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Most Deadly Pandemics in History

A 'pandemic' is an epidemic that breaks out on a global scale.

1. The Peloponnesian War Pestilence

The very first pandemic in recorded history was described by Thucydides. In 430 BC, during the Peloponnesian war between Athens and Sparta, the Greek historian told of a great pestilence that wiped out over 30,000 of the citizens of Athens (roughly one to two thirds of all Athenians died). Thucydides described the disease as such "People in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath." Next came coughing, diarrhea, spasms, and skin ulcers. A handful survived, but often without their fingers, sights, and even genitals (Source). Until today, the disease that decimated ancient Athens has yet to be identified.

2. The Antonine Plague

In 165 AD, Greek physician Galen described an ancient pandemic, now thought to be smallpox, that was brought to Rome by soldiers returning from Mesopotamia. The disease was named after Marcus Aurelius Antoninus, one of two Roman emperors who died from it. At its height, the disease killed some 5,000 people a day in Rome. By the time the disease ran its course some 15 years later, a total of 5 million people were dead.

3. The Plague of Justinian

In 541-542 AD, there was an outbreak of a deadly disease in the Byzantine Empire. At the height of the infection, the disease, named the Plague of Justinian after the reigning emperor Justinian I, killed 10,000 people in Constantinople every day. With no room nor time to bury them, bodies were left stacked in the open. By the end of the outbreak, nearly half of the inhabitants of the city were dead. Historians believe that this outbreak decimated up to a quarter of human population in the eastern Mediterranean.
What was the culprit? It was the bubonic plague, caused by the bacterium Yersinia pestis. This outbreak, the first known bubonic plague pandemic in recorded human history, marked the first of many outbreaks of plague - a disease that claimed as many as 200 million lives throughout history.

4. The Black Death

After the Plague of Justinian, there were many sporadic oubreaks of the plague, but none as severe as the Black Death of the 14th century. While no one knows for certain where the disease came from (it was thought that merchants and soldiers carried it over caravan trading routes), the Black Death took a heavy toll on Europe. The fatality was recorded at over 25 million people or one-fourth of the entire population.

It's interesting to note that the Black Death actually came in three forms: the bubonic, pneumonic, and septicemic plague.

1. The first, the bubonic plague, was the most common: people with this disease have buboes or enlarged lymphatic glands that turn black (caused by decaying of the skin while the person is still alive). Without treatment, bubonic plague kills about half of those infected within 3 to 7 days.
2. In pneumonic plague, droplets of aerosolized Y. pestis bacteria are transmitted from human to human by coughing. Unless treated with antibiotics in the first 24 hours, almost 100% of people with this form of infection die in 2 to 4 days.
3. The last form, septicemic plague, happens when the bacteria enter the blood from the lymphatic or respiratory system. Patients with septicemic plague develop gangrenes in their fingers and toes, which turn the skin black (which gives the disease its moniker) Though rare, this form of the disease is almost always fatal - often killing its victims the same day the symptoms appear.

We haven't heard the last of the bubonic plague. In 1855, another bubonic plague epidemic (named the Third Epidemic) hit the world - this time, the initial outbreak was in Yunnan Province, China. Human migration, trade and wars helped the disease spread from China to India, Africa, and the Americas. All in all, this pandemic lasted about 100 years (it officially ended in 1959) and claimed over 12 million people in India and China alone.

5. The Spanish Flu

Emergency military hospital at Camp Funston, Kansas (Image: National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington D.C.) via PLoS Biology. In March 1918, in the last months of World War I, an unusually virulent and deadly flu virus was identified in a US military camp in Kansas. Just 6 months later, the flu had become a worldwide pandemic in all continents. When the Spanish Flu pandemic was over, about 1 billion people or half the world's population had contracted it. It is perhaps the most lethal pandemic in the history of humankind: between 20 and 100 million people were killed, more the number killed in the war itself. The Spanish Flu actually didn't originate in Spain - it got its name because at the time, Spain wasn't involved in the war and had not imposed wartime censorship, thus it received great press attention there. Recently, scientists were able to "resurrect" the virus from a well-preserved corpse buried in the permafrost of Alaska. In 1918 and 1919, the Spanish Flu pandemic killed more people than Hitler, nuclear weapons and all the terrorists of history combined.

Smallpox (430 BC? - 1979):

Killed more than 300 million people worldwide in the 20th century alone, and most of the native inhabitants of the Americas. Smallpox (also known by the Latin names Variola or Variola vera) is a contagious disease unique to humans. Smallpox is caused by either of two virus variants named Variola major and Variola minor. The deadlier form, V. major, has a mortality rate of 30–35%, while V. minor causes a milder form of disease called alastrim and kills ~1% of its victims. Long-term side-effects for survivors include the characteristic skin scars. Occasional side effects include blindness due to corneal ulcerations and infertility in male survivors. Smallpox killed an estimated 60 million Europeans, including five reigning European monarchs, in the 18th century alone. Up to 30% of those infected, including 80% of the children under 5 years of age, died from the disease, and one third of the survivors became blind.

