I can see and from the research that I did, the first treatments that were developed were actually in 1943.
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It was streptomycin was the first treatment used for TB.
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I don't specifically believe that's used nowadays, matt, correct me if I'm wrong, but I don't think so.
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They use it in resistance.
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So in people who have treatment failure it's a second line treatment.
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There you go.
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Or it can be used in people who have complicated TB, things like cerebral TB or like meningitis, tb, meningitis, things like that.
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Sometimes in treatment failures they'll use streptomycin.
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So it's not ideal.
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There's other alternatives and it depends on the country too.
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In countries where there is, for example, high prevalence of multidrug resistant tuberculosis, you tend to use more things like quinolones, which is why you don't see them prescribed as widely for general respiratory infections in some other countries.
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It's because you want to reserve those kinds of things for TB treatment, because they can be quite effective in the second line treatment.
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But I think Camille is going to be getting into more antimicrobial stuff later on.
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But you're right on Streptomycin certainly is not first line.
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It has a lot of toxicities you're right on, streptomycin certainly is not first line.
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It has a lot of toxicities.
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Interesting, yeah, and I think medication that we do so use as first line.
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I know TB, we typically will throw a few medications at it as a first line treatment.
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But isoniazid specifically at least from the textbooks, from what I know is considered one of the first line treatments and that was specifically brought out and used in 1952 from what I could see.
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So it really shows a solid 20, 30 years after World War I finished we didn't really develop, I guess, common treatments for TB until then.
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So it just really shows how aggressive this disease process was, how hard it is to treat, and highlights just the effect that it had overall on populations throughout World War I, which was the first world war, right, and so there were so many countries that came together, so many countries involved.
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Really just you're able to understand, when you think about it from that aspect, how tuberculosis had such a rampant effect and a really detrimental effect on the population.
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Yeah, no, that's right on.
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We treat people now with four drugs.
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There's the drugs that stop the bacteria from replicating those are bacteriostatic and then there's bactericidal, the ones that kill it, and so you need a couple of different ways to get at this because it's just like in so much of medicine we need drugs to attack things that are fast growing, so we're good at that.
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We're less good at attacking things that are slow growing, so this one needs a lot of help to be able to treat it.
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And you're right, times of war, times of disruption, and in a time where these drugs, these countermeasures, are not readily available and you're displacing populations and it wasn't so much, as I understand it, of a military issue, as much as it was for the populations in the countries that were experiencing the war and hosting these conflicts, that were most affected by these contagions during World War I.
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And it wasn't just TB.
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We had a lot of sexually transmitted infections, typhoid, malaria, so a lot of other pathogens went rampant during the times of these wars.
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Yeah, I completely agree.
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I actually settled on TV and World War I specifically because I just finished reading a historical fiction book that was set in the time of both World War I and World War II, but it specifically talked about the establishment of a preventorium I think is how you pronounce it where they would isolate patients with tuberculosis, and it was cool to pull that into this.
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What's the name of the book with?
00:22:06.561 --> 00:22:09.789
tuberculosis and it was cool to pull that into this what's the name of the book.
00:22:12.869 --> 00:22:13.392
I have the book right here.
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Give me one second.
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Well, while she's getting the book, I'll just say that Sir William Osler, who lived from 1849 to 1919, the father of modern medicines.
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He wrote the first real seminal medical textbook of medical management called the Principles and Practice of Medicine, and tuberculosis slash consumption features heavily in his textbook.
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He has a whole chapter dedicated to it and, like you said, Christina, there were precious few things you could do.
00:22:37.789 --> 00:22:48.021
Osler was a fan of prescribing opium in these circumstances because it was good for cough, it was good for pain and obviously there were other countermeasures that they would try.
00:22:48.021 --> 00:22:53.755
But when you read these old textbooks you realize they were working mostly with public health control measures.
00:22:53.755 --> 00:22:56.402
They can go to altitude, go outside in the sunlight.
