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Example of an epidemic showing the number of new infections over time. 2014 West Africa Ebola Epidemic - New Cases per Week.svg
Example of an epidemic showing the number of new infections over time.

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. [1] [2]


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. [3]

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. [1] :§1:72 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. [2] 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.[ citation needed ]


The 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 Plague in an Ancient City LACMA AC1997.10.1 (1 of 2).jpg
The 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

The United States Centers for Disease Control and Prevention defines epidemic broadly: "Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area." The term "outbreak" can also apply, but is usually restricted to smaller events. [1] :§1:72 [2]

Any sudden increase in disease prevalence may generally be termed an epidemic. This may include contagious disease (i.e. easily spread between persons) such as influenza; vector-borne diseases such as malaria; water-borne diseases such as cholera; and sexually transmitted diseases such as HIV/AIDS. The term can also be used for non-communicable health issues such as obesity. [2] [4] [5]

The term epidemic derives from a word form attributed to Homer's Odyssey , which later took its medical meaning from the Epidemics, a treatise by Hippocrates. [5] Before Hippocrates, epidemios, epidemeo, epidamos, and other variants had meanings similar to the current definitions of "indigenous" or "endemic". [5] Thucydides' description of the Plague of Athens is considered one of the earliest accounts of a disease epidemic. [5] By the early 17th century, the terms endemic and epidemic referred to contrasting conditions of population-level disease, with the endemic condition a "common sicknesse" and the epidemic "hapning in some region, or countrey, at a certaine time, ....... producing in all sorts of people, one and the same kind of sicknesse". [6]

The term "epidemic" is often applied to diseases in non-human animals, although "epizootic" is technically preferable. [7] [8]


There are several factors that may contribute (individually or in combination) to causing an epidemic. There may be changes in a pathogen, in the population that it can infect, in the environment, or in the interaction between all three. Factors include the following: [9] :§1:72

Antigenic Change

Illustration depicting the different mechanisms of antigenic shift and antigenic drift Differences-Between-Antigenic-Shift-and-Antigenic-Drift.webp
Illustration depicting the different mechanisms of antigenic shift and antigenic drift

An antigen is a protein on the virus' surface that host antibodies can recognize and attack. Changes in the antigenic characteristics of the agent make it easier for the changed virus to spread throughout a previously immune population. There are two natural mechanisms for change - antigenic drift and antigenic shift. Antigenic drift arises over a period of time as an accumulation of mutations in the virus genes, possibly through a series of hosts, and eventually gives rise to a new strain of virus which can evade existing immunity. Antigenic shift is abrupt - in this, two or more different strains of a virus, coinfecting a single host, combine to form a new subtype having a mixture of characteristics of the original strains. The best known and best documented example of both processes is influenza. [10] SARS-CoV2 has demonstrated antigenic drift and possibly shift as well. [11]

Drug resistance

Antibiotic resistance applies specifically to bacteria that become resistant to antibiotics. [12] Resistance in bacteria can arise naturally by genetic mutation, or by one species acquiring resistance from another through horizontal gene transfer. [13] Extended use of antibiotics appears to encourage selection for mutations which can render antibiotics ineffective. This is especially true of tuberculosis, with increasing occurrence of multiple drug-resistant tuberculosis (MDR-TB) worldwide. [14] [15]

Changes in transmission

Anopheles mosquito, the vector of malaria Anopheles gambiae mosquito feeding 1354.p lores.jpg
Anopheles mosquito, the vector of malaria

Pathogen transmission is a term used to describe the mechanisms by which a disease-causing agent (virus, bacterium, or parasite) spreads from one host to another. Common modes of transmission include: [16] -

The first three of these require that pathogen must survive away from its host for a period of time; an evolutionary change which increases survival time will result in increased virulence. [17]

Another possibility, although rare, is that a pathogen may adapt to take advantage of a new mode of transmission [18] [19]


Seasonal diseases arise due to the change in the environmental conditions, especially such as humidity and temperature, during different seasons. Many diseases display seasonality, [20] [21] This may be due to one or more of the following underlying factors: - [22]

Human behaviour

A Court for King Cholera. Illustration from Punch (1852). Punch-A Court for King Cholera.png
A Court for King Cholera. Illustration from Punch (1852).

Changes in behaviour can affect the likelihood or severity of epidemics. The classic example is the 1854 Broad Street cholera outbreak, in which a cholera outbreak was mitigated by removing a supply of contaminated water - an event now regarded as the foundation of the science of epidemiology. [30] Urbanisation and overcrowding (e.g. in refugee camps) increase the likelihood of disease outbreaks. [31] [32] A factor which contributed to the initial rapid increase in the 2014 Ebola virus epidemic was ritual bathing of (infective) corpses; one of the control measures was an education campaign to change behaviour around funeral rites. [33]

Changes in the host population

The level of immunity to a disease in a population - herd immunity - is at its peak after a disease outbreak or a vaccination campaign. In the following years, immunity will decline, both within individuals and in the population as a whole as older individuals die and new individuals are born. Eventually, unless there is another vaccination campaign, an outbreak or epidemic will recur. [34]

