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\"From the masters of storytelling-meets-science and co-authors of Quackery, Patient Zero tells the long and fascinating history of disease outbreaks-how they start, how they spread, the science that lets us understand them, and how we race to destroy them before they destroy us. Written in the authors' lively and accessible style, chapters include page-turning medical stories about a particular disease or virus-smallpox, Bubonic plague, polio, HIV-that combine \"Patient Zero\" narratives, or the human stories behind outbreaks, with historical examinations of missteps, milestones, scientific theories, and more. Learn the tragic stories of Patient Zeros throughout history, such as Mabalo Lokela, who contracted Ebola while on vacation in 1976, and the Lewis Baby on London's Broad Street, the first to catch cholera in an 1854 outbreak that led to a major medical breakthrough. Interspersed are origin stories of a different sort-how a rye fungus in 1951 turned a small village in France into a phantasmagoric scene reminiscent of Burning Man. Plus the uneasy history of human autopsy, how the HIV virus has been with us for at least a century, and more\"-- Provided by publisher.

It is now thirty years since the discovery of AIDS but its origins continue to puzzle doctors and scientists. Inspired by his own experiences working as an infectious diseases physician in Africa, Jacques Pepin looks back to the early twentieth-century events in Africa that triggered the emergence of HIV/AIDS and traces its subsequent development into the most dramatic and destructive epidemic of modern times. He shows how the disease was first transmitted from chimpanzees to man and then how urbanization, prostitution, and large-scale colonial medical campaigns intended to eradicate tropical diseases combined to disastrous effect to fuel the spread of the virus from its origins in Léopoldville to the rest of Africa, the Caribbean and ultimately worldwide. This is an essential new perspective on HIV/AIDS and on the lessons that must be learnt if we are to avoid provoking another pandemic in the future.

Background Patients with moderate-to-severe atopic dermatitis (AD) have increased infection risk, including skin infections and systemic infections. Immunomodulators (e.g., anti-tumor necrosis factors, anti-interleukin [anti-IL]-23, anti-IL-17, Janus kinase inhibitors) increase risk of infections. Dupilumab (a monoclonal antibody blocking the shared receptor component for IL-4 and IL-13) is approved for inadequately controlled moderate-to-severe AD and for moderate-to-severe eosinophilic or oral corticosteroid-dependent asthma. Objective The aim was to determine the impact of dupilumab on infection rates in patients with moderate-to-severe AD. Methods This analysis pooled data from seven randomized, placebo-controlled dupilumab trials in adults with moderate-to-severe AD. Exposure-adjusted analyses assessed infection rates. Results Of 2932 patients, 1091 received placebo, 1095 dupilumab 300 mg weekly, and 746 dupilumab 300 mg every 2 weeks. Treatment groups had similar infection rates overall per 100 patient-years (placebo, 155; dupilumab weekly, 150; dupilumab every 2 weeks, 156; dupilumab combined, 152), and similar non-skin infection rates. Serious/severe infections were reduced with dupilumab (risk ratio 0.43; p  < 0.05), as were bacterial and other non-herpetic skin infections (risk ratio 0.44; p  < 0.001). Although herpesviral infection rates overall were slightly higher with dupilumab than placebo, clinically important herpesviral infections (eczema herpeticum, herpes zoster) were less common with dupilumab (risk ratio 0.31; p  < 0.01). Systemic anti-infective medication use was lower with dupilumab. Conclusions Dupilumab is associated with reduced risk of serious/severe infections and non-herpetic skin infections and does not increase overall infection rates versus placebo in patients with moderate-to-severe AD. ClinicalTrials.gov Identifiers NCT01548404, NCT02210780, NCT01859988, NCT02277743, NCT02277769, NCT02260986, and NCT02755649.