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Tuberculosis bacilli do not like UV light, they do not like circulating air and so when you go to a ward, especially in Southern Africa or other places where TB is highly prevalent, when there's a TB ward, it'll often be very well lit, the windows will be open and the fans will be blasting, in addition to all of the masking and other countermeasures that we have, because people know that it's those environmental things that are also going to help contain the contagion.
00:23:23.431 --> 00:23:24.796
Wow, that's really interesting.
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I didn't know that.
00:23:25.798 --> 00:23:28.432
And then, Dennis, for your question.
00:23:28.432 --> 00:23:33.282
The book is called the Women of Chateau Lafayette, so pretty good book.
00:23:33.970 --> 00:23:36.378
I can only hear Hamilton saying Lafayette.
00:23:37.089 --> 00:23:39.398
No, yeah, they actually talk about Hamilton in the book too.
00:23:39.398 --> 00:23:44.038
So if you can't get enough of Hamilton, read the book.
00:23:44.038 --> 00:23:48.419
It was a good one, but that's all I have for TB World War I.
00:23:48.419 --> 00:23:54.121
I think, dennis, you have the next war and pathogen that we're going to talk about today, so you want to take over.
00:23:54.561 --> 00:23:55.503
Yeah, absolutely.
00:23:55.503 --> 00:24:23.380
I want to talk about a disease that was discovered during World War II and it's also a good example of how war can shape or can create ecological disturbances and modifies the landscape and that leads to an outbreak of diseases that rely on the ecological complexity that's then disturbed through war and I'm going to talk about my favorite pathogen.
00:24:23.380 --> 00:24:24.803
I've been very humble.
00:24:24.803 --> 00:24:30.163
I've never really talked about Crimean Congo hemorrhagic fever here on this podcast, my main focus.
00:24:30.163 --> 00:24:40.678
But Crimean Congo hemorrhagic fever was discovered in 1944 in the Crimean Peninsula and what had happened is the Crimean Peninsula.
00:24:40.678 --> 00:24:49.637
I think everybody at this point in time has an idea where that is located in time has an idea where that is located.
00:24:49.657 --> 00:25:10.215
With the Crimean War and with the Ukrainian War, the Crimean Peninsula was occupied by German soldiers for many years and in 1944, the Russian soldiers were pushing the German soldiers out of the Crimean and also out of parts of the East and pushing them back towards Central Europe, and during the occupation the farming in this area had stopped.
00:25:10.215 --> 00:25:13.728
You can imagine, during an occupation, everything stops right.
00:25:13.728 --> 00:25:19.642
The farmers don't take care of their fields, so grass overgrows, pests maybe, come in.
00:25:19.642 --> 00:25:24.277
A lot of wild animals like rabbits, hares, mice, you name it.
00:25:24.277 --> 00:25:31.902
They come in, they can hide in the grass and they often bring other vectors with them, and so they brought in quite a number of ticks.
00:25:31.902 --> 00:25:51.797
And so what happened in 1944 is, when the Crimean Peninsula was reoccupied by the Russians, roughly 200 Russian soldiers fell ill with a hemorrhagic fever, and it was very severe, and the spotlight really quickly fell on the ticks, because the tick density was so high in that area.
00:25:51.797 --> 00:25:56.816
The grass that had overgrown, the rabbits that had come in, that brought the ticks, and so on.
00:25:56.816 --> 00:26:04.718
So there were ticks crawling all over the place and they caused a very severe disease, hemorrhagic fever, with high fatality rates.
00:26:05.599 --> 00:26:22.784
And what the Russians did is they dispatched a team that had already discovered a new disease in 1937 in the far east of Russia, and Mikhail Chumakov, like a famous virologist, was sent and was to investigate the case, identify the pathogen.
00:26:22.784 --> 00:26:36.811
This took a long time, it took decades until they finally figured out that it's a bunia virus, and they had a lot of suspicion what it could be, and it took them a long time to figure it out.
