With a growing human population exposed to new and continuously mutating infectious agents, there is significant and growing interest in the study of infectious diseases. Once the domain of specialized practitioners, the topic of epidemic and pandemic threats has now reached the general public.  Production and distribution of antiviral and antimicrobial agents (as well as the rapid international transmission of deadly infectious agents such as SARS and Avian Influenza) have brought a sense of urgency to the general public.

Manitoba is home to the Canadian Science Centre for Human and Animal Health which studies both human and animal infectious diseases and has both considerable interest and expertise in the field.  Research at the HSC and SBRC as well as the universities is both active and effective. There is considerable local expertise in infectious disease research and development.

This introduction will establish a few basic concepts in the study of infectious disease and pandemic events and also contains the Course Outline.

INTRODUCTION

What causes a Pandemic?

1. New Infectious Disease - emergence of a new disease to the population
2. Infectivity - the new disease can agent infects humans, causing serious illness
3. Transmission and Sustainability - spreads easily and persists in population

Pandemic Stages:

According to the W.H.O. (World Health Organization 2006) pandemic events evolve through three different stages described as the Interpandemic,  Pandemic Alert  and the Pandemic periods.

1. Interpandemic period:

Phase 1: no new infectious subtypes have been detected in humans.

Phase 2: no new infectious subtypes have been detected in humans, but an animal variant threatens human disease.

2. Pandemic alert period

Phase 3: human infection(s) with a new subtype but no human-to-human spread.

Phase 4: small cluster(s) with limited localized human-to-human transmission

Phase 5: larger cluster(s) but human-to-human spread still localized.

3. Pandemic period:

Phase 6: Pandemic: increased and sustained transmission in general population.

History of Pandemics

Human history has had many significant occurrences of epidemic and pandemic events. Often of animal, or zoonotic origin, many of these pandemic had devastating consequences for the human population of the period. At the time many of these outbreaks of infectious disease were considered to be the "Wrath of God" or some other form of divine retribution as people sought an explanation for the misery and suffering.

"their fauces, in most of them, were painful from first to last, having redness with inflammation; defluxions thin, small and acrid; they were soon wasted and became worse, having no appetite for any kind of food throughout; no thirst; most persons delirious when near death. So much concerning the phthisical affections."  Hippocrates, 400 BC

A few example of highly significant historical epidemic and pandemic events are described below.

541 - Bubonic Plague

Commencing in Egypt and moving throughout the Mediterranean to reach Constantinople  in a single year, the outbreak was recorded as killing 10,000 individuals a day. Estimates suggest one quarter of the eastern Mediterranean population succumbed to this infection.

"Father abandoned child, wife husband, one brother another... And I, Agnolo di Tura...buried my five children with my own hands... So many died that all believed that it was the end of the world."

1300's - The Black Death

Beginning in Asia in the early 1300's  the Black Death reached Europe in 1348. Over a six-year span, 20,000,000 Europeans were killed, representing a quarter of the total population. In some areas there was nearly complete depopulation. Transmission was from rats and flea bites.

"After the pestilence, many buildings, great and small, fell into ruins in every city for lack of inhabitants, likewise many villages and hamlets became desolate, not a house being left in them, all having died who dwelt there; and it was probable that many such villages would never be inhabited."

1816 - 1961 Cholera

Cholera has been the causative agent of seven pandemics commencing in India in 1816 until 1966 in the USSR. Cholera has been responsible for millions of deaths but has been greatly reduced due to better water purification and control practices. That being said there are consistent outbreaks in areas lacking sanitation practices such as observed in recent outbreaks in Angola and other areas of Africa.

“The endemic and epidemic diseases fall chiefly, as is usual, on the poor.”

Influenza

With it's lethality and global impact often under-estimated, influenza has probably affected more human beings than other pandemic agents. Influenza has appeared repeatedly under different names. This includes the Asiatic (1889),  Spanish (1918), Asia (1957) and Hong Kong (1968) influenza outbreaks.  Some estimates suggest a total of 18,000,000 people died of influenza world-wide during the period of 1918-1919 alone. In modern society there are significant concerns over the potential for another significant influenza outbreak with many governmental health organizations establishing extensive emergency measures and contingency plans.

