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Medical Provider The Antonine Plague (Medicine Paper Example)

The Antonine Plague is estimated to have wiped out about 30% of the total population of Romans. The disease that occurred during the time was measles caused by the measles virus. The paper investigates what could have been done to control the above condition and reduce the effects that were noted during that time. A literature review showing effects associated with the disease is presented. The paper hypothesis is that the use of immunological methods based on antigen-antibody specificity and passive immunization would have eliminated the effects of the above condition. It focuses on the development of live attenuated vaccines and the production of antibodies that are specific to the measles virus in the elimination of the disease based on the materials that would have been accessible at the time of the Antonine Plague. The paper shows that the use of immunological methods would have reduced the effects of measles in the community though it would not have eliminated the disease because of cultural interferences.

Background Information

The Antonine Plague occurred in the Roman Empire during the years 165-180 AD, killing more than 30% of the population (Manley, 2014). The plague is also associated with the decline of the Roman Empire and was named after the empire Aurelius Antoninus since it emerged when the named emperor was in power. Later on, it was discovered that the measles virus had caused the Antonine Plague. Measles is considered to be a highly infectious disease spread through contact with an infected party (Moss & Griffin, 2012). In essence, infection occurs after one infected individual either sneezes or coughs close to other parties or through direct contact with secretions of infected parties (Moss & Griffin, 2012). This method of infection explains the high number of deaths witnessed in the Roman Empire, especially since affected parties had no cure or utilized methods that were no effective in containing a viral disease. Understanding certain aspects such as the genome structure, clinical manifestation of the disease, as well as pathogenesis provides details on how any disease condition can be controlled by specific settings. The genome structure reveals that the virus is a negative-strand single-stranded enveloped virus belonging to the genus Morbillivirus and the family Paramyxoviridiae (Moss & Griffin, 2012).

Clinical manifestation and pathogenesis of the disease are similar to other diseases, making the disease management more difficult. A key characteristic of the disease that stands out is the presence of the disease in the human host only. No other animal host is known to date to house the above organism. This paper presents a hypothetical situation involving time travel during the Antonine Plague and identifies specific measures that could have been utilized during that time to control the disease with the assumption that people living during this period had selective amnesia and did not understand any of the associated techniques. The techniques to be utilized are based on the current knowledge and expertise in health research. In this paper, several important assumptions are made regarding the above case. First, the paper assumes that during this time no parties had a deep understanding of current techniques and the only available material for the future that would be utilized include the smartphone and solar powered laptops for data collection. Considering that Rome was the father of civilization, one unique method applied during the above time could have proved to be useful in dealing with the above condition. Development of an effective treatment based on antibody-antigen reactions could have significantly reduced the number of people who died during the above mentioned period. In other words, passive immunization could have reduced the death rate and successfully managed to control the spread of the disease during the 7th century.

Literature Review

Cause of the Antonine Plague

The Antonine Plague hit the Roman Empire in the year 165 AD and its effects were felt up to the year 180 AD. The result was the loss of about 30% of its population. The disease followed soldiers who were coming from the war in the Middle East. The disease rampaged through the entire empire, moving from Spain, Persia, and some parts of Egypt (Hanna, 2015). The disease killed all people irrespective of the class in the society, including the brother of the Emperor who also served as the co-emperor Lucius Verus (Hanna, 2015). The impact of the disease was so grave that it was named after the emperor who was in power. In 178 AD, it is approximated that the disease caused 2,000 deaths per day and the same number was infected per day. This shows high infectivity rates of the disease (Sabbatani & Fiorino, 2009). By the end of the year, the disease was estimated to have killed more than five million people. The results of the disease decimated about every one soldier who was present in the Roman Empire. The rates of the disease were higher among soldiers since they had come together, meaning that the most likely contamination method for the above disease condition was either through air contact or direct contact with secretions of an infected party. Attacks by rivalries such as the Italians and other barbarians ensured that this population diminished to very low numbers. This weakened aspects in trade, labor force, economy, and other aspects such as diminished reliability links (Hanna, 2015).