00:26:36.811 --> 00:26:54.759
And in the meantime, in the 1960s, another virus had been discovered in the Congo, in Central Africa, and that's why they then found out that those are the same diseases and that's why it has this funky name, crimean-congo hemorrhagic fever, because they thought it was two different diseases.
00:26:54.759 --> 00:27:04.532
But in the 1960s they actually realized it's the same disease and neither the Russians nor the people in Africa wanted to budge and that's why they came up with that name.
00:27:04.813 --> 00:27:06.336
That's interesting.
00:27:06.336 --> 00:27:10.303
I didn't realize that that's where the namesake comes from, that's really cool, Camille.
00:27:10.323 --> 00:27:10.864
what are your thoughts?
00:27:11.670 --> 00:27:12.412
I was just curious.
00:27:12.412 --> 00:27:16.101
Why do you think it took them so long to figure out what virus it was?
00:27:16.101 --> 00:27:18.394
Was it just the molecular techniques were not there?
00:27:18.394 --> 00:27:19.217
Was it something else?
00:27:20.138 --> 00:27:22.532
Yeah, now, looking back, you can only speculate.
00:27:22.532 --> 00:27:24.317
Back then they did a lot of the things.
00:27:24.317 --> 00:27:34.315
They would grind up the ticks, they would take blood from the patients and they would inject it into any animal that they can get their hands on, from cats to you name it.
00:27:34.315 --> 00:27:43.803
They also injected it into prisoners, prisoners of war, and, yeah, that was a common occurrence back then, and they were able to isolate Rickettsia.
00:27:43.803 --> 00:28:00.720
But this turned out to be a contamination later on, and the reason why it took them so long is that what we hear in the West I don't know if that's correct or not is people in Africa, for example, had worked with mice as an isolation technique suckling mice and the Russians had not done that.
00:28:00.720 --> 00:28:08.402
But once the Russians used this technology and used animals as an isolation mechanism, specifically suckling mice, they were able to isolate the virus.
00:28:08.402 --> 00:28:14.354
Like you said, camille, it was a different type of technology that was used to detect the disease.
00:28:14.354 --> 00:28:21.673
So I want to also add on a quick story about another bunya virus, another war.
00:28:21.673 --> 00:28:35.963
This is specifically the Korean War, which was from 1951 to 1954, I think, and again some sort of ecological disturbance led to the discovery of the virus.
00:28:36.170 --> 00:28:44.560
The virus, just like Korean-Ming-Kongo it took decades to isolate the virus later on and the agent was identified as Hantan virus.
00:28:44.560 --> 00:28:56.867
It's a river that runs through Korea and so in 1951, 54, around that time during the Korean War they had roughly 3,500 UN soldiers.
00:28:56.867 --> 00:29:03.943
So United Nations soldiers were affected by this really severe disease, with case fatality rates up to 10%.
00:29:03.943 --> 00:29:10.575
And then once they got treatment and they had better care, the case fatality rate went down to 5%.
00:29:10.575 --> 00:29:21.321
But the disease back then was presented with high fever, headache, bleeding, kidney failure, leading to severe illness and death in otherwise healthy young soldiers.
00:29:21.321 --> 00:29:33.719
And once they had an idea what the exposure mechanism is, which is rodents rodents carry the disease they were able to contain the transmission and reduce the transmission.
00:29:33.719 --> 00:29:36.503
But again it took them quite a while.
00:29:36.503 --> 00:29:44.951
It took probably like four decades really to identify and to characterize the causative agent of Korean hemorrhagic fever.
00:29:45.755 --> 00:29:53.270
And that's another classic story in virology and it's a classic example in military medicine.
00:29:53.270 --> 00:29:56.903
And you can imagine having a disease going on during the war.
00:29:56.903 --> 00:29:58.347
We talked about this with TB.
00:29:58.347 --> 00:30:07.810
It strains medical resources, it makes the forces that are fighting less efficient and everybody's concerned, especially if they don't know how the disease is transmitted.
