Meningococcal Meningitis and Coal Mining in Provincial England: Geographical Perspectives on a Major Epidemic, 1929–33

This article presents the first systematic study of the spatial transmission of the 1929–33 epidemic of meningococcal meningitis and its association with local coal mining communities in three adjacent high incidence counties of England; Nottinghamshire, Derbyshire, and the West Riding of Yorkshire. Drawing on a robust method of spatial epidemiological analysis (swash‐backwash model), we demonstrate a gradient response with local levels of employment in coal mining for each of three key parameters of the epidemic wave: spatial velocity of transmission; duration of infectivity; and spatial reach. Partial least squares regression analysis identifies the relatively young and fertile demographic of local mining communities as the principal determinant of the resulting epidemic burden. Other sociodemographic parameters, including established risk factors for invasive meningococcal disease (low social class, high residential density, and overcrowding) are found to play little, or no, role in the spatial distribution of the disease. Our findings have importance for understanding the historic links between the coal mining industry and epidemic meningococcal meningitis, and point to possible present‐day opportunities for intervention through the designation of coal mining communities as defined risk groups for meningococcal vaccines

Meningococcal Meningitis and Coal Mining in Provincial England: Geographical Perspectives on a Major Epidemic, 1929–33

This article presents the first systematic study of the spatial transmission of the 1929–33 epidemic of meningococcal meningitis and its association with local coal mining communities in three adjacent high incidence counties of England; Nottinghamshire, Derbyshire, and the West Riding of Yorkshire. Drawing on a robust method of spatial epidemiological analysis (swash‐backwash model), we demonstrate a gradient response with local levels of employment in coal mining for each of three key parameters of the epidemic wave: spatial velocity of transmission; duration of infectivity; and spatial reach. Partial least squares regression analysis identifies the relatively young and fertile demographic of local mining communities as the principal determinant of the resulting epidemic burden. Other sociodemographic parameters, including established risk factors for invasive meningococcal disease (low social class, high residential density, and overcrowding) are found to play little, or no, role in the spatial distribution of the disease. Our findings have importance for understanding the historic links between the coal mining industry and epidemic meningococcal meningitis, and point to possible present‐day opportunities for intervention through the designation of coal mining communities as defined risk groups for meningococcal vaccines

Armed conflicts have an impact on the spread of tuberculosis: the case of the Somali Regional State of Ethiopia

<p>Abstract</p> <p/> <p>A pessimistic view of the impact of armed conflicts on the control of infectious diseases has generated great interest in the role of conflicts on the global TB epidemic. Nowhere in the world is such interest more palpable than in the Horn of Africa Region, comprising Ethiopia, Somalia, Eritrea, Djibouti, Kenya and Sudan. An expanding literature has demonstrated that armed conflicts stall disease control programs through distraction of health system, interruption of patients' ability to seek health care, and the diversion of economic resources to military ends rather than health needs. Nonetheless, until very recently, no research has been done to address the impact of armed conflict on TB epidemics in the Somali Regional State (SRS) of Ethiopia.</p> <p>Methods</p> <p>This study is based on the cross-sectional data collected in 2007, utilizing structured questionnaires filled-out by a sample of 226 TB patients in the SRS of Ethiopia. Data was obtained on the delay patients experienced in receiving a diagnosis of TB, on the biomedical knowledge of TB that patients had, and the level of self-treatment by patients. The outcome variables in this study are the delay in the diagnosis of TB experienced by patients, and extent of self-treatment utilized by patients. Our main explanatory variable was place of residence, which was dichotomized as being in 'conflict zones' and in 'non-conflict zones'. Demographic data was collected for statistical control. Chi-square and Mann-Whitney tests were used on calculations of group differences. Logistic regression analysis was used to determine the association between outcome and predictor variables.</p> <p>Results</p> <p>Two hundred and twenty six TB patients were interviewed. The median delay in the diagnosis of TB was 120 days and 60 days for patients from conflict zones and from non-conflict zones, respectively. Moreover, 74% of the patients residing in conflict zones undertook self-treatment prior to their diagnosis. The corresponding proportion from non-conflict zones was 45%. Fully adjusted logistic regression analysis shows that patients from conflict zones had significantly greater odds of delay (OR = 3.06; 95% CI: 1.47-6.36) and higher self treatment utilization (OR = 3.34; 95% CI: 1.56-7.12) compared to those from non-conflict zones.</p> <p>Conclusion</p> <p>Patients from conflict zones have a longer delay in receiving a diagnosis of TB and have higher levels of self treatment utilization. This suggests that access to TB care should be improved by the expansion of user friendly directly observed therapy short-course (DOTS) in the conflict zones of the region.</p