It's also possible for disease which is endemic in one population to become epidemic if it is introduced into a novel setting where the host population is not immune. An example of this was the introduction European diseases such as smallpox into indigenous populations during the 16th century. [35]


Possibilities for zoonotic disease transmissions Figure 3- Examples of Zoonotic Diseases and Their Affected Populations (6323431516).jpg
Possibilities for zoonotic disease transmissions

A zoonosis is an infectious disease of humans caused by a pathogen that can jump from a non-human host to a human. [36] Major diseases such as Ebola virus disease and salmonellosis are zoonoses. HIV was a zoonotic disease transmitted to humans in the early part of the 20th century, though it has now evolved into a separate human-only disease. [37] Some strains of bird flu and swine flu are zoonoses; these viruses occasionally recombine with human strains of the flu and can cause pandemics such as the 1918 Spanish flu or the 2009 swine flu. [38]


Common source outbreak

In a common source outbreak epidemic, the affected individuals had an exposure to a common agent. If the exposure is singular and all of the affected individuals develop the disease over a single exposure and incubation course, it can be termed as a point source outbreak. If the exposure was continuous or variable, it can be termed as a continuous outbreak or intermittent outbreak, respectively. [1] :56

Propagated outbreak

In a propagated outbreak, the disease spreads person-to-person. Affected individuals may become independent reservoirs leading to further exposures. [1] :56Many epidemics will have characteristics of both common source and propagated outbreaks (sometimes referred to as mixed outbreak).[ citation needed ]

For example, secondary person-to-person spread may occur after a common source exposure or an environmental vector may spread a zoonotic diseases agent. [1] :56–58


Preparations for an epidemic include having a disease surveillance system; the ability to quickly dispatch emergency workers, especially local-based emergency workers; and a legitimate way to guarantee the safety and health of health workers. [39] [40]

Effective preparations for a response to a pandemic are multi-layered. The first layer is a disease surveillance system. Tanzania, for example, runs a national lab that runs testing for 200 health sites and tracks the spread of infectious diseases. The next layer is the actual response to an emergency. According to U.S.-based columnist Michael Gerson in 2015, only the U.S. military and NATO have the global capability to respond to such an emergency. [39] Still, despite the most extensive preparatory measures, a fast-spreading pandemic may easily exceed and overwhelm existing health-care resources. [41] Consequently, early and aggressive mitigation efforts, aimed at the so-called "epidemic curve flattening" need to be taken. [41] Such measures usually consist on non-pharmacological interventions such as social/physical distancing, aggressive contact tracing, "stay-at-home" orders, as well as appropriate personal protective equipment (i.e., masks, gloves, and other physical barriers to spread). [41]

See also

Related Research Articles

<span class="mw-page-title-main">Pandemic</span> Widespread, often global, epidemic of severe infectious disease

A pandemic is an epidemic of an infectious disease that has spread 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.

<span class="mw-page-title-main">Zoonosis</span> Disease that can be transmitted from other species to humans

A zoonosis or zoonotic disease is an infectious disease of humans caused by a pathogen that can jump from a non-human to a human and vice versa.

<span class="mw-page-title-main">Infection</span> Invasion of an organisms body by pathogenic agents

An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable disease, is an illness resulting from an infection.

<span class="mw-page-title-main">Spanish flu</span> 1918–1920 global influenza pandemic caused by the H1N1 influenza A virus

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 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.

<i>Influenza A virus</i> Species of virus

Influenza A virus (IAV) is a pathogen that causes the flu in birds and some mammals, including humans. It is an RNA virus whose subtypes have been isolated from wild birds. Occasionally, it is transmitted from wild to domestic birds, and this may cause severe disease, outbreaks, or human influenza pandemics.

<span class="mw-page-title-main">Avian influenza</span> Influenza caused by viruses adapted to birds

Avian influenza, also known as avian flu, is a bird flu caused by the influenza A virus, which can infect people. It is similar to other types of animal flu in that it is caused by a virus strain that has adapted to a specific host. The type with the greatest risk is highly pathogenic avian influenza (HPAI).

<i>Orthomyxoviridae</i> Family of RNA viruses including the influenza viruses

Orthomyxoviridae is a family of negative-sense RNA viruses. It includes seven genera: Alphainfluenzavirus, Betainfluenzavirus, Gammainfluenzavirus, Deltainfluenzavirus, Isavirus, Thogotovirus, and Quaranjavirus. The first four genera contain viruses that cause influenza in birds and mammals, including humans. Isaviruses infect salmon; the thogotoviruses are arboviruses, infecting vertebrates and invertebrates. The Quaranjaviruses are also arboviruses, infecting vertebrates (birds) and invertebrates (arthropods).

The Hong Kong flu, also known as the 1968 flu pandemic, was a flu pandemic that occurred in 1968 and 1969 and which killed between one and four million people globally. It is among the deadliest pandemics in history, and was caused by an H3N2 strain of the influenza A virus. The virus was descended from H2N2 through antigenic shift, a genetic process in which genes from multiple subtypes are reassorted to form a new virus.