The society also became quite disintegrated due to the decline of various important aspects of the community. In brief, the presence of the above disease was the start of the downfall of the Roman Empire, which before the disease had been one of the most feared areas. The disease condition was later come to be known as measles, a disease caused by the measles virus. More relevant clinical information about measles is provided in the subsequent sections. This information could be used in the development of treatment regimens that could manage the disease condition during the above period.

Measles Virus

The measles virus falls in the paramyxovirus family and the genus Morbillivirus. It is estimated to have a diameter of between 120-250 nm (Gould, 2015). It contains single stranded DNA and is closely related to two viruses, including the rinderpest and canine distemper. The virus contains two membrane envelope proteins that play an important role in its pathogenesis. These proteins are the F-fusion protein and the Hemaglutinin protein (Gould, 2015). The latter is responsible for the adsorption of the virus to the cells, while the former is responsible for the fusion of the host cell membrane with the virus. There only exists one antigenic type of the virus though some viruses have been shown to have the H glycoprotein (Gould, 2015). Measles can be readily inactivated using a variety of methods, including the use of sunlight, heat, acidic PH, trypsin, and ether. The virus has a short survival time of about less than 2 hours.

Pathogenesis

Measles is one of the systematic infections that affect a given cell. Its primary site of infection is the nose. Two to three days after the virus has infected any individual, it invades and replicates in the respiratory epithelium and other areas, including the lymph nodes, and subsequently primary viremia occurs (Gould, 2015). This refers to increased virus levels in the body system as a result of the virus undergoing the lytic cycle. The subsequent infection is localized in the reticuloendothelial system. Following further periodic incidences of replication of the virus in the reticuloendothelial system, the second form of viremia occurs after 5-7 days of initial infection. During this period, the infection spreads to the respiratory tract and other organs of the body (Gould, 2015). The virus is normally shed from the nasal system after 3-4 days after the rash onset.

Epidemiology

The disease occurs across the world though the infection stage that occurred in the case of the Roman Empire showed that the disease was most likely caused in a different part of the world and the Roman soldiers were infected with the disease outside their areas of residence (Morton, 2016). Once an individual is infected, the measles virus stays in the human host, meaning that it does not affect any other host such as other animals though there is no evidence to show that other animals can also act as hosts to the disease. Transmission of the disease is largely based on aerial transmission from one individual to another, making it highly infective. In the above case, the Roman soldiers returning to their homes after the first war were infected with the disease. Since they interacted directly with all of the patients, then it is probable that they readily infected other parties through direct contact with them (Gould, 2015). When people are kept in a localized environment and air transmission is carried out, it only takes two hours for an individual in the same room to be affected by the disease. High rates of the disease have also been noted during winter and spring and they are sometimes difficult to distinguish between other kinds of diseases that are in existence in the world today. Measles is considered to be one of the most infectious diseases of all times as evident from its wiping out of more than a third of the population during the Antonine Plague (Gould, 2015). One key characteristic of the disease is the presence of rash four days after infection with the condition. The chances of spreading the disease during such times are quite high.

Clinical Features

The incubation period of the virus normally ranges from between 10-12 days though differences can be noted among individuals. The rash onset occurs commonly 14 days after the time of infection. This includes the infection stage. The prodrome period, which indicates earlier symptoms of the disease, usually lasts for 2-4 days (Gould, 2015). It is associated with high incidences of fever among individuals. The fever increases in a stepwise fashion in most patients until it reaches a peak high. This is then followed by the onset of coughs, conjunctivitis, and presence of a running nose. The Koplik Spots, which occur as rashes in the mucous membranes, have been identified to play an important factor in measles (Gould, 2015). They are noted 1-2 days after the infection period. They commonly appear as punctuate blue and white spots on the right red part of the buccal mucosa. The rash is commonly maculopapular and lasts for about five days. After this, it begins to be noted in the upper face and upper neck parts of the body. In the next three days, the rash gradually moves to hands and finally to feet. These lesions are normally discrete in the body, but with time they may become visible on specific parts of the body. There is also the formation of the lesion blanch that is commonly associated with fingertip pressure. In four days, pressure is normally present, but lacks the blanch (Gould, 2015). Fine desquamation occurs in cases that are considered to be more severe. In other cases, rash normally disappears slowly from the head to the body extremities. Other common clinical features that are associated with the above condition include the presence of anorexia and diarrhea in infants and lymphadenopathy in some individuals.