New World Pandemics

First encounters between the "new world" and European (and other) explorers often caused epidemic and pandemic events for indigenous peoples. Diseases like smallpox, measles and influenza decimated many communities which had absolutely no innate immunity. Prior to this, early trade between Asia and Europe had a similar impact  with the onset of the Bubonic Plague in Europe being unintentionally transmitted by Italian traders returning from China in 1348.

Modern Times

In modern times any infectious disease is eighteen hours away (or less) based on the speed of international travel.  This was never more apparent than with the SARS (severe acute respiratory syndrome) outbreaks in Asia which in days had spread globally. From a single outbreak in Asia infections (and deaths) spread to countries world-wide:

	Canada
	USA
	Brazil
	Switzerland
	Spain
	Italy
	Kuwait
	South Africa
	India
	Malaysia
	Indonesia
	Australia
	Ireland
	Britain
	France
	Germany
	Sweden
	Romania
	Bulgaria
	Mongolia
	Japan
	China
	Hong Kong
	Singapore
	Taiwan
	Vietnam
	Philippines

With airport-to-airport arrival times less than eighteen hours (regardless of international destination) there are no longer small, "remote" outbreaks. Even with immediate travel restrictions to prevent its' spread, SARS quickly reached many countries around the globe. The convenience of rapid international travel can mean quick local transmission of infectious agents is possible (if not probable) in the case of "distant" outbreaks. Serious implications indeed for the public and medical practitioner alike.

COURSE OUTLINE

Course Code and Title  T07 –CXXX   Pandemic Science (Introductory)

Department Health Sciences

Program  Chemical and Biosciences Technology

Total Hours 28     Credit Hours  3

Course Description    An internet-based research course designed to introduce the student to the language, concepts and issues of pandemic diseases and epidemiology. This course deals with the current state of pandemic diseases around the globe and examines core concepts as well as specific case studies.

 Academic Pre-requisites   Entrance Requirements  NA

 Course Delivery Method  Online

 The following Communication tools will be used in this course

Email, online content.

Course Format   The course is an internet based course with (2) written / report-based assignments to be turned in via email to the instructor.

Effective date  January 1, 2007

Instructor information      David Blicq         dblicq@rrc.mb.ca   (632-2577)  A425M 2055 Notre Dame Ave, Wpg., MB, R3H 0J9

Student Readiness   Computer, internet, other – floppy disc to save assignments

Student Commitments and Contact times   Online commitments

Course Resources  Textbook - there is no textbook for this course.   References include posted notes, internet searches.

 Student Learning

Learning outcomes

By the end of this course of study, you should be able to….

1.      define epidemiology, pandemic and other core concepts.

2.      understand and use the language and concepts of infectious disease studies.

3.      comprehend core concepts of pandemics, basic microbiology, virology, infectious diseases and specific infectious pathogens.

4.      maintain a successful working knowledge of pandemic science as the field continues to develop.

5.      seek and find pertinent information on infectious diseases and epidemiology and related fields of activity.

Instruction Schedule  Self directed internet course.   Please email the instructor to start the course.  As well, please mail the instructor with any questions regarding the course content or the assignments.  The instructor will respond within a reasonable time during normal working hours.

Assessment and Evaluation   Assignments 1+2 together make up 100% of the course grade.  Assignments 1+2 must be typed and referenced.

Letter grade Distribution

A+	4.5	90 – 100 %
A	4.0	80 – 89 %
B+	3.5	75 – 79 %
B	3.0	70 – 74 %
C+	2.5	65 – 69 %
C	2.0	60 – 64 %
F	0.0	0 – 59 %

General Academic Policies    It is the student’s responsibility to be familiar with and adhere to the Red River College (RRC) Academic Policies and Procedures.  These Policies and Procedures can be found in the RRC calendar or online at http://www.rrc.mb.ca/academicpolicy/default.htm#

 Supplemental Policies   Students can submit completed assignments by correspondence or email.  All assignments MUST be submitted on time.  Assignments will NOT be accepted late; you will receive a grade of F in the course.   

Additional Information / Frequently asked questions   References must be included with your assignments and should follow the following format:

Book: author, title, publisher, date, pages

Internet site: the URL, title, author, date sourced

Journal: the title of the journal, title of article, author, volume #, date, pages