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The Pandemics and Epidemics Portal

A pandemic (/pænˈdɛmɪk/ pan-DEM-ik) is an epidemic of an infectious disease that has a sudden increase in cases and spreads across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. Widespread endemic diseases with a stable number of infected individuals such as recurrences of seasonal influenza are generally excluded as they occur simultaneously in large regions of the globe rather than being spread worldwide.

Throughout human history, there have been a number of pandemics of diseases such as smallpox. The Black Death, caused by the Plague, caused the deaths of up to half of the population of Europe in the 14th century. The term pandemic had not been used then, but was used for later epidemics, including the 1918 H1N1 influenza A pandemic—more commonly known as the Spanish flu—which is the deadliest pandemic in history. The most recent pandemics include the HIV/AIDS pandemic, the 2009 swine flu pandemic and the COVID-19 pandemic. Almost all these diseases still circulate among humans though their impact now is often far less.

In response to the COVID-19 pandemic, 194 member states of the World Health Organization began negotiations on an International Treaty on Pandemic Prevention, Preparedness and Response, with a requirement to submit a draft of this treaty to the 77th World Health Assembly during its 2024 convention. Further, on 6 May 2024, the White House released an official policy to more safely manage medical research projects involving potentially hazardous pathogens, including viruses and bacteria, that may pose a risk of a pandemic. (Full article...)

An epidemic (from Greek ἐπί epi "upon or above" and δῆμος demos "people") is the rapid spread of disease to a large number of hosts in a given population within a short period of time. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.

Epidemics of infectious disease are generally caused by several factors including a change in the ecology of the host population (e.g., increased stress or increase in the density of a vector species), a genetic change in the pathogen reservoir or the introduction of an emerging pathogen to a host population (by movement of pathogen or host). Generally, an epidemic occurs when host immunity to either an established pathogen or newly emerging novel pathogen is suddenly reduced below that found in the endemic equilibrium and the transmission threshold is exceeded.

An epidemic may be restricted to one location; however, if it spreads to other countries or continents and affects a substantial number of people, it may be termed as a pandemic. The declaration of an epidemic usually requires a good understanding of a baseline rate of incidence; epidemics for certain diseases, such as influenza, are defined as reaching some defined increase in incidence above this baseline. A few cases of a very rare disease may be classified as an epidemic, while many cases of a common disease (such as the common cold) would not. An epidemic can cause enormous damage through financial and economic losses in addition to impaired health and loss of life. (Full article...)

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Image 1

The 12 January 1890 edition of the Paris satirical magazine Le Grelot [fr] depicted an unfortunate person with influenza bowled along by a parade of physicians, druggists, skeleton musicians, and dancing women representing quinine and antipyrine.

The 1889–1890 pandemic, often referred to as the "Asiatic flu" or "Russian flu", was a worldwide respiratory viral pandemic. It was the last great pandemic of the 19th century, and is among the deadliest pandemics in history. The pandemic killed about 1 million people out of a world population of about 1.5 billion (0.067% of population). The most reported effects of the pandemic took place from October 1889 to December 1890, with recurrences in March to June 1891, November 1891 to June 1892, the northern winter of 1893–1894, and early 1895.

According to researchers' estimates, excess mortality from Russian influenza in the Russian Empire for the period 1889–1890 could be from 60,000 to 90,000 people, with lethality from the virus, a little more than 0.2%. (Full article...)
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Soldiers sick with Spanish flu at a hospital ward at Camp Funston in Fort Riley, Kansas

The 1918–1920 flu pandemic, also known as the Great Influenza epidemic or by the common misnomer Spanish flu, was an exceptionally deadly global influenza pandemic caused by the H1N1 subtype of the influenza A virus. The earliest documented case was March 1918 in the state of Kansas in the United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in history.

The pandemic broke out near the end of World War I, when wartime censors in the belligerent countries suppressed bad news to maintain morale, but newspapers freely reported the outbreak in neutral Spain, creating a false impression of Spain as the epicenter and leading to the "Spanish flu" misnomer. Limited historical epidemiological data make the pandemic's geographic origin indeterminate, with competing hypotheses on the initial spread. (Full article...)
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Aztec smallpox victims

The history of smallpox in Mexico spans approximately 430 years from the arrival of the Spanish to the official eradication in 1951. It was brought to what is now Mexico by the Spanish, then spread to the center of Mexico, where it became a significant factor in the fall of Tenochtitlan. During the colonial period, there were major epidemic outbreaks which led to the implementation of sanitary and preventive policy. The introduction of smallpox vaccination in New Spain by Francisco Javier de Balmis and the work of Ignacio Bartolache reduced the mortality and morbidity of the disease. (Full article...)
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The 735–737 Japanese smallpox epidemic (天平の疫病大流行, Tenpyō no ekibyō dairyūkō, "Epidemic of the Tenpyō era") was a major smallpox epidemic that afflicted much of Japan. Killing approximately one third (around 1 million individuals) of the entire Japanese population, the epidemic had significant social, economic, and religious repercussions throughout the country. (Full article...)
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The red ribbon is a symbol for solidarity with HIV-positive people and those living with AIDS.

