When there was outbreak of SARS, Ebola, H1N1 influenza, HIV and other certain diseases in the past such as Cholera, Plague (Black death), everyone all around the world were concerned about those diseases.  They spread over many countries in a short span of time, claiming many lives, causing anxiety, panics, terrors and sufferings. Whereas, there are other diseases, which are contained within certain geographic spaces. 

The recall of HIV/AIDS Pandemic as a child in rural Nepal

The first pandemic I became aware of was HIV/AIDS. After its spread from one country after another country, it also invaded the border of Nepal along with identification of the first case of HIV in 1988. HIV contracted one after another since then fueled by stigma, scarce knowledge about disease pathology, lack of management facilities. I have vivid image of my childhood where HIV was so stigmatized and people's perception about its mode of transmission: the illicit sexual act. When I was in middle school, it became more apparent due to its coverage in news and media, educational forums, debates. As I saw the epidemic rise of HIV/AIDS during my childhood, this childhood memory of HIV/AIDS as fear producing factor always relates to subsequent pandemics. 

Conditions favoring Pandemics

  1. New antigens or infectious diseases: as people are not immune to new antigens or infectious diseases, there is possibility. Sometimes, the diseases are under researched or so new that we become unaware of its route of transmission. As in case of HIV/AIDS, at first it was thought it was transmitted among gay men only. It took several years to identify the modes of disease transmission.
  2. Antigenic shift
  3. Globalization: global diffusion of SARS traces back to the visit of a case (from Guangdong China) of SARS in Hong Kong in 2003 thereby spreading SARS to other people staying in the same hotel. Then the infectious agents of SARS travelled to different countries along with those people.
  4. Bioterrorism: Use of biological agents as a means of war can bring pandemics.

Disease outbreak Vs Epidemic Vs Pandemic

Disease outbreak occurs when the disease occurs in many people at a time more than expected at that point of time or more than usual occurrence. However, sometimes there shouldn’t necessarily be occurrence in large number of people, a single disease case is still considered outbreak. For example, one case of yellow fever in Nepal is considered outbreak/epidemic as there is no occurrence of yellow fever in the past. Public health professionals and the disease surveillance system should be effective enough to identify such outbreaks to tackle its spread and management in time. Outbreak is usually used to refer to a small geographical region.

Epidemic: If the disease outbreak is concentrated in a certain geography or within certain communities and if there is no possibility of spread in other regions or countries, then it is called disease epidemic.

Pandemic: When the disease spreads over several countries, continents or all around the world, usually affecting large number of people, this is termed as Pandemics. 


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