As for the Americas, after the first contacts with Europeans and Africans, some believe that the death of 90 to 95 percent of the native population of the New World was caused by Old World diseases. It is suspected that smallpox was the chief culprit and responsible for killing nearly all of the native inhabitants of the Americas. In Mexico, when the Aztecs rose up in rebellion against Cortés, outnumbered, the Spanish were forced to flee. In the fighting, a Spanish soldier carrying smallpox died. After the battle, the Aztecs contracted the virus from the invaders' bodies. When Cortes returned to the capital, smallpox had devastated the Aztec population. It killed most of the Aztec army, the emperor, and 25% of the overall population. Cortés then easily defeated the Aztecs and entered Tenochtitlán, where he found that smallpox had killed more Aztecs than had the cannons.

Smallpox was responsible for an estimated 300–500 million deaths in the 20th century. As recently as 1967, the World Health Organization (WHO) estimated that 15 million people contracted the disease and that two million died in that year. After successful vaccination campaigns throughout the 19th and 20th centuries, the WHO certified the eradication of smallpox in 1979. To this day, smallpox is the only human infectious disease to have been completely eradicated from nature.

Malaria (1600 - today):

Kills about 2 million people per year. Malaria causes about 400–900 million cases of fever and approximately one to three million deaths annually — this represents at least one death every 30 seconds. The vast majority of cases occur in children under the age of 5 years; pregnant women are also especially vulnerable. Despite efforts to reduce transmission and increase treatment, there has been little change in which areas are at risk of this disease since 1992. Indeed, if the prevalence of malaria stays on its present upwards course, the death rate could double in the next twenty years. Precise statistics are unknown because many cases occur in rural areas where people do not have access to hospitals or the means to afford health care. Consequently, the majority of cases are undocumented. Malaria is one of the most common infectious diseases and an enormous public-health problem. It's parasites are transmitted by female Anopheles mosquitoes. The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia (light headedness, shortness of breath, tachycardia etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness, and in severe cases, coma and death. The disease is caused by protozoan parasites of the genus Plasmodium. It is widespread in tropical and subtropical regions, including parts of the Americas, Asia, and Africa.

AIDS (1981 - today):

Killed 25 million people worldwide. Acquired Immune Deficiency Syndrome (AIDS) has led to the deaths of more than 25 million people since it was first recognized in 1981, making it one of the most destructive epidemics in recorded history. Despite recent improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed approximately 3.1 million (between 2.8 and 3.6 million) lives in 2005 (an average of 8,500 per day), of which 570,000 were children. UNAIDS and the WHO estimate that the total number of people living with the human immunodeficiency virus (HIV) has reached its highest level. There are an estimated 40.3 million (estimated range between 36.7 and 45.3 million) people now living with HIV. Moreover, almost 5 million people have been estimated to have been infected with HIV in 2005 alone.

The pandemic is not homogeneous within regions with some countries more afflicted than others. Even at the country level there are wide variations in infection levels between different areas. The number of people living with HIV continues to rise in most parts of the world, despite strenuous prevention strategies. Sub-Saharan Africa remains by far the worst-affected region, with 23.8 million to 28.9 million people living with HIV at the end of 2005, 1 million more than in 2003. Sixty-four percent of all people living with HIV are in sub-Saharan Africa, as are more than 77% of all women living with HIV. South & South East Asia are second most affected with 15%.

The key facts surrounding this origin of AIDS are currently unknown, particularly where and when the pandemic began, though it is said that it originated from the apes in Africa.

Cholera (1817 - today)

8 pandemics; hundreds of thousands killed worldwide. In the 19th century, Cholera became the world's first truly global disease in a series of epidemics that proved to be a watershed for the history of plumbing. Festering along the Ganges River in India for centuries, the disease broke out in Calcutta in 1817 with grand - scale results. When the festival was over, they carried cholera back to their homes in other parts of India. There is no reliable evidence of how many Indians perished during that epidemic, but the British army counted 10,000 fatalities among its imperial troops. Based on those numbers, it's almost certain that at least hundreds of thousands of natives must have fallen victim across that vast land. Cholera sailed from port to port, the germ making headway in contaminated kegs of water or in the excrement of infected victims, and transmitted by travelers. The world was getting smaller thanks to steam-powered trains and ships, but living conditions were slow to improve. By 1827 cholera had become the most feared disease of the century.

The major cholera pandemics are generally listed as: First: 1817-1823, Second: 1829-1851, Third: 1852-1859, Fourth: 1863-1879, Fifth: 1881-1896, Sixth: 1899-1923: Seventh: 1961- 1970, and some would argue that we are in the Eighth: 1991 to the present. Each pandemic, save the last, was accompanied by many thousands of deaths. As recently as 1947, 20,500 of 30,000 people infected in Egypt died. Despite modern medicine, cholera remains an efficient killer.