00:30:07.810 --> 00:30:12.050
If you're interested in this, look up Korean War and Hantan virus.
00:30:12.050 --> 00:30:20.590
It's like one of the hallmarks in bunyal virus virology and I think then we're going on to the current war, camille.
00:30:21.201 --> 00:30:22.164
One of the current wars?
00:30:22.204 --> 00:30:45.271
yeah, Dennis, I love the way that you described especially the One Health elements of how these pathogens emerged in times of war, and you described the environmental disruption leading to animal encroachment, vector growth and propagation and then sort of the perfect storm, if you will, of factors coming together to allow these diseases to emerge or to reemerge.
00:30:46.055 --> 00:30:49.825
And so I was thinking about when you were talking about Congo especially.
00:30:49.825 --> 00:30:52.913
I thought about there was this time in the mid 1800s.
00:30:52.913 --> 00:31:21.643
We use this a lot in our public health teaching where we talk about the African sleeping sickness outbreaks that took place during sort of colonial times in Central and East Africa and a lot of war, a lot of conflict, a lot of disruption and the increase in abundance of tsetse flies were largely related to changes to the environment from the movement, the mass movement of populations away from areas that they had taken care of.
00:31:21.643 --> 00:31:44.391
And as we think about war as a context for disease emergence and for pathogens, it really is thinking about not just the boom boom that happens but the social, economic, cultural and environmental disruption that takes place during times of war that many point to as sort of inflection points of when many diseases have emerged or re-emerged.
00:31:44.391 --> 00:31:47.079
So if you pay attention to infectious diseases.
00:31:47.079 --> 00:31:52.772
Then you also want to pay attention to war and conflict, because these two are intimately tied.
00:31:53.680 --> 00:31:54.564
Yeah, that's very true.
00:31:54.564 --> 00:32:02.310
One thing that always comes to mind when I read about these stories and when I learn about these stories is this was also a very different time.
00:32:02.310 --> 00:32:07.991
Right Nowadays, when a new disease emerges, probably within days or weeks, we know what it is.
00:32:07.991 --> 00:32:12.991
Right, we hear these stories oh, there's something suspicious going on in this country, xyz.
00:32:12.991 --> 00:32:19.050
And then a week later we hear it's Marble Virus or it's in Seoul, right and back.
00:32:19.050 --> 00:32:23.048
Then it took them decades and they had these symptomology.
00:32:23.048 --> 00:32:31.186
They called it Korean hemorrhagic fever or they called it Crimean fever or Crimean hemorrhagic fever, and for decades nobody knew what it was.
00:32:31.186 --> 00:32:32.631
Can you imagine this?
00:32:32.631 --> 00:32:39.294
Can you imagine living in a time where people fall sick and die and nobody has an answer what it was?
00:32:39.294 --> 00:32:41.165
Nobody can even tell you.
00:32:41.165 --> 00:32:42.444
It was crazy times.
00:32:42.444 --> 00:32:46.411
I think we're very lucky to have the diagnostic capabilities that we have nowadays.
00:32:47.180 --> 00:33:14.104
Yeah, I completely agree, dennis, and I think it's important to also put that into context when we're talking about just in general not even just in wartime, but in general, like whenever there is a new disease that presents itself right the reason that we're able to detect things earlier and develop treatments and stuff like that earlier is because the technology has advanced in a way that is so beneficial to us as a population.
00:33:14.104 --> 00:33:22.906
It's not necessarily something is being done unethically or something's being done that's maybe not up to standard.
00:33:22.906 --> 00:33:43.846
Our technology has advanced incredibly, and while, yes, it's still not perfect, that's the direction we want to be moving right, because that's how we can save so many more lives, and so I think it really is amazing to see that transition from 40, 50, 60 years ago to now, how rapidly we're able to respond as a society to these new encroaching pathogens.