The human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. It is a preventable disease. There is no vaccine or cure for HIV. It can be managed with treatment and become a manageable chronic health condition. While there is no cure or vaccine, antiretroviral treatment can slow the course of the disease and enable people living with HIV to lead long and healthy lives. An HIV-positive person on treatment can expect to live a normal life, and die with the virus, not of it. Effective treatment for HIV-positive people (people living with HIV) involves a life-long regimen of medicine to suppress the virus, making the viral load undetectable. Without treatment it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS).

Treatment is recommended as soon as the diagnosis is made. An HIV-positive person who has an undetectable viral load as a result of long-term treatment has effectively no risk of transmitting HIV sexually. Campaigns by UNAIDS and organizations around the world have communicated this as Undetectable = Untransmittable. Without treatment the infection can interfere with the immune system, and eventually progress to AIDS, sometimes taking many years. Following initial infection an individual may not notice any symptoms, or may experience a brief period of influenza-like illness. During this period the person may not know that they are HIV-positive, yet they will be able to pass on the virus. Typically, this period is followed by a prolonged incubation period with no symptoms. Eventually the HIV infection increases the risk of developing other infections such as tuberculosis, as well as other opportunistic infections, and tumors which are rare in people who have normal immune function. The late stage is often also associated with unintended weight loss. Without treatment a person living with HIV can expect to live for 11 years. Early testing can show if treatment is needed to stop this progression and to prevent infecting others. (Full article...)
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Saint Sebastian pleading for the life of a gravedigger afflicted with plague during the 7th-century Plague of Pavia, by South Netherlandish painter Josse Lieferinxe ca. 1498

The first plague pandemic was the first historically recorded Old World pandemic of plague, the contagious disease caused by the bacterium Yersinia pestis. Also called the early medieval pandemic, it began with the Plague of Justinian in 541 and continued until 750 or 767. At least fifteen to eighteen major waves of plague following the Justinianic plague have been identified from historical records. The pandemic affected the Mediterranean Basin most severely and most frequently, but also infected the Near East and Northern Europe, and potentially East Asia as well. The Roman emperor Justinian I's name is sometimes applied to the whole series of plague epidemics in late antiquity.

The pandemic is best known from its first and last outbreaks: the Justinianic Plague of 541–549, described by the contemporary Roman historian Procopius, and the late 8th century plague of Naples described by Neapolitan historian John the Deacon in the following century (distinct from the much later Naples Plague). Other accounts from contemporaries of the pandemic are included in the texts of Evagrius Scholasticus, John of Ephesus, Gregory of Tours, Paul the Deacon, and Theophanes the Confessor; most seem to have believed plague was a divine punishment for human misdeeds. (Full article...)
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The 1957–1958 Asian flu pandemic was a global pandemic of influenza A virus subtype H2N2 that originated in Guizhou in Southern China. The number of excess deaths caused by the pandemic is estimated to be 1–4 million around the world (1957–1958 and probably beyond), making it one of the deadliest pandemics in history. A decade later, a reassorted viral strain H3N2 further caused the Hong Kong flu pandemic (1968–1969). (Full article...)
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Indigenous victims (likely smallpox), Florentine Codex (compiled 1540–1585)

The Cocoliztli Epidemic or the Great Pestilence was an outbreak of a mysterious illness characterized by high fevers and bleeding which caused 5–15 million deaths in New Spain during the 16th century. The Aztec people called it cocoliztli, Nahuatl for pestilence. It ravaged the Mexican highlands in epidemic proportions, resulting in the demographic collapse of some Indigenous populations.

Based on the death toll, this outbreak is often referred to as the worst epidemic in the history of Mexico. Subsequent outbreaks continued to baffle both Spanish and native doctors, with little consensus among modern researchers on the pathogenesis. However, recent bacterial genomic studies have suggested that Salmonella, specifically a serotype of Salmonella enterica known as Paratyphi C, was at least partially responsible for this initial outbreak. Others believe cocoliztli was caused by an indigenous viral hemorrhagic fever, perhaps exacerbated by the worst droughts to affect that region in 500 years and poor living conditions for Indigenous peoples of Mexico following the Spanish conquest (c. 1519). (Full article...)
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Since 2012, an outbreak of Middle East respiratory syndrome coronavirus has affected several countries, primarily in its namesake, the Middle East. The virus, which causes Middle East respiratory syndrome (MERS), is a novel coronavirus that was first identified in a patient from Jeddah, Saudi Arabia on 6 June 2012.

