The diffusion of cholera in Egypt, 1947: a time-space analysis of one of the largest single outbreaks in the twentieth century

The epidemic of cholera that spread through Egypt in the latter months of 1947 was one of the largest single outbreaks of the disease in the twentieth century. Using a swash–backwash model, this paper examines the geographical wave-like spread and subsequent retreat of the epidemic from an apparent origin in the settlements and prisoner-of-war camps of the Nile Delta area to reach its maximum geographical extent some six weeks later at Aswan (850 km away). Our results demonstrate the very rapid spatial advance of the epidemic wave through the provinces and governorates of Egypt, with an approximately linear sequence of progression up the Nile. Superimposed on this national pattern are pronounced differences in the rate of epidemic advance in the traditional geographical divisions of Lower and Upper Egypt. Alternative visualisations of the cholera spaces of Egypt, using techniques of multidimensional scaling (MDS) and cluster analysis, underscore the differential patterns of cholera transmission in these areas of the country. The patterns are interpreted in relation to a vigorous control effort that included restrictions on public transport, patient isolation, contact tracing and mass vaccination of the entire population exposed to risk of infection

Geographical perspectives on epidemic transmission of cholera in Haiti, October 2010 through March 2013

The current epidemic of El Tor cholera in the Caribbean republic of Haiti is one of the largest single outbreaks of the disease ever recorded. The prospects are that the epidemic will continue to present challenges to workers in public health medicine, epidemiology and allied fields in the social sciences for years to come. This article introduces geographers to the environmental context of the Haiti cholera epidemic, the principal data sources available to analyze the occurrence of the epidemic, and evidence regarding its geographical origins and dispersal during the first thirty months of the epidemic, October 2010–March 2013. Using weekly case data collated by the Haitian Ministère de la Santé Publique et de la Population (MSPP), techniques of time series analysis are used to examine inter- and intra-departmental patterns of cholera activity. Our analysis demonstrates a pronounced lag structure to the spatial development of the epidemic (Artibonite and northern departments Ouest and metropolitan Port-au-Prince southern departments). Observed variations in levels of epidemiological integration, both within and between departments, provide new perspectives on the spatio-temporal evolution of the epidemic to its March 2013 pattern

Variola minor in coalfield areas of England and Wales, 1921–34: geographical determinants of a national smallpox epidemic that spread out of effective control

This paper uses techniques of binary logistic regression to identify the spatial determinants of the last national epidemic of smallpox to spread in England and Wales, the variola minor epidemic of 1921–34. Adjusting for age and county-level variations in vaccination coverage in infancy, the analysis identifies a dose-response gradient with increasing odds of elevated smallpox rates in local government areas with (i) medium (odds ratio [OR] = 5.32, 95% Confidence Interval [95% CI] 1.96–14.41) and high (OR = 11.32, 95% CI 4.20–31.59) coal mining occupation rates and (ii) medium (OR = 16.74, 95% CI 2.24–125.21) and high (OR = 63.43, 95% CI 7.82–497.21) levels of residential density. The results imply that the spatial transmission of variola virus was facilitated by the close spatial packing of individuals, with a heightened transmission risk in coal mining areas of the country. A syndemic interaction between common respiratory conditions arising from exposure to coal dust and smallpox virus transmission is postulated to have contributed to the findings. We suggest that further studies of the geographical intersection of coal mining and acute infections that are transmitted via respiratory secretions are warranted

Theresienstadt: A Geographical Picture of Transports, Demography, and Communicable Disease in a Jewish Camp-Ghetto, 1941–45

The Nazi ghetto system was one of the principal vehicles for the persecution of Jewish and other peoples in German-occupied Europe in World War II. Transport and confinement – twin pillars of the ghetto system – were intrinsically geographical matters that operated on scales from the international to the local and which shaped the demographic and epidemiological character of ghettos across Eastern Europe. This article uses geographical techniques of map-based visualisation and spatial analysis to portray the demographic and epidemic history of the Nazi ‘model’ camp-ghetto at Theresienstadt (Terezín) in the former German Protectorate of Bohemia and Moravia, 1941–45. Our study reconstructs the space-time pattern and demographic structure of transports of Jewish prisoners to the ghetto and their association with substantial outbreaks of communicable diseases in the ghetto. The study highlights the importance of a geographical approach to an understanding of the demographic and public health impacts of both the Holocaust and other genocidal events