Complications

Measles is associated with one or more common complications, especially for smaller children below the age of five and adults below the age of twenty. It is common for diarrhea to be noted among younger individuals affected by measles. In other cases, other diseases associated with harmful bacteria such as those with same features as pneumonia have been noted. Sometimes, there is a rash onset on the forehead being followed by a series of some symptoms, including vomiting, headaches, stiff necks, convulsions, drowsiness, and coma (Gould, 2015). Individuals with such symptoms normally die at a faster rate as compared to other individuals. When seizures occur without fevers, then death cases are reduced. In some cases, the disease is associated with signs associated with mental illness. This is a common occurrence in a small number of cases. The onset of the condition is associated with a decrease and a progressive deterioration of behaviors of an individual followed by incidences associated with myoclonic seizures, ataxia, and subsequently death (Gould, 2015). When the disease affects pregnant mothers, there is a high risk of premature labor as well as birth of underweight infants. In other cases, spontaneous abortion has been noted. Sometimes, atypical measles occurs in different individuals. In this case, people are affected by the measles virus, but do not exhibit any symptom associated with the condition (Gould, 2015). This is solely based on an individual’s genetic makeup since individuals may be resistant to the disease. However, the number of isolated cases involving such individuals is quite small though such individuals hold the key to solving this disease that affects most individuals. When the disease affects individuals who suffer from any other disease that reduces immune functions, its effects are more adverse as compared to other individuals.

The information provided above is relevant and of great importance in understanding what originally happened in the Roman Empire and whether there was something that could have been done to salvage the above state or condition. The scenario described in this paper is presented in the section below.

Scenario

In 165 AD, a plague known as the Antonine Plague hit the Roman Empire, which killed about 30% of the population in Rome by 180 AD. Soldiers came back from the Parthian War infected with this horrid disease that at the time was unknown. Later on, we discovered that the cause of the rapid death was the disease called measles. However, due to amnesia we did not know at the time that it was measles until we discovered symptoms that were associated with this disease. We believe that the Antonine Plague was the cause of the decline of the Roman Empire, which exhausted trade, reduced the labor force, and wrecked the economy.

As a medical provider, I am in charge of providing medical care to anyone who is infected and prevent the disease from spreading. I noticed the soldiers had symptoms of fever, sore throat, and a runny nose. Many soldiers also complained about pain in their muscles and felt very weak. Another observation I made was red rash that seemed to spread throughout different areas of the body. This is how I came to the conclusion that the disease was measles. As a medical provider, I was tasked with coming up with an effective method that could be used to manage the disease condition and prevent it from spreading. Since all indicators pointed to the presence of measles, I developed a method referred to as passive immunization that could have been appropriately used during this specific period to reduce effects associated with the condition. Passive immunization is an immunologic mechanism based on the interaction of antibodies and antigens in the body that is commonly used in the treatment of different diseases. It is an effective method of controlling specific infectious diseases such as insulin. Since the key assumption in the study is the lack of newer technologies, the study will focus on passive immunization of measles applicable in the given century.

Objectives

This paper is aimed at achieving several objectives:

Investigate how passive immunization would reduce the number of cases recorded during the Antonine Plague

Statement of the Problem

The Antonine Plague killed millions of people in the Roman Empire due to the high infectivity rate of the disease coupled with the first rate of infection. This reduced productivity in the Roman Empire, in the process making the Empire one of the weakest. Treatment of the disease became more difficult due to selective amnesia and lack of understanding of the disease. Proposed new methods of the disease treatment based on the novel antigen-antibody reaction related to the development of vaccines could have been utilized to decrease the effects of the disease in the Roman Empire. This method could introduce a form of vaccination that would have reduced the incidence rate of measles during the period.

