Pandemics of the Past Trivia Quiz

Answer: Spanish flu

The Spanish flu was caused by an unusually severe and deadly Influenza A virus strain of subtype H1N1. About 50-100 million ultimately died from it. To fight the infection the body releases a large numbers of white blood cells (T cells, macrophages, etc.) that engulf and digest pathogens. But this causes the release of inflammatory cytokines, which cause more white blood cells to be released. For reasons not entirely clear, the immunity system may overdo this, and the endless loop created is called a cytokine storm. So much inflammation develops that airways get clogged and shut down, the cells absorb insufficient oxygen, and the patient dies of asphyxiation. The pandemic began in 1918 and was completely over by 1920.

The specific virus strain that caused the Spanish no longer exists; perhaps an entity that destroys its own host so effectively has not used the best strategy for long-term survival.

Answer: cholera

The bacterium Vibrio cholerae infects the small intestine through unsafe food and, especially, unsafe water contaminated by human feces. The classic symptoms include watery diarrhea, and sunken eyes and wrinkled skin from severe dehydration. The disease is entirely preventable with good hygiene, clean water, best sewage management practices, and vaccines. Treatment is with fluids, electrolytes, zinc supplementation, and antibiotics, though resistance has developed in some cases.

Seven cholera pandemics have arisen since 1817, but advances in public health minimized or prevented the spread of the sixth and seventh pandemics to Western Europe and North America, the last of which ended in 1975. Smaller outbreaks have occurred around the world in the 21st century, and scientists have predicted that rising sea levels from global heating will lead to increases in incidences of the disease by the middle of the 21st century.

Answer: swine flu

Swine flu was first reported in Mexico in 2009, but rapidly the USA found itself in the middle of a pandemic. The new strain of H1N1 was actually a mutation of four strains, one in people, one in birds, and two in swine (hence the common name). Because it was so new, there was no immunity, and it spread rapidly.

The WHO confirmed that 18,000 people had died from the disease. Like Spanish flu, death usually comes as a result of inflammation from a cytokine storm, or it might come from an opportunistic bacterial infection.

The pandemic officially ended in August 2010.

Answer: malaria

Neither a bacterium nor a virus, the pathogen is a protozoan (a microscopic organism that can move freely about and ingest food, but it is not considered an animal) of the genus Plasmodium. Transmitted by the bite of an Anopheles mosquito, the pathogen infects the red blood cells. The patient suffers cycling fevers and chills, which can progress to seizures, coma, and death. Antibiotics are of no use, but anti-malarials such as chloroquine can do the trick, although drug-resistant strains have become a problem.

Tonic water, such as the carbonated beverage used in a "gin and tonic", is called so because it contains quinine, an old-school anti-malarial imbibed by the British during the colonial days in Africa.

The name malaria comes from the Italian 'mala aria', meaning "bad air", as it was once thought that vapors emitted from swamps caused the disease. In a sense, this is not far off, as the mosquitoes breed in such environments, and take to the air.

Answer: yellow fever

The disease is transmitted by mosquitoes, primarily Aedes aegypti, that infect humans and other primates with a virus of the genus Flavivirus. The Spanish call yellow fever 'vómito negro' ("black vomit") as one of the symptoms is blood in the vomit from gastrointestinal bleeding.

Not only the liver but the kidneys may fail, accompanied by delirium and to add insult to injury, the hiccups. If you manage to survive, however, you are immune for life. Although primarily a tropical disease, it has spread up to New York and Philadelphia in pandemics before the 20th century. Prevention measures include vaccination, DEET to repel mosquitoes, and proper clothing to hinder bites.

Answer: Ebola virus disease (EVD)

A viral hemorrhagic fever (VHF) is any disorder with severe bleeding and fever that can lead to shock and death. The Zaire ebolavirus, or simply Ebola virus (EBOV), causes Ebola virus disease (EVD) in humans and other primates. Biologists initially named the virus after the country in which it was first described, now the Democratic Republic of the Congo, but EBOV is the preferred name.

The natural reservoir of the EBOV, that is to say the long-term host for the virus, is the Old World fruit bat.

The disease begins with aches and pains, fever, and a sore throat, and then it progresses to vomiting and diarrhea, followed perhaps by internal bleeding. The fluid loss causes blood pressure to drop too low to sustain life. The disease cannot be carried through the air, but rather is spread through direct contact of body fluids, including the eating of poorly prepared bushmeat.

Answer: tuberculosis (TB)

The bacteria Mycobacterium tuberculosis infect the lungs, and there develop masses of lymphocytes and epithelioid cells, lesions known as tubercles. (A tubercle can also refer to any tuber-like projection or swelling on a plant or on a bone.) The classic chronic coughing, night sweats, and fever are accompanied by loss of appetite and severe weight loss. TB can be carried through the air when an infected person coughs or spits.

There is a vaccine, and antibiotics will cure it, but there are many antibiotic-resistant strains now, so it remains a problem in the developing world and in prisons, homeless shelters, and ghettos in developed countries such as the USA.

Answer: typhus

'Typhus' comes from the Greek 'tūphos', meaning "smoky, hazy" and aptly describes the feverish stupor suffered by victims. Typhus, properly speaking, refers to a group of bacterial diseases. Often it refers to the epidemic disease caused by the Rickettsia prowazekii bacetrium, which is spread by body lice. Rat fleas, however, can spread murine typhus through the Rickettsia typhi bacterium. There is no vaccine; the only prevention is to keep the pests away and to avoid close quarters or, failing that, to provide prisoners, detainees, soldiers, sailors, etc. with hygienic conditions. Death, however, is now uncommon if the patient is treated with antibiotics in time.

In addition to the Crusades, the Thirty Years' War (1618-48) saw an epidemic of typhus, and during the French retreat from Moscow during the Napoleonic wars, more Frenchmen died of typhus than from battle.

Do not confuse typhus with the unrelated but similarly named typhoid fever, which is caused by completely different bacteria, the Salmonella enterica serotype Typhi, and is chiefly spread through contaminated water and food.

Answer: smallpox

Smallpox began with fever, vomiting, and mouth sores, and would eventually cause blisters that scabbed over to create the ugly pockmarks for which the disease is named. It was called "smallpox" to distinguish it from the "great pox", which is to say, syphilis.

While the disease typically lasted only about four weeks, it could leave the patient with widespread scarring and even blindness. Edward Jenner developed a vaccine in the 18th century from cowpox, a similar disease, as milkmaids were known to develop immunity from smallpox.

There is no cure, only supportive treatment such as wound care, but vaccination has proved extremely effective at prevention. The last known "wild" case of smallpox was in 1977.

Answer: leprosy

Leprosy, known in modern times as Hansen's disease, is actually a mildly contagious disease caused by the bacteria Mycobacterium leprae or Mycobacterium lepromatosis. Lesions form on the skin and mucous membranes. Eventually, peripheral nerve damage can lead to muscle weakness and atrophy, poor eyesight or even blindness, loss of sensation, and permanent organ damage. M. leprae was the first bacterium to be identified as causing disease in humans, by Gerhard Henrik Armauer Hansen in Norway in 1873. Leprosy was once a lifelong painful curse; with antibiotics as part of multi-drug therapy (MDT), however, it is quite curable in the 21st century, and the treatment is free by the World Health Organization.