Sporadic cases, small clusters, and large outbreaks have been reported in 24 countries, with over 2,600 cases of the virus and over 900 deaths, as of 2021. (Full article...)
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The angel of death striking a door during the plague of Rome: an engraving by Levasseur after Jules-Elie Delaunay

The Antonine Plague of AD 165 to 180, also known as the Plague of Galen (after Galen, the Greek physician who described it), was a prolonged and destructive epidemic, which impacted the Roman Empire. It was possibly contracted and spread by soldiers who were returning from campaign in the Near East. Scholars generally believed the plague was smallpox, due to the skin eruptions over the entirety of the body which appeared to be red and black (Horgan), although measles has also been suggested, and recent genetic evidence strongly suggests that the most severe form of smallpox arose in Europe much later. As yet, there is no genetic evidence from the Antonine plague.

Ancient sources agree that the plague is likely to have appeared during the Roman siege of the Mesopotamian city of Seleucia in the winter of 165–166, during the Parthian campaign of Lucius Verus. Ammianus Marcellinus reported that the plague spread to Gaul and to the legions along the Rhine. Eutropius stated that a large proportion of the empire's population died from this outbreak. According to the contemporary Roman historian Cassius Dio, the disease broke out again nine years later in 189 AD and caused up to 2,000 deaths a day in the city of Rome, 25% of those who were affected. The total death count has been estimated at 5–10 million, roughly 10% of the population of the empire. The disease was particularly deadly in the cities and within the Roman army. (Full article...)
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The 2009 swine flu pandemic, caused by the H1N1/swine flu/influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, was the third recent flu pandemic involving the H1N1 virus (the first being the 1918–1920 Spanish flu pandemic and the second being the 1977 Russian flu). The first identified human case was in La Gloria, Mexico, a rural town in Veracruz. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses which further combined with a Eurasian pig flu virus, leading to the term "swine flu".

Unlike most strains of influenza, the pandemic H1N1/09 virus did not disproportionately infect adults older than 60 years; this was an unusual and characteristic feature of the H1N1 pandemic. Even in the case of previously healthy people, a small percentage develop pneumonia or acute respiratory distress syndrome (ARDS). This manifests itself as increased breathing difficulty and typically occurs three to six days after initial onset of flu symptoms. The pneumonia caused by flu can be either direct viral pneumonia or a secondary bacterial pneumonia. A November 2009 New England Journal of Medicine article recommended that flu patients whose chest X-ray indicates pneumonia receive both antivirals and antibiotics. In particular, it is a warning sign if a child seems to be getting better and then relapses with high fever, as this relapse may be bacterial pneumonia. (Full article...)
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A world map illustrating the proportion of population infected with HIV in 2019

The global pandemic of HIV/AIDS (human immunodeficiency virus infection and acquired immunodeficiency syndrome) began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), by 2023, HIV/AIDS had killed approximately 40.4 million people, and approximately 39 million people were infected with HIV globally. Of these, 29.8 million people (75%) are receiving antiretroviral treatment. There were about 630,000 deaths from HIV/AIDS in 2022. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2023, there are about 1.3 million new infections of HIV per year globally.

According to the WHO, the prevalence of HIV in the Africa Region was estimated at 1.1 million people as of 2018. The African Region accounts for two thirds of the incidence of HIV around the world. Sub-Saharan Africa is the region most affected by HIV. As of 2020, more than two thirds of those living with HIV are living in Africa. HIV rates have been decreasing in the region: From 2010 to 2020, new infections in eastern and southern Africa fell by 38%. Still, South Africa has the largest population of people with HIV of any country in the world, at 8.45 million, 13.9% of the population as of 2022. (Full article...)
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Plague in an Ancient City, Michiel Sweerts, c. 1652–1654

The Plague of Athens (Ancient Greek: Λοιμὸς τῶν Ἀθηνῶν, Loimos tôn Athênôn) was an epidemic that devastated the city-state of Athens in ancient Greece during the second year (430 BC) of the Peloponnesian War when an Athenian victory still seemed within reach. The plague killed an estimated 75,000 to 100,000 people, around 25% of the population, and is believed to have entered Athens through Piraeus, the city's port and sole source of food and supplies. Thucydides, an Athenian survivor, wrote that much of the eastern Mediterranean also saw an outbreak of the disease, albeit with less impact.

