Super-Spreading in Infectious Diseases


Richard A. Stein
Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, USA

Series: Microbiology Research Advances
BISAC: MED022090

As one of the biological factors that most powerfully impacted history, infectious diseases continue to be a leading cause of global morbidity and mortality. At least two major factors are making infectious diseases assume more important roles than ever before. One of these is the increasing ability of certain microorganisms, normally limited to other species, to cross or jump across the species barrier and become human pathogens. The second factor — our increasing and unprecedented global mobility which has made traveling between any two remote locations on the planet possible in less than 24 hours.

As a result, a local outbreak anywhere in the world becomes a global concern. A significant challenge that is shared by most (if not all) infectious diseases is our insufficient understanding of the dynamic host-pathogen interaction. In particular, one of the gaps in visualizing our interaction with microorganisms stems from the fact that historically, pathogen transmission in populations was assumed to be homogeneous, with infected individuals having approximately equal opportunities to infect secondary contacts. However, in what became known as “the 20/80 rule”, an increasing number of studies and observations point towards a small number of individuals (20%) that are responsible for most (80%) transmission events in a population. This minority of individuals who infect a disproportionately large number of secondary contacts has become known as “super-spreaders”. The phenomenon of super-spreading lies at the core of understanding the biology of microorganisms and their ability to cause outbreaks, and is instrumental for developing and implementing preventive and therapeutic strategies. This book proposes to examine super-spreading in infectious diseases. Super-spreading dates back as far as Typhoid Mary, the first documented example, and it was documented for most microorganisms, including Mycobacterium tuberculosis, Plasmodium and Schistosoma species, HIV, hepatitis C, influenza virus, Ebola virus, rhinoviruses, Escherichia coli, West Nile virus, and the SARS coronavirus. A thought-provoking find from the SARS pandemic was that in the absence of super-spreading events, most infected individuals caused very few (if any) secondary contacts, but a low number of super-spreaders fueled the global outbreak. Super-spreading was described in human, animal, and plant hosts, and it exists at the level of the individual as well as at that of the species. One of the common denominators of super-spreading events is that they are virtually always identified only retroactively, as part of epidemiologic investigations. There is, however, a great interest and an acute need in being able to prospectively predict super-spreading, as this would considerably improve the opportunities to prevent, control, and limit outbreaks. A fundamentally important and far-reaching topic in infectious diseases, the study of super-spreading holds key implications for managing epidemics and pandemics, and promises to fill an important gap in microbiology, medicine, public health, agriculture, animal sciences, and biodefense.
(Imprint: Nova Biomedical)

Table of Contents

Table of Contents


Chapter 1. Typhoid Mary and “Mr. N. the Milker”

Chapter 2. The Basic Reproduction Number

Chapter 3. Super-spreading during the 2002-2003 SARS Pandemic

Chapter 4. Super-spreading in Other Infectious Diseases

Chapter 5. The Cloud Baby, the Cloud Adult, and the Cloud Healthcare Worker

Chapter 6. Super-Spreading in Vector-Borne Diseases

Chapter 7. Super-Spreading in Other Species

Chapter 8. Before Super-Spreading: Zoonoses and the Species Barrier



“A delightful and compelling read. Dr. Stein took a relatively complicated topic and made it simple for me as the non infectious disease specialist. I have recommended it to my students and would encourage its use in any medical school curriculum.” – <strong>Matt T. Rosenberg, M.D., Director of the Mid-Michigan Health Centers, Associate Editor of <i>Urology, International Journal of Clinical Practice </i>MedScape Urology Editorial Board Member</strong>

“Super-spreading is as relevant today as it is concerning. Our task is to understand the epidemiology of infectious diseases; specifically, how they are able to move though a population. What Stein has achieved in this detailed, eloquent, and fascinating work, is nothing less than brilliant. He presents easy-to-read, multi-dimensional stories of modern history told through the lens of various infectious diseases. Thoroughly enjoyable on many levels. You will walk away more informed and thoughtful of mankind’s existence and our humble place in the biosphere.” – <strong>David E. Katz, M.D., M.P.H, FACP, Former Epidemic Intelligence Service Officer, CDC</strong>

This book has also been reviewed by the following people:

<b>Stephen A. Berger, M.D.,</b> Associate Professor of Medicine, University of Tel Aviv Medical Center, Former Director of Geographic Medicine and Clinical Microbiology, Co-Founder of GIDEON (Global Infectious Diseases and Epidemiology Network). To read the review, <a href=”” target=”_blank” rel=”noopener”>click here.</a> – <strong></strong>

<b>Professor Adrian Streinu-Cercel, M.D., Ph.D.,</b>Carol Davila University of Medicine and Pharmacy, National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest, Romania. To read the review, <a href=”” target=”_blank” rel=”noopener”>click here.</a> – <strong></strong>

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