Vulnerability to high risk sexual behaviour (HRSB) following exposure to war trauma as seen in post-conflict communities in eastern uganda: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Much of the literature on the relationship between conflict-related trauma and high risk sexual behaviour (HRSB) often focuses on refugees and not mass in-country displaced people due to armed conflicts. There is paucity of research about contexts underlying HRSB and HIV/AIDS in conflict and post-conflict communities in Uganda. Understanding factors that underpin vulnerability to HRSB in post-conflict communities is vital in designing HIV/AIDS prevention interventions. We explored the socio-cultural factors, social interactions, socio-cultural practices, social norms and social network structures that underlie war trauma and vulnerability to HRSB in a post-conflict population.</p> <p>Methods</p> <p>We did a cross-sectional qualitative study of 3 sub-counties in <it>Katakwi </it>district and 1 in <it>Amuria </it>in Uganda between March and May 2009. We collected data using 8 FGDs, 32 key informant interviews and 16 in-depth interviews. We tape-recorded and transcribed the data. We followed thematic analysis principles to manage, analyse and interpret the data. We constantly identified and compared themes and sub-themes in the dataset as we read the transcripts. We used illuminating verbatim quotations to illustrate major findings.</p> <p>Results</p> <p>The commonly identified HRSB behaviours include; transactional sex, sexual predation, multiple partners, early marriages and forced marriages. Breakdown of the social structure due to conflict had resulted in economic destruction and a perceived soaring of vulnerable people whose propensity to HRSB is high. Dishonour of sexual sanctity through transactional sex and practices like incest mirrored the consequence of exposure to conflict. HRSB was associated with concentration of people in camps where idleness and unemployment were the norm. Reports of girls and women who had been victims of rape and defilement by men with guns were common. Many people were known to have started to display persistent worries, hopelessness, and suicidal ideas and to abuse alcohol.</p> <p>Conclusions</p> <p>The study demonstrated that conflicts disrupt the socio-cultural set up of communities and destroy sources of people's livelihood. Post-conflict socio-economic reconstruction needs to encompass programmes that restructure people's morals and values through counselling. HIV/AIDS prevention programming in post-conflict communities should deal with socio-cultural disruptions that emerged during conflicts. Some of the disruptions if not dealt with, could become normalized yet they are predisposing factors to HRSB. Socio-economic vulnerability as a consequence of conflict seemed to be associated with HRSB through alterations in sexual morality. To pursue safer sexual health choices, people in post-conflict communities need life skills.</p

Civil conflict and sleeping sickness in Africa in general and Uganda in particular

Conflict and war have long been recognized as determinants of infectious disease risk. Re-emergence of epidemic sleeping sickness in sub-Saharan Africa since the 1970s has coincided with extensive civil conflict in affected regions. Sleeping sickness incidence has placed increasing pressure on the health resources of countries already burdened by malaria, HIV/AIDS, and tuberculosis. In areas of Sudan, the Democratic Republic of the Congo, and Angola, sleeping sickness occurs in epidemic proportions, and is the first or second greatest cause of mortality in some areas, ahead of HIV/AIDS. In Uganda, there is evidence of increasing spread and establishment of new foci in central districts. Conflict is an important determinant of sleeping sickness outbreaks, and has contributed to disease resurgence. This paper presents a review and characterization of the processes by which conflict has contributed to the occurrence of sleeping sickness in Africa. Conflict contributes to disease risk by affecting the transmission potential of sleeping sickness via economic impacts, degradation of health systems and services, internal displacement of populations, regional insecurity, and reduced access for humanitarian support. Particular focus is given to the case of sleeping sickness in south-eastern Uganda, where incidence increase is expected to continue. Disease intervention is constrained in regions with high insecurity; in these areas, political stabilization, localized deployment of health resources, increased administrative integration and national capacity are required to mitigate incidence. Conflict-related variables should be explicitly integrated into risk mapping and prioritization of targeted sleeping sickness research and mitigation initiatives

Spatial growth rate of emerging SARS-CoV-2 lineages in England, September 2020-December 2021

This paper uses a robust method of spatial epidemiological analysis to assess the spatial growth rate of multiple lineages of SARS-CoV-2 in the local authority areas of England, September 2020–December 2021. Using the genomic surveillance records of the COVID-19 Genomics UK (COG-UK) Consortium, the analysis identifies a substantial (7.6-fold) difference in the average rate of spatial growth of 37 sample lineages, from the slowest (Delta AY.4.3) to the fastest (Omicron BA.1). Spatial growth of the Omicron (B.1.1.529 and BA) variant was found to be 2.81× faster than the Delta (B.1.617.2 and AY) variant and 3.76× faster than the Alpha (B.1.1.7 and Q) variant. In addition to AY.4.2 (a designated variant under investigation, VUI-21OCT-01), three Delta sublineages (AY.43, AY.98 and AY.120) were found to display a statistically faster rate of spatial growth than the parent lineage and would seem to merit further investigation. We suggest that the monitoring of spatial growth rates is a potentially valuable adjunct to outbreak response procedures for emerging SARS-CoV-2 variants in a defined population

Seasonality in tropical AIDS: a geographical analysis.

This paper presents evidence that the growth rate of the AIDS epidemic at the district level in Uganda, Central Africa, displays a seasonally recurring geographical pattern, with epidemic acceleration in some areas of the country in the first 8 months of each year. The spatial and temporal variations in acceleration appear to be correlated with the predominant agricultural systems in different parts of Uganda. Based upon the frequently hypothesized relationship between malnourishment and the progression to clinical AIDS in HIV-infected people, it is suggested that the variations in epidemic speed reflect the seasonal patterns of nutritional deficiency which occur under some tropical agricultural systems. These preliminary findings require further verification since they have important implications for directing nutrition-related remedial responses to the AIDS epidemic in tropical countries where malnutrition and endemic HIV infection coincide

Civil war and the spread of AIDS in Central Africa.

Using ordinary least squares regression techniques this paper demonstrates, for the first time, that the classic association of war and disease substantially accounts for the presently observed geographical distribution of reported clinical AIDS cases in Uganda. Both the spread of HIV 1 infection in the 1980s, and the subsequent development of AIDS to its 1990 spatial pattern, are shown to be significantly and positively correlated with ethnic patterns of recruitment into the Ugandan National Liberation Army (UNLA) after the overthrow of Idi Amin some 10 years earlier in 1979. This correlation reflects the estimated mean incubation period of 8-10 years for HIV 1 and underlines the need for cognizance of historical factors which may have influenced current patterns of AIDS seen in Central Africa. The findings may have important implications for AIDS forecasting and control in African countries which have recently experienced war. The results are compared with parallel analyses of other HIV hypotheses advanced to account for the reported geographical distribution of AIDS in Uganda

Controlling the geographical spread of infectious disease: plague in Italy, 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