\"Plagues upon the Earth is a history of human civilization and the germs that have shaped its course. At every stage in our species' past, micro-organisms have had macro-effects on the development of human societies. Kyle Harper proposes the first history of human disease to make full use of a radical new source of evidence: pathogen genomes as a biological archive and window into prehistoric times. We can now begin to reconstruct the natural history of human disease at the molecular level, tracing the biographies of the viruses, bacteria, and protozoa that have haunted our species. The story reveals, Harper will show, the continuing importance of the deep past in determining the patterns of global divergence today. Plagues upon the Earth puts the dynamic two-way relationship between humanity and its germs in the foreground. The takeover and transformation of the planet by Homo sapiens has been the most powerful force shaping the evolution of microbial pathogens, and in turn, pathogen evolution has been a decisive influence on the destiny of human societies. From humanity's dispersal out of Africa to the rise of agriculture and complex civilizations, from the great pandemics of the medieval world to the age of global expansion and industrialization, from the modern increase in life expectancy to the ongoing threats of microbial resistance and emerging pathogens like HIV and Ebola, disease evolution has been and remains a primary, powerful, and unpredictable factor in human history. This will be the story of how we made our germs, and how our germs made the world as we know it. Harper aims to cover the entire timespan of Homo sapiens and to set the history of our species in deep perspective. The pathogens that exist today are the heirs of millions of years of evolution. Similarly, the patterns of economic development, and the roots of global inequality, have distant origins. Thus, Harper aims to bring together two bodies of literature: the history of disease and the study of geography and social development. The book is global in coverage, insisting on the importance of understanding how the tropics and temperate zones, the Old World and the New World, differ and interact throughout the course of history. Viruses, bacteria, and protozoa - in all their peculiarity and specificity - have played an enormous part in shaping the different outcomes experienced by human societies. Plagues upon the Earth combines biology, geography, and economics to understand these differences but emphasizes the central importance of evolution as a source of constant change. The past is always present in the history of disease, and the future is always unpredictable. The story continues right up to our own world. The book closes with a reflection on antibiotic resistance as a form of evolution that continues the ancient molecular antagonism between pathogens and host immune systems, and the importance of seeing this struggle in a broader environmental framework. Freedom from infectious disease remains an unachieved goal for our species, which is more interconnected than ever. The biology of infectious disease has been one of the great forces shaping the patterns of global development, but only with a sense of history - of the interplay of change, conjunction, and chance - can we begin to understand the intertwined story of human societies and their germs\"-- Provided by publisher.

Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings. Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness. Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.

Over 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum. The principal presentation was pneumonia in 278 (51%), genitourinary infection in 76 (14%), skin infection in 68 (13%), bacteremia without evident focus in 59 (11%), septic arthritis/osteomyelitis in 20 (4%) and neurological melioidosis in 14 (3%). 298 (55%) were bacteremic and 116 (21%) developed septic shock (58 fatal). Internal organ abscesses and secondary foci in lungs and/or joints were common. Prostatic abscesses occurred in 76 (20% of 372 males). 96 (18%) had occupational exposure to Burkholderia pseudomallei. 118 (22%) had a specific recreational or occupational incident considered the likely infecting event. 436 (81%) presented during the monsoonal wet season. The higher proportion with pneumonia in December to February supports the hypothesis of infection by inhalation during severe weather events. Recurrent melioidosis occurred in 29, mostly attributed to poor adherence to therapy. Mortality decreased from 30% in the first 5 years to 9% in the last five years (p<0.001). Risk factors for melioidosis included diabetes (39%), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%). There was no identifiable risk factor in 20%. Of the 77 fatal cases (14%), 75 had at least one risk factor; the other 2 were elderly. On multivariate analysis of risk factors, age, location and season, the only independent predictors of mortality were the presence of at least one risk factor (OR 9.4; 95% CI 2.3-39) and age ≥ 50 years (OR 2.0; 95% CI 1.2-2.3). Melioidosis should be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care.

\"This book synthesizes the flourishing field of anthropology of infectious disease in a critical, biocultural framework. Leading medical anthropologist Merrill Singer holistically unites the behaviors of microorganisms and the activities of complex social systems, showing how we exist with pathogenic agents of disease in a complex process of co-evolution. He also connects human diseases to larger ecosystems and various other species that are future sources of new human infections. Anthropology of Infectious Disease integrates and advances research in this growing, multifaceted area and offers an ideal supplement to courses in anthropology, public health, development studies, and related fields\"-- Provided by publisher.

Canine rabies causes many thousands of human deaths every year in Africa, and continues to increase throughout much of the continent. This paper identifies four common reasons given for the lack of effective canine rabies control in Africa: (a) a low priority given for disease control as a result of lack of awareness of the rabies burden; (b) epidemiological constraints such as uncertainties about the required levels of vaccination coverage and the possibility of sustained cycles of infection in wildlife; (c) operational constraints including accessibility of dogs for vaccination and insufficient knowledge of dog population sizes for planning of vaccination campaigns; and (d) limited resources for implementation of rabies surveillance and control. We address each of these issues in turn, presenting data from field studies and modelling approaches used in Tanzania, including burden of disease evaluations, detailed epidemiological studies, operational data from vaccination campaigns in different demographic and ecological settings, and economic analyses of the cost-effectiveness of dog vaccination for human rabies prevention. We conclude that there are no insurmountable problems to canine rabies control in most of Africa; that elimination of canine rabies is epidemiologically and practically feasible through mass vaccination of domestic dogs; and that domestic dog vaccination provides a cost-effective approach to the prevention and elimination of human rabies deaths.