<span class="mw-page-title-main">Natural reservoir</span> Type of population in infectious disease ecology

In infectious disease ecology and epidemiology, a natural reservoir, also known as a disease reservoir or a reservoir of infection, is the population of organisms or the specific environment in which an infectious pathogen naturally lives and reproduces, or upon which the pathogen primarily depends for its survival. A reservoir is usually a living host of a certain species, such as an animal or a plant, inside of which a pathogen survives, often without causing disease for the reservoir itself. By some definitions a reservoir may also be an environment external to an organism, such as a volume of contaminated air or water.

<span class="mw-page-title-main">Swine influenza</span> Infection caused by influenza viruses endemic to pigs

Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.

<span class="mw-page-title-main">Flu season</span> Recurring periods of influenza

Flu season is an annually recurring time period characterized by the prevalence of an outbreak of influenza (flu). The season occurs during the cold half of the year in each hemisphere. It takes approximately two days to show symptoms. Influenza activity can sometimes be predicted and even tracked geographically. While the beginning of major flu activity in each season varies by location, in any specific location these minor epidemics usually take about three weeks to reach its pinnacle, and another three weeks to significantly diminish.

<span class="mw-page-title-main">Influenza A virus subtype H1N1</span> Subtype of Influenza A virus

In virology, influenza A virus subtype H1N1 (A/H1N1) is a subtype of influenza A virus. Major outbreaks of H1N1 strains in humans include the 1918 Spanish flu pandemic, the 1977 Russian flu pandemic and the 2009 swine flu pandemic. It is an orthomyxovirus that contains the glycoproteins hemagglutinin (H) and neuraminidase (N), antigens whose subtypes are used to classify the strains of the virus as H1N1, H1N2 etc. Hemagglutinin causes red blood cells to clump together and binds the virus to the infected cell. Neuraminidase is a type of glycoside hydrolase enzyme which helps to move the virus particles through the infected cell and assist in budding from the host cells.

<span class="mw-page-title-main">Influenza pandemic</span> Pandemic involving influenza

An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.

<i>Influenza B virus</i> Species of virus

Influenza B virus is the only species in the genus Betainfluenzavirus in the virus family Orthomyxoviridae.

<i>Influenza C virus</i> Genus of viruses in the family Orthomyxoviridae

Influenza C virus is the only species in the genus Gammainfluenzavirus, in the virus family Orthomyxoviridae, which like other influenza viruses, causes influenza.

<span class="mw-page-title-main">Emerging infectious disease</span> Infectious disease of emerging pathogen, often novel in its outbreak range or transmission mode

An emerging infectious disease (EID) is an infectious disease whose incidence has increased recently, and could increase in the near future. The minority that are capable of developing efficient transmission between humans can become major public and global concerns as potential causes of epidemics or pandemics. Their many impacts can be economic and societal, as well as clinical. EIDs have been increasing steadily since at least 1940.

An emergent virus is a virus that is either newly appeared, notably increasing in incidence/geographic range or has the potential to increase in the near future. Emergent viruses are a leading cause of emerging infectious diseases and raise public health challenges globally, given their potential to cause outbreaks of disease which can lead to epidemics and pandemics. As well as causing disease, emergent viruses can also have severe economic implications. Recent examples include the SARS-related coronaviruses, which have caused the 2002-2004 outbreak of SARS (SARS-CoV-1) and the 2019–21 pandemic of COVID-19 (SARS-CoV-2). Other examples include the human immunodeficiency virus which causes HIV/AIDS; the viruses responsible for Ebola; the H5N1 influenza virus responsible for avian flu; and H1N1/09, which caused the 2009 swine flu pandemic. Viral emergence in humans is often a consequence of zoonosis, which involves a cross-species jump of a viral disease into humans from other animals. As zoonotic viruses exist in animal reservoirs, they are much more difficult to eradicate and can therefore establish persistent infections in human populations.

<span class="mw-page-title-main">Influenza</span> Infectious disease

Influenza, commonly known as "the flu" or just "flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms begin from one to four days after exposure to the virus and last for about 2–8 days. Diarrhea and vomiting can occur, particularly in children. Influenza may progress to pneumonia, which can be caused by the virus or by a subsequent bacterial infection. Other complications of infection include acute respiratory distress syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such as asthma and cardiovascular disease.

Influenza prevention involves taking steps that one can use to decrease their chances of contracting flu viruses, such as the Pandemic H1N1/09 virus, responsible for the 2009 flu pandemic.

<span class="mw-page-title-main">Endemic COVID-19</span> Theoretical future stage of COVID-19

COVID-19 is predicted to become an endemic disease by many experts. The observed behavior of SARS-CoV-2, the virus that causes COVID-19, suggests it is unlikely it will die out, and the lack of a COVID-19 vaccine that provides long-lasting immunity against infection means it cannot immediately be eradicated; thus, a future transition to an endemic phase appears probable. In an endemic phase, people would continue to become infected and ill, but in relatively stable numbers. Such a transition may take years or decades. Precisely what would constitute an endemic phase is contested.


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Further reading