Typhus (430 BC? - today)

Killed 3 million people between 1918 and 1922 alone, and most of Napoleon's soldiers on Russia.Typhus is any one of several similar diseases caused by louse-borne bacteria. The name comes from the Greek typhos, meaning smoky or lazy, describing the state of mind of those affected with typhus. Rickettsia is endemic in rodent hosts, including mice and rats, and spreads to humans through mites, fleas and body lice. The arthropod vector flourishes under conditions of poor hygiene, such as those found in prisons or refugee camps, amongst the homeless, or until the middle of the 20th century, in armies in the field.

The first description of typhus was probably given in 1083 at a convent near Salerno, Italy. Before a vaccine was developed in World War II, typhus was a devastating disease for humans and has been responsible for a number of epidemics throughout history. During the second year of the Peloponnesian War (430 BC), the city-state of Athens in ancient Greece was hit by a devastating epidemic, known as the Plague of Athens, which killed, among others, Pericles and his two elder sons. The plague returned twice more, in 429 BC and in the winter of 427/6 BC. Epidemic typhus is one of the strongest candidates for the cause of this disease outbreak, supported by both medical and scholarly opinions. Epidemics occurred throughout Europe from the 16th to the 19th centuries, and occurred during the English Civil War, the Thirty Years' War and the Napoleonic Wars. During Napoleon's retreat from Moscow in 1812, more French soldiers died of typhus than were killed by the Russians. A major epidemic occurred in Ireland between 1816-19, and again in the late 1830s, and yet another major typhus epidemic occurred during the Great Irish Famine between 1846 and 1849.

In America, a typhus epidemic killed the son of Franklin Pierce in Concord, New Hampshire in 1843 and struck in Philadelphia in 1837. Several epidemics occurred in Baltimore, Memphis and Washington DC between 1865 and 1873. During World War I typhus caused three million deaths in Russia and more in Poland and Romania. De-lousing stations were established for troops on the Western front but the disease ravaged the armies of the Eastern front, with over 150,000 dying in Serbia alone. Fatalities were generally between 10 to 40 percent of those infected, and the disease was a major cause of death for those nursing the sick. Following the development of a vaccine during World War II epidemics occur only in Eastern Europe, the Middle East and parts of Africa.

THE HIV/AIDS PANDEMIC IN INDIA IS REAL

Today, India is facing 4 deadly pandemics. (i) Tuberculosis (TB) and especially multi-drug resistant variants (roughly 2 million Indians had active TB in 1998). (ii) Sexually Transmitted Diseases (STD) like syphilis and gonorrhea (70-100 million new occurrences per year). (iii) Hepatitis B and Hepatitis C (The long term effect of hepatitis infections is to cause cirrhosis of the liver. Hepatitis C has no vaccine or cure and is fatal in the long run, about 30 years). And (iv) HIV leading to AIDS, is the unforgiving killer. Conservative estimates are 5 million HIV infections by end 1998, and doubling every 2-3 years. Most people suspect that the numbers of HIV infections may already be much higher, closer to 20 million. Worse still, the rate of new infections is very large and also growing rapidly.

Each of these diseases are by themselves affecting millions of Indians and spreading very fast. Their combination is particularly disastrous as they each reinforce the spread of all others. For example, in someone co-infected with TB, the HIV infection is likely to proceed more rapidly to AIDS; and of those with HIV, 63% in India have died of TB. Similarly, a person with history of STD is far more vulnerable to HIV infection per sexual encounter due to lesions, sores, ulcers. Hepatitis is also spread through sex and blood, and is devastating on its own. Since the Hepatitis virus is far more virulent and able to survive outside bodily fluids than HIV, precautions by medical workers (using properly sterilized instruments) have to be very strict.

Even using the conservative estimate of infections, 5 million by end 1998, and doubling every 3 years, there will be 100 million Indians infected by year 2010 if not sooner. This is one in every ten. Thus, on average, one in every nuclear family of brothers and sisters and their children will be HIV positive. I don't anticipate anyone wants to witness such a situation. Unfortunately, the only way to avoid it requires that we act decisively and start in a very big way TODAY.

The two leading causes for the explosive spread are risky sex and contaminated blood supply and surgical instruments. It is in our hands to stop the spread provided we can change habits leading to these behaviors. During my recent visit to India (March 1 - 8, 1999) lecturing on AIDS awareness in Ludhiana and Delhi, I was heartened to find that the people are receptive to the message. The problem is in reaching one billion people and in MAINTAINING A CONTINUOUS REINFORCEMENT OF THE MESSAGE for years as is needed to change lifestyles. The current reality is that in spite of the efforts by the government (through NACO -- National Aids Control Organization) we are barely making a dent in curbing the spread.

At this point there is no cure and no vaccine for HIV. In India, even though people like to deny it, risky sexual behavior exists at all socio-economic levels. There is increasing evidence of a sexual revolution amongst school and college kids, similar to what happened in the US in the sixties.

And last but not least . . . The Coronavirus (COVID-19) pandemic of 2020

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Web sites for more information on above pandemics:

http://www.neatorama.com/2009/04/27/5-deadliest-pandemics-in-history/

http://www.oddee.com/item_90608.aspx

http://www.pandemicflu.gov/