00:33:44.931 --> 00:34:04.703
I absolutely agree with that as well, and I think that before we had the kind of globalized connectivity of researchers sharing information back and forth, which is so valuable and really helps us maintain surveillance and keep everyone safe, before we were able to identify these diseases there was so much fear, and I think that's where we saw a lot of things cropping up around.
00:34:04.703 --> 00:34:17.447
You know, disease was linked to morality, right, so like people had this idea that they could keep themselves safe in a way if they were just like good enough or something like that, or that being sick said something about a person or whatever, and I think we've talked about that on previous episodes.
00:34:17.447 --> 00:34:31.891
I think I got into this field, into infectious diseases, with kind of that hope that we could start to move away from that and more towards just caring about people because they're people and treating them because we have whatever's available, whether that's a vaccine or good antivirals or good antibiotics.
00:34:32.659 --> 00:34:36.190
It takes me back to the miasmas that we've previously talked about, camille.
00:34:36.190 --> 00:34:42.606
I think there was like a line in the book, or some paragraph or something like that, that talked about how it was.
00:34:42.606 --> 00:34:48.469
You know, associated with the smell of a person is how susceptible they are to disease and stuff like that.
00:34:48.469 --> 00:34:56.347
So the nobility were able to surround themselves with nice smelling gardens and good perfumes, and that would keep the diseases away.
00:34:56.347 --> 00:35:12.231
Versus the other status levels weren't able to do that because they didn't have the, I guess, resources to do so, nor the space, as we know, and so they were presumed to be a dirtier or more sickly population because of so.
00:35:12.773 --> 00:35:17.000
Yeah, and I think if there is a miasma, war is the miasma right.
00:35:17.000 --> 00:35:20.206
If there is something that's like just going through and spreading disease, it's war right.
00:35:20.206 --> 00:35:26.512
So, like war is the equivalent of kind of our modern miasma of this can spread very quickly and spill over right.
00:35:26.512 --> 00:35:30.847
Wars spill over borders and they spill over groups of people and drive all of these changes.
00:35:30.847 --> 00:35:41.077
And a lot of times it can very much be something that if it's not happening to you, it's not happening in your backyard, it's invisible, right, and this invisible spread of pathogens until it does show up on your doorstep.
00:35:41.077 --> 00:35:52.190
And that's actually how I came to this episode was thinking about one of the current wars, which is the Russian-Ukrainian War, and so, for context, that began on February 24th 2022.
00:35:52.190 --> 00:35:54.461
I can actually remember where I was when this war began.
00:35:54.461 --> 00:36:00.813
It's ongoing, as of this recording, and, like many conflicts throughout history, this war has really shaped pathogens.
00:36:00.813 --> 00:36:04.911
So what I first saw about this it came out in November 2024.
00:36:04.911 --> 00:36:16.309
It was an article published by Science and basically the article was saying that the prophylactic use of broad-spectrum antibiotics in Ukrainian triage centers was really promoting drug-resistant bacteria.
00:36:16.309 --> 00:36:17.753
It's really interesting.
00:36:17.753 --> 00:36:32.612
They quoted a lot of different people in this article and one of them was Jason Bennett, who was the director of the Walter Reed Army Institute of Research, saying multi-drug-resistant organisms, and he stated that it's eye-opening just how incredibly resistant some of the bacteria coming out of Ukraine are.
00:36:32.612 --> 00:36:52.472
I haven't seen anything like it, and what I think is interesting about this is that seeing multi-drug resistance rise, or any drug resistance rise, isn't likely new, but we have the technology now to see it happening in real time, and there's certainly been a lot of funds poured into Ukraine, and so we are seeing this happen in.
00:36:52.492 --> 00:36:54.273
I want to talk about is Klebsiella pneumoniae.
00:36:54.753 --> 00:37:17.170
This is a bacteria it's known to cause one in five deaths that are attributed to antimicrobial resistance globally and has been reported to be hyper virulent and pan drug resistant when cultured from Ukrainian casualties, and that's from a December 2024 article in the Journal of Infection.
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