Operation Pied Piper: a geographical reappraisal of the impact of wartime evacuation on scarlet fever and diphtheria rates in England and Wales, 1939–1945

This paper examines the geographical impact of the British Government’s wartime evacuation scheme on notified rates of two common acute childhood diseases (scarlet fever and diphtheria) in the 1470 local government districts of England and Wales, 1939–1945. Drawing on the notifications of communicable diseases collated by the General Register Office (GRO), we establish pre-war (baseline) disease rates for the 1470 districts. For the war years, techniques of binary logistic regression analysis are used to assess the associations between (a) above-baseline (‘raised’) disease rates in evacuation, neutral and reception districts and (b) the major phases of the evacuation scheme. The analysis demonstrates that the evacuation was temporally associated with distinct national and regional effects on notified levels of disease activity. These effects were most pronounced in the early years of the dispersal (1939–1941) and corresponded with initial levels of evacuation-related population change at the regional and district scales

Operation Pied Piper: a geographical reappraisal of the impact of wartime evacuation on scarlet fever and diphtheria rates in England and Wales, 1939–1945

This paper examines the geographical impact of the British Government’s wartime evacuation scheme on notified rates of two common acute childhood diseases (scarlet fever and diphtheria) in the 1470 local government districts of England and Wales, 1939–1945. Drawing on the notifications of communicable diseases collated by the General Register Office (GRO), we establish pre-war (baseline) disease rates for the 1470 districts. For the war years, techniques of binary logistic regression analysis are used to assess the associations between (a) above-baseline (‘raised’) disease rates in evacuation, neutral and reception districts and (b) the major phases of the evacuation scheme. The analysis demonstrates that the evacuation was temporally associated with distinct national and regional effects on notified levels of disease activity. These effects were most pronounced in the early years of the dispersal (1939–1941) and corresponded with initial levels of evacuation-related population change at the regional and district scales

Suzbijanje geografskog širenja zaraze: kuga u Italiji od 1347.-1851.

After the establishment of the first quarantine station in the Republic of Ragusa (modern-day Dubrovnik) in 1377, the states and principalities of Italy developed a sophisticated system of defensive quarantine in an attempt to protect themselves from the ravages of plague. Using largely unknown and unseen historical maps, this paper reconstructs the extent and operation of the system used. It is shown that a cordon sanitaire existed around the coast of Italy for several centuries, consisting of three elements: (i) an outer defensive ring of armed sailing boats in the Mediterranean and the Adriatic, (ii) a middle coastal ring of forts and observation towers, and (iii) an inner defensive ring of land-based cavalry. The principles established, although not especially successful at the time against a disease of (then) unknown aetiology, are still used today in attempts to control the spread of infections of animal and human populations.Nakon uspostave prvoga lazareta u Dubrovačkoj Republici 1377., talijanske državice i kneževine razradile su sustav karantena kako bi se zaštitile od razarajućega djelovanja kuge. Oslanjajući se mahom na dosad nepoznate povijesne karte, u ovome se članku rekonstruira kako je i u kojem razmjeru djelovao sustav zaštite. Duž talijanske obale stoljećima je postojao sanitarni kordon, a sastojao se od tri dijela: (i) vanjski pojas sastavljen od naoružanih jedrenjaka na Sredozemnom i Jadranskome moru, (ii) srednji obrambeni pojas sastavljen od utvrda i promatračnica te (iii) unutarnji obrambeni pojas na kopnu sastavljen od konjice. Premda ovaj sustav svojevremeno i nije bio pretjerano uspješan u zaštiti od bolesti (tada) nepoznate etiologije, njegova se načela još uvijek rabe za sprječavanje širenja bolesti među ljudima i životinjama