Thread by @EdithMirante

1. This History Thread is about epidemics & pandemics + significant disease outbreaks in Burma (Myanmar.) Historical epidemiology incl. plague, smallpox, cholera, HIV/AIDS, influenza. Malaria not included as more endemic (locally present) than epidemic (& rates its own thread.)

2. Thado Minbya young King/Founder of Ava died in smallpox epidemic circa 1367. Arakan used variola smallpox inoculation, captives of 1785 Burmese invasion brought practice to Burma. British colonial smallpox vaccination campaigns limited until 1920s. Certified eradicated 1977.

3. Plague bacillus (endemic Burma) in fleas carried by rodents. 3rd Plague Pandemic (12 million dead) spread from neighboring Yunnan 1855 thru China, beyond by ship. 1906 alone 8,637 reported plague deaths Burma.
@Jonathan_Saha on British Colonial photos: colonizinganimals.blog/2013/03/20/pla…

4. Burma's 1947 plague outbreak (1,192 dead) considered last w/o antibiotic treatment. Sporadic outbreaks continue. WHO 2000: “Myanmar & Viet Nam have reported cases of human plague virtually every year since 1954.” 2010: plague cases treated in Yangon, infected rats at Naypyidaw

5. 1st Cholera pandemic of 1817-23 swept through Burma in 1819. 2nd Pandemic 1842-3 cholera took lives from China/Burma frontier to Tenasserim. 1853-54 it devastated Arakan civilians & struck British troops. 6th Pandemic hit Burma 1901. Lesser outbreaks throughout 20th Century.

6. Cholera still appears sporadically in & adjacent to Myanmar. Yangon 2014 outbreak. Thailand border w. Myanmar had several outbreaks 2005-2015. Mid-2016 cholera outbreak in Pegu Div. & Magwe Reg., central Myanmar. 782 cases reported nationwide for 2016. irrawaddy.com/news/burma/cho…

7. Tuberculosis of concern (affected “working adults”) to British colonial admin early 20th C Burma. Poor & crowded urban = high infection rate. Suppression attempts post WW2, limited success. Ongoing epidemic w. drug resistance: Burma/Thai border, Yangon. theguardian.com/global-develop…

8. “Spanish” influenza H1N1 1918-19 pandemic: Burma (then part of British India colonial admin.) lost “about 1% of population” est. 60,000 (overall India 10 to 20 million died, the highest mortality in the pandemic.) Distant from India entry point (returning WW1 soldiers) Bombay.

9. During WW2 in Burma infectious diseases (including dysentery, hepatitis) ravaged displaced civilians as well as soldiers on both sides. Severe outbreaks of scrub typhus (Tsutsugamushi Disease) which was endemic but military operations increased troops’ exposure.

10. Many setbacks for Burma/Myanmar eradicating poliomyelitis (polio.) War, migration, lack of infrastructure. 2007 Burma/Bangladesh border outbreak. Vaccine-derived poliovirus (VDPV) appeared in Mandalay 2011. VDPV outbreak in Karen (Kayin) St. in 2019. travelhealthpro.org.uk/news/446/myanm…

11. Myanmar HIV/AIDS infection rate one of Asia’s highest 1980s-90s, prevention info scarce, shared needles, condoms were illegal. Now info access better, ART availability good (70% adults with HIV.) Infection high (19% 2018) for people who inject drugs. avert.org/professionals/…

12. Some early 21 C. Emerging Infectious Diseases took hold in Myanmar, some didn’t. SARS (2002-03) & MERS (2015) bypassed Myanmar. H1N1 “swine flu” (2009-2010 pandemic) Influenza now seasonal/sporadic Myanmar, dozens of deaths in 2017, 36+ dead mid-2019. voanews.com/east-asia-paci…

13. Emerging Zoonotic (animal to human) Avian Influenzas (“bird flu”) affect Myanmar. H5N1 Avian Influenza appeared Myanmar 2006, sporadic outbreaks poultry & humans 2015, 2017 (10 people died.) H5N6 & H9N2 avian influenza found in Myanmar poultry by 2017. mmtimes.com/business/13459…

14. Global virus hunting project Predict discovered new SARS-related virus in Myanmar bat species 2018. Deforestation & wildlife trade may add risk of zoonotic crossover of new viruses. Note: bats are crucial pollinators, best practice is leave them alone. smithsonianmag.com/science-nature…

15. Predict’s fieldwork (it was a USAID + partners project) is now defunct, its funding cut off by US Government, current administration in 2019. nytimes.com/2019/10/25/hea…

16. Burma (Myanmar) vulnerabilities incl. decades of military spending utterly diminishing healthcare spending (<2% GDP), severe inequality, corruption, false “cures” & treatments, brain drain of doctors. But still so many dedicated professionals, often women, including in EAOs.

17. Myanmar public health programs improving but underfunded. Many people in Myanmar seek medical injections & IV drips when safer therapies as effective. Efforts for TB, Japanese encephalitis, measles vaccination but big gaps in vaccination for children. unicef.org/myanmar/health…

18. Rohingya health needs neglected incl. “basic childhood immunizations.” Bangladesh refugee camps for 2017 influx of Rohingyas had to give cholera vaccination to all new arrivals. There have been outbreaks of diphtheria and chickenpox in the vast camps. npr.org/sections/goats…

19. People of Myanmar’s mountain regions suffer gaps in immunization and lack other health care. 2016 measles outbreak killed 68 Naga people, mostly children in a remote part of Sagaing Region. Tuberculosis outbreak killed 14 people there in 2017. frontiermyanmar.net/en/in-naga-hil…

20. Burma/Myanmar under military rule history of suppressing outside medical input & health info. Pattern of restricted or bad information persists, incl. blaming other countries or foreigners for public health crises. "Zero COVID-19 cases" as of March 18. theguardian.com/world/2020/mar…

21. Some Burma epidemiology sources. Smallpox: Hopkins 2002, Naono 2009. Plague: Pollitzer 1951. Cholera: MacNamara 1876, Pollitzer 1959. TB: Chuengsatiansup + 2019. Colonialism: Ritchell 2006. “War Epidemics” Smallman-Raynor 2004. Johns Hopkins 2007 link:
jhsph.edu/research/cente…

22/22. Thanks to @himmoderator for expert input on this historical epidemiology thread! My previous History Threads and reports are linked at projectmaje.org This thread was brought to you by #SocialDistancingNow