The war, along with the plague, had lasting effects on Athenian society. Short-term, there was civil disorder, and violations of usual funerary practices. Thucydides describes a decrease in traditional religious practices and increase in superstitious explanations. He estimates that it took 15 years for the Athenian population to recover. Long-term, the high death toll drastically redistributed wealth within Athenian society, and weakened Athens politically. (Full article...)
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A plague doctor and his typical apparel during the 17th century

The second plague pandemic was a major series of epidemics of plague that started with the Black Death, which reached medieval Europe in 1346 and killed up to half of the population of Eurasia in the next four years. It followed the first plague pandemic that began in the 6th century with the Plague of Justinian, but had ended in the 8th century. Although the plague died out in most places after 1353, it became endemic and recurred regularly. A series of major epidemics occurred in the late 17th century, and the disease recurred in some places until the late 18th century or the early 19th century. After this, a new strain of the bacterium gave rise to the third plague pandemic, which started in Asia around the mid-19th century.

Plague is caused by the bacterium Yersinia pestis, which exists in parasitic fleas of several species in the wild and of rats in human society. In an outbreak, it may kill all of its immediate hosts and thus die out, but it can remain active in other hosts that it does not kill, thereby causing a new outbreak years or decades later. (Full article...)
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The Persian plague epidemic of 1772–1773, also simply known as the Persian Plague, was a massive outbreak of plague, more specifically Bubonic plague, in the Persian Empire, which claimed around 2 million lives in total. It was one of the most devastating Plague epidemics in recorded human history. The outbreak resulted in the introduction of several quarantine measures for the first time in the Persian Gulf regions. (Full article...)

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The following are images from various pandemic- and epidemic-related articles on Wikipedia.

Image 1The various types of influenza viruses in humans. Solid squares show the appearance of a new strain, causing recurring influenza pandemics. Broken lines indicate uncertain strain identifications. (from Influenza pandemic)
Image 2Scaled examples of past influenza pandemics and past influenza seasons. Color scheme included to represent corresponding estimates of hypothetical influenza deaths in the 2010 US population, with the same color scale as the previous figure. (from Pandemic Severity Assessment Framework)
Image 3Structure of the influenza viron. The hemagglutinin (HA) and neuraminidase (NA) proteins are shown on the surface of the particle. The viral RNAs that make up the genome are shown as red coils inside the particle and bound to Ribonuclear Proteins (RNPs). (from Influenza pandemic)
Image 41892 cholera outbreak in Hamburg, hospital ward (from History of cholera)
Image 5Influenza intervals in the CDC's Pandemic Intervals Framework (from Influenza pandemic)
Image 6By 12 February 2009, the number of cases of infection by cholera in sub-Saharan Africa had reached 128,548 and the number of fatalities, 4,053. (from History of cholera)
Image 7Anopheles mosquito, the vector of malaria (from Epidemic)
Image 8First cholera pandemic (from History of cholera)
Image 9A Court for King Cholera. Illustration from Punch (1852). (from Epidemic)
Image 10The Plague of Athens (c. 1652–1654) by Michiel Sweerts, illustrating the devastating epidemic that struck Athens in 430 BC, as described by the historian Thucydides (from Epidemic)
Image 11Register of Patients Gosport Naval Hospital August 1832 cholera cases (from History of cholera)
Image 12Estimates of hypothetical influenza deaths in the 2010 United States population (308,745,538 persons) across varying values of case-fatality ratio and the cumulative incidence of infection in the population. Selected estimated numbers of deaths are indicated with a black line, across each relevant combination of case-fatality ratio and cumulative incidence. In addition, the background color transitions from blue to yellow to red as the estimated absolute number of deaths increases. Case-fatality ratio is an example of a clinical severity measure and cumulative incidence of infection is an example of a transmissibility measure in the Pandemic Severity Assessment Framework. (from Pandemic Severity Assessment Framework)
Image 13Disposal of dead bodies during the cholera epidemic in Palermo in 1835 (from History of cholera)
Image 14A pump memorializing John Snow for his study of contaminated water as a likely source of cholera during the 1854 Broad Street Cholera outbreak (from History of cholera)
Image 15Possibilities for zoonotic disease transmissions (from Epidemic)
Image 16Influenza ward at Walter Reed Hospital, in Washington, D.C., during the 1918 flu pandemic (from Influenza pandemic)
Image 17Patients suffering from cholera in 1854 (from History of cholera)
Image 18Hand bill from the New York City Board of Health, 1832. The outdated public health advice demonstrates the lack of understanding of the disease and its actual causative factors. (from History of cholera)
Image 19Example of an epidemic showing the number of new infections over time. (from Epidemic)
Image 20The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line). (from Influenza pandemic)
Image 21Bodies of Rwandan refugees who died during the cholera epidemic, October 1994 (from History of cholera)