Tournement of Pandemics - Cholera vs Yellow Fever - Part Two
Yellow fever (YF) is an arthropod-borne virus, spread by a mosquito vector. Most patients develop fever, aches, and nausea three to six days after they've been infected, and after a few more days they recover. About 15% develop the more severe, hemorrhagic form of the disease and, of that unlucky portion, about half die. A safe, effective vaccine for YF that gives long lasting immunity has been available since the 1930s, although gaps in consistent administration of that vaccine account for the continued burden of the disease. YF remains endemic in sub-Saharan Africa and in Central and South America, where the bulk of the unvaccinated population are also found.
Vaccination is doubly important since there is no effective cure for YF. All that can be done for patients, including those who reach that toxic phase, is to give supportive care and treat the symptoms.
The Match-Up
At first glance, these two are stacked pretty evenly, and neither jumps out with a stark advantage. What could happen to change the relatively static current situation, or what lurks behind the scenes that we haven't yet considered?
Historical patterns together with current events offer perhaps the best scenario for cholera to win: political unrest or some large catastrophe resulting in the widespread collapse sanitation and/or general public health and health care delivery systems. (Not very likely? I agree, but people in Iraq and Zimbabwe may not have predicted that chaos in their countries would let cholera bloom, either.)
With yellow fever, we have a virus that relies on certain species of mosquito for transmission. Seems fairly well limited geographically to the habitat of those bugs, until we start to contemplate how global warming or shifts in human settlement and agriculture might alter our contact with that habitat. The jury is still out as to whether these changes really constitute enough of an influence to set off a pandemic, but there is enough evidence that something is afoot for this scenario to win out over the doomsday collapse that cholera requires to win.
The bottom line: it's a long shot for taking the entire tournament by storm, but in today's match-up yellow fever plays a wily game and uses all the noise in the house to its advantage to bring cholera down.
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