Hypothesis

Passive immunization would have reduced the incidence rate of measles during the Antonine Plague and confer immunity to all Roman nationals within the Roman population.

Research Questions

  • How does the use of passive immunization reduce the incidence rate of measles in a population that is already infected?
  • What is the impact of educating people on passive immunization during the Antonine Plague?

Materials and Methods

Selection of Participants

Selection of participants affected by the disease was the first and most important step. A random population of people affected by the disease was selected and isolated from the rest of the population. An effective method of selection, in this case, involved selection of individuals who had already shown some symptoms associated with the disease. Since all individuals affected by the disease had been quarantined from the rest of the population and placed in different treatment units, random samples would be collected for various individuals. Modified protective wear, including a face mask, was utilized when collecting the samples and when coming into contact with any of the infected individuals. All individuals who had come into contact with the affected parties and had not contacted the disease for longer periods were selected since they were resistant to the disease.

Sample Collection and Isolation of the Samples

5ml of blood was collected from all individuals suffering from measles and from individuals who had shown some form of resistance to the disease. The blood was kept in different test tubes that had been sterilized for a long period by the use of alcohol and boiling in hot water. This blood contained the antigen of interest, which in this case was the measles virus affecting all of the above parties. The blood was passed through a homemade centrifuge machine commonly used for separating cream from milk. Centrifugation of the blood samples was done for about ten minutes. After this, the supernatant layer was collected and placed in a different tube. The second round of centrifugation was done and the concentrate or supernatant was collected. Samples of the blood, as well as that of the supernatant were preserved in cold in some of the posts present in the Roman Empire. Water in the pot was maintained at the lowest temperature possible.

Selection of Model Organisms

Twenty different rabbits were selected the next day as model organisms. The rabbits were on specific diets for about a week and were assessed for any disease condition. Those rabbits that showed the presence of any disease condition were eliminated from the study. Three rabbits were selected for antibody production, while the remaining seventeen were to be utilized in the subsequent phases.

Antibody Production

The selected three rabbits were then injected with a portion of the supernatant that had been collected and preserved. This supernatant composed of the serum of the blood of affected individuals that was injected into the back of the ear of the rabbit. The antigen sera were mixed with an oily substance at the back of the ear after injection to facilitate entry of the antigen. Subsequent injections were made after three and six days to boost production of antibodies. The sample containing the serum of individuals who had been resistant to the disease was also injected in a different rabbit utilizing the same approach as described in the first case. The rabbits were then slaughtered after two weeks and their lymph nodes were collected. Antibodies present in the lymph node were collected and stored.

Testing Antigen-Antibody Reaction

Agar weed was collected and agar was extracted from agar weed. The agar was then boiled in water to turn it into agarose gel. Wells were made on either side of the agarose gel and one side was filled with the sera antigen and the next was filled with the antibodies collected from the rabbit. Both plates were filled and the two products were allowed to diffuse in different directions. A similar method was applied to individuals who had proven to be resistant to the virus. The results of the above experiment were noted. The antibodies were applied to individuals who had been bedridden and whose signs and symptoms associated with the disease were noted. The antibodies were also applied to uninfected individuals and respective signs and symptoms associated with the disease were noted. The antibodies were applied after other two weeks to the individuals, while in some individuals they were applied after a period of four weeks. This mechanism was repeated for about a year.

Inactivation of the Virus

The second method utilized involved collection of samples from the same patient and isolation of the virus causing the disease. The blood containing the virus was inactivated through the use of heat resulting in the formation of the live attenuated virus. The virus was then reapplied directly in the blood of volunteers who had not suffered from the above disease. Signs and symptoms associated with the disease were noted. The survival rates of the above patients were monitored. The live attenuated virus was applied after other two weeks to the individuals, while in some individuals it was applied after a period of four weeks. This mechanism was repeated for about a year.

Results

Table 1 shows the reduction in the number of people dying from measles from March to April after the application of different treatment regimens. The numbers decrease as more individuals are willing accept the cure though there are some who are limited by cultural barriers and do not take the cure and, