Pandemic: Epidemic of Infectious Disease Spread across a Large Region

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A pandemic is an epidemic of infectious disease that has spread through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic. Further, flu pandemics generally exclude recurrences of seasonal flu. Throughout history there have been a number of pandemics, such as smallpox and tuberculosis. More recent pandemics include the HIV pandemic and the H1N1 pandemics of 1918 and 2009.Definition and stages

A pandemic can be defined as "An epidemic occurring worldwide or over a very wide area, crossing international boundaries, and usually affecting a large number of people."[1]

The World Health Organization (WHO) has a six-stage classification that describes the process by which a novel influenza virus moves from the first few infections in humans through to a pandemic. This starts with the virus mostly infecting animals, with a few cases where animals infect people, then moves through the stage where the virus begins to spread directly between people, and ends with a pandemic when infections from the new virus have spread worldwide.[2]

A disease or condition is not a pandemic merely because it is widespread or kills many people;it must also be infectious. For instance, cancer is responsible for many deaths but is not considered a pandemic because the disease is not infectious or contagious.

In a virtual press conference in May 2009 on the influenza pandemic Dr Keiji Fukuda, Assistant Director-General ad Interim for Health Security and Environment, WHO said "An easy way to think about pandemic ... is to say: a pandemic is a global outbreak. Then you might ask yourself: “What is a global outbreak”? Global outbreak means that we see both spread of the agent ... and then we see disease activities in addition to the spread of the virus."[3]

In planning for a possible influenza pandemic the WHO published a document on pandemic preparedness guidance in 1999, revised in 2005 and in February 2009, defining phases and appropriate actions for each phase in an aide memoir entitled WHO pandemic phase descriptions and main actions by phase. The 2009 revision, including definitions of a pandemic and the phases leading to its declaration, were finalized in February 2009. The pandemic H1N1 2009 virus, was neither on the horizon at that time nor mentioned in the document [4][5] All versions of this document refer to influenza. The phases are defined by the spread of the disease; virulence and mortality are not mentioned in the current WHO definition, although these factors have previously been included. HIV spread to the United States and much of the rest of the world beginning around 1969.[7] HIV, the virus that causes AIDS, is currently a pandemic, with infection rates as high as 25% in southern and eastern Africa. In 2006 the HIV prevalence rate among pregnant women in South Africa was 29.1%.[8] Effective education about safer sexual practices and bloodborne infection precautions training have helped to slow down infection rates in several African countries sponsoring national education programs. Infection rates are rising again in Asia and the Americas. AIDS could kill 31 million people in India and 18 million in China by 2025, according to projections by U.N. population researchers.[9] AIDS death toll in Africa may reach 90–100 million by 2025.There have been a number of significant pandemics recorded in human history, generally zoonoses which came about with domestication of animals, such as influenza and tuberculosis. There have been a number of particularly significant epidemics that deserve mention above the "mere" destruction of cities: Plague of Athens, 430 BC. Typhoid fever killed a quarter of the Athenian troops, and a quarter of the population over four years. This disease fatally weakened the dominance of Athens, but the sheer virulence of the disease prevented its...
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