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Humans have been battling viruses since before our species had even evolved into its modern form. For some viral diseases, vaccines and antiviral drugs have allowed us to keep infections from spreading widely, and have helped sick people recover. For one disease — smallpox — we've been able to eradicate it, ridding the world of new cases.
But as the Ebola outbreak now devastating West Africa demonstrates, we're a long way from winning the fight against viruses.
The strain that is driving the current epidemic, Ebola Zaire, kills up to 90 percent of the people it infects, making it the most lethal member of the Ebola family. "It couldn't be worse," said Elke Muhlberger, an Ebola virus expert and associate professor of microbiology at Boston University.
Marburg virus
This colorized image shows a number of Marburg
virus virions, as seen through a transmission electron microscope. Ebola
viruses and Marburg virus both belong to the same family of viruses,
called the filovirus family.
Credit: Frederick Murphy
Credit: Frederick Murphy
The mortality rate in the first outbreak was 25 percent, but it was more than 80 percent in the 1998-2000 outbreak in the Democratic Republic of Congo, as well as in the 2005 outbreak in Angola, according to the World Health Organization (WHO).
Ebola virus
A scanning electron micrograph of the Ebola virus.
Credit: Cynthia Goldsmith | CDC
Credit: Cynthia Goldsmith | CDC
One strain, Ebola Reston, doesn't even make people sick. But for the Bundibugyo strain, the fatality rate is up to 50 percent, and it is up to 71 percent percent for the Sudan strain, according to WHO.
The outbreak underway in West Africa began in early 2014, and is the largest and most complex outbreak of the disease to date, according to WHO.
Rabies
This image of the rabies virus, taken through an
electron microscope, shows particles of the virus itself, as well as the
round structures called Negri bodies, which contain viral proteins.
Credit: CDC/ Dr. Fred Murphy
Credit: CDC/ Dr. Fred Murphy
"It destroys the brain, it's a really, really bad disease," Muhlberger said. "We have a vaccine against rabies, and we have antibodies that work against rabies, so if someone gets bitten by a rabid animal we can treat this person," she said.
However, she said, "if you don't get treatment, there's a 100 percent possibility you will die."
HIV
The human immunodeficiency virus (HIV, in green), infecting a cell. Image taken with an electron scanning microscope.
Credit: Cynthia Goldsmith, Centers for Disease Control and Prevention
Credit: Cynthia Goldsmith, Centers for Disease Control and Prevention
An estimated 36 million people have died from HIV since the disease was first recognized in the early 1980s. "The infectious disease that takes the biggest toll on mankind right now is HIV," Adalja said.
Powerful antiviral drugs have made it possible for people to live for years with HIV. But the disease continues to devastate many low- and middle-income countries, where 95 percent of new HIV infections occur. Nearly 1 in every 20 adults in Sub-Saharan Africa is HIV-positive, according to WHO.
Smallpox
A single smallpox virus, magnified at 310,000X.
Smallpox is a highly contagious and sometimes fatal disease. There is
no specific treatment for people with smallpox, and the only prevention
is vaccination.
Credit: CDC/ J. Nakano
Credit: CDC/ J. Nakano
Mortality rates were far higher in populations outside of Europe, where people had little contact with the virus before visitors brought it to their regions. For example, historians estimate 90 percent of the native population of the Americas died from smallpox introduced by European explorers. In the 20th century alone, smallpox killed 300 million people.
"It was something that had a huge burden on the planet, not just death but also blindness, and that's what spurred the campaign to eradicate from the Earth," Adalja said.
Hantavirus
This image shows the hantavirus known as the Sin
Nombre virus (SNV), under a transmission electron microscope. This virus
caused an outbreak in November 1993, in the Four Corners region of the
U.S.
Credit: Cynthia Goldsmith. Provided by CDC/ Brian W.J. Mahy, PhD; Luanne H. Elliott, M.S.
Credit: Cynthia Goldsmith. Provided by CDC/ Brian W.J. Mahy, PhD; Luanne H. Elliott, M.S.
The virus is not transmitted from one person to another, rather, people contract the disease from exposure to the droppings of infected mice.
Previously, a different hantavirus caused an outbreak in the early 1950s, during the Korean War, according to a 2010 paper in the journal Clinical Microbiology Reviews. More than 3,000 troops became infected, and about 12 percent of them died.
While the virus was new to Western medicine when it was discovered in the U.S., researchers realized later that Navajo medical traditions describe a similar illness, and linked the disease to mice.
Influenza
This digitally-colorized image shows the H1N1
influenza virus under a transmission electron microscope. In 2009, this
virus (then called the swine flu) caused a pandemic, and is thought to
have killed 200,00 people worldwide.
Credit: National Institute of Allergies and Infectious Diseases (NIAID)
Credit: National Institute of Allergies and Infectious Diseases (NIAID)
The most deadly flu pandemic, sometimes called the Spanish flu, began in 1918 and sickened up to 40 percent of the world's population, killing an estimated 50 million people.
"I think that it is possible that something like the 1918 flu outbreak could occur again," Muhlberger said. "If a new influenza strain found its way in the human population,and could be transmitted easily between humans, and caused severe illness, we would have a big problem."
Dengue
This image shows round, Dengue virus particles as
they look under a transmission electron microscope. Dengue viruses are
transmitted to humans by the bite of an infected mosquito.
Credit: Frederick Murphy. Provided by CDC/ Frederick Murphy, Cynthia Goldsmith
Credit: Frederick Murphy. Provided by CDC/ Frederick Murphy, Cynthia Goldsmith
Dengue sickens 50 to 100 million people a year, according to WHO. Although the mortality rate for dengue fever is lower than some other viruses, at 2.5 percent, the virus can cause an Ebola-like disease called dengue hemorrhagic fever, and that condition has a mortality rate of 20 percent if left untreated.
"We really need to think more about dengue virus because it is a real threat to us," Muhlberger said. There is no current vaccine against dengue, but large clinical trials of an experimental vaccine developed by French drug maker Sanofi have had promising results.
Rotavirus
Rotaviruses particles are shown here under a very high magnification of 455,882X.
Credit: CDC/ Dr. Erskine L. Palmer
Credit: CDC/ Dr. Erskine L. Palmer
Although children in the developed world rarely die from rotavirus infection, the disease is a killer in the developing world, where rehydration treatments are not widely available.
The WHO estimates that worldwide, 453,000 children younger than age 5 died from rotavirus infection in 2008. But countries that have introduced the vaccine have reported sharp declines in rotavirus hospitalizations and deaths.
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