The evolution of public health in British India and the history of disease prevention in that part of world in the 19th and early 20th century provide a valuable insight into the period that witnessed the development of new trends in medical systems and a transition from surveys to microscopic studies in medicine. Although Indian subcontinent might have witnessed widespread illnesses and virus outbreaks in different times of the history, including the SARS outbreak between 2002-2004, statistics show that since the 1990s, they were nowhere as widespread as the COVID-19 that has now reached almost every part of the country and almost every country in the world. It harbors the earliest laboratory works and groundbreaking achievements in microbiology and immunology. The advent of infectious diseases and tropical medicine was a direct consequence of colonialism. The history of diseases and their prevention in the colonial context traces back the epidemiology of infectious diseases, many of which are still prevalent in third world countries. It reveals the development of surveillance systems and the response to epidemics by the imperial government. It depicts how the establishment of health systems under the colonial power shaped disease control in British India to improve the health of its citizens.
WHO defines epidemics as “the occurrence in a community or region of cases of an illness, specific health related behavior, or other health-related events clearly in excess of normal expectancy. The community or region and the period in which the cases occur are specified precisely. There is a long list of epidemic episodes in last hundred and twenty years of history of the Indian subcontinent.
Encephalitis lethargica, also known as ‘lethargic encephalitis’ was a type of epidemic encephalitis that spread around the world between 1915 and 1926. The disease was characterized by increasing languor, apathy, drowsiness and lethargy and by 1919, had spread across Europe, the US, Canada, Central America and India.
Before most of the world had recovered from the spread of Encephalitis lethargica, there was a new virus to contend with, the Spanish flu in 1918. This epidemic was a viral infectious disease caused due to a deadly strain of avian influenza. The spread of this virus was largely due to World War I that despite drawing to a close by the time the epidemic had peaked, has caused mass mobilization of troops in various parts of the world, whose travels helped spread this infectious disease.
Vibrio cholera, one type of bacterium, has caused seven cholera pandemics since 1817. In 1961, the El Tor strain of the Vibrio cholera bacterium caused the seventh cholera pandemic. In a span of less than five years, the virus spread to other parts of Southeast Asia and South Asia.
This flu pandemic was caused by the H3N2 strain of the influenza A virus and appears to have emerged in Hong Kong in July 1968. It did not take much time for the virus to spread around the world. Soon after the discovery of the presence of the virus in Hong Kong, by the end of July 1968, the outbreak spread to Vietnam and Singapore.
Over a four year period (1972-75), an estimated 225,000 smallpox cases and 40,000 smallpox deaths occurred in Bangladesh. With an infrastructure destroyed by Great War of Liberation in 1971, major floods and severe famine in 1974 Bangladesh was initially incapable of controlling its smallpox epidemic, later on by the unparalleled leadership of Bangabandhu, this crisis was solved. Besides Bangladesh, in 1974 smallpox epidemic of India was one of the worst smallpox epidemics of the 20th century. Over 15,000 people contracted and died from smallpox between January and May 1974. Most of the deaths occurred in the Indian states of Bihar, Orissa and West Bengal.
Plague in Surat
In September 1994, pneumonic plague hit Surat, causing people to flee the city in large numbers. Rumours and misinformation led to people hoarding essential supplies and widespread panic. This mass migration contributed to the spread of the disease to other parts of the country. Within weeks, reports emerged of at least 1,000 cases of patients afflicted with the disease and 50 deaths.
In April 2003, India recorded its first case of SARS, severe acute respiratory syndrome that was traced to Foshan, China. Similar to COVID-19, the causative agent of SARS was a type of coronavirus, named SARS CoVthat was known for its frequent mutations and spread through close person-to-person contact and through coughing and sneezing by infected people.
Dengue and chikungunya outbreak
Dengue fever is an acute febrile viral disease transmitted by the bite of Aedes mosquitoes carrying any one of the four dengue viral serotypes. Approximately half of the world’s population is at risk, especially people residing in tropical and subtropical climates such as in Bangladesh. The first official outbreak of dengue fever in Bangladesh was in 2000, and since then the number of hospitalized patients has exceeded 3000 patients six times, 6232 in 2002, 3934 in 2004, 3162 in 2015, 6060 in 2016, 10 148 in 2018, and 100 107 in 2019.
The upsurge in dengue cases and the recent outbreak of chikungunya and zika introduce major threats to the health of the community people. During the dengue outbreaks from 2000–2017, both types of the vectors (Aedes aegypti and Aedes albopictus) were identified in Bangladesh. Chikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries like Bangladesh. Several states in India reported simultaneous outbreaks of dengue and chikungunya virus in 2006 that affected people in several states across the country, including the Andaman and Nicobar Islands. Both are mosquito-borne tropical diseases and stagnation of water provides breeding ground for these mosquitoes that impact local communities.
Gujarat, India hepatitis outbreak
In February 2009, reports emerged that approximately 125 people in Modasa, Gujarat, were infected with hepatitis B, an infectious disease caused by the hepatitis B virus that affects the liver. The disease is caused due to transmission of infected blood and other body fluids and local doctors were suspected of having administered treatments on patients with used and contaminated syringes.
Odisha, India jaundice outbreak
Several towns in Odisha witnessed an outbreak of jaundice in September 2014, with the first few cases having been reported from the town of Sambalpur. Within three months, at least six people had died and more than 670 cases of jaundice had been reported in the town.
Swine flu outbreak
In the last few months of 2014, reports emerged of the outbreak of the H1N1 virus, one type of influenza virus, with states like Gujarat, Rajasthan, Delhi, Maharashtra and Telangana being the worst affected. By March 2015, according to India’s Health Ministry, approximately 33,000 cases had been reported across the country and 2,000 people had died.
Although the city of Gorakhpur in Uttar Pradesh, India had a history of being affected by encephalitis, in 2017, it witnessed an increase in numbers where several children died of encephalitis, specifically Japanese encephalitis (JE) and acute encephalitis syndrome (AES), caused primarily due to mosquito bites. Both are viral infections that cause inflammation of the brain leaving long-term physical disabilities and even resulting in death.
Between 2001 and 2014, 33 outbreaks of Nipah virus encephalitis were reported in Bangladesh and India. During 2004–12, 157 Nipah virus infections were reported in Bangladesh. Nipah virus is usually transmitted by bats, but it can also be spread from one infected person to another. In Bangladesh, Nipah virus is usually acquired through consumption of date palm sap contaminated with bat saliva or urine. The spread of the outbreak remained largely within the state of Kerala, due to efforts by the local government and various community leaders who worked in collaboration to prevent its spread even inside the state. Between May and June 2018, at least 17 people died of Nipah virus and by June, the outbreak was declared to have been completely contained.