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World Geography of poliomyelitis

World Geography of poliomyelitis

Closed swimming pools and cinemas; calipers; an iron lung; a withered limb; too often a premature death - the enduring images of poliomyelitis each summer for generations of parents in the first half of the twentieth century as the disease spread with increasing severity around the world. For parents, few infections scored higher than poliomyelitis on the 'dread' factor from the early years of the twentieth century as each successive wave of the disease outdid its predecessor in the number of children it crippled and killed.

Poliomyelitis has been associated with humans since they first lived in large communities in the riverine civilizations of the Middle East some 5,000 years ago. For centuries it remained a scarcely-noticed background disease. But, from the last two decades of the nineteenth century, it emerged as a global epidemic disease during the first half of the twentieth century. Then, from the mid-1950s, the availability of safe and effective vaccines and the articulation of worldwide mass vaccination programmes by the World Health Organization (WHO) and national agencies brought poliomyelitis to the brink of global eradication. Circulation of wild polioviruses has now been limited by vaccination to a handful of countries in South Asia and Africa which, together, reported 1,263 cases in 2004.

This project aims to reconstruct the historical geography of poliomyelitis to the present day in four parts: Part One, Epidemic Emergence, 1881-1920, looks at the transition from endemic to epidemic poliomyelitis in Europe and the United States. Part Two, Global Expansion, 1921-55, covers the pre-vaccination period of epidemic poliomyelitis at world, continental and island scales. Part Three, Global Retreat, 1955-88, focuses upon the control of poliomyelitis by mass vaccination campaigns. Part Four, Approaching Global Eradication, focuses upon the road to eradication, to which the 41st World Health Assembly committed in 1988. Today, poliomyelitis looks set to be the first disease since smallpox in 1979 to be eradicated by direct human intervention.

The evolution of poliomyelitis to global epidemiological significance from the 1920s marks it out as one of the world's major emergent infections of the twentieth century. What causes diseases to wax and wane in time and space is a theme of contemporary scientific interest as we seek to understand the appearance of new conditions such as Ebola fever, Legionnaires' disease and HIV, and this project will contribute to our comprehension of likely causes.

Principal publications:

  • 2005A 'The spatial structure of epidemic emergence: geographical aspects of poliomyelitis in the northeastern United States, July-October 1916' (with B. Trevelyan and M.R. Smallman-Raynor). Journal of the Royal Statistical Society A, 168, pp. 701-22.
  • 2005B 'The spatial dynamics of poliomyelitis in the U.S.A.: from epidemic emergence to vaccine-induced retreat, 1910-1971' (with B. Trevelyan and M.R. Smallman-Raynor). Annals of the Association of American Geographers, 95, pp. 269-93.
  • Poliomyelitis: a world geography from epidemic emergence to eradication, 1850-2005 (with M.R. Smallman-Raynor, C. Nettleton and B. Trevelyan). 800 pp. Oxford: Oxford University Press (to be published 2006).

Funding body

Wellcome Trust. 'Historical geography of emerging and re-emerging epidemics: GIS (Geographical Information Systems) programme', £217,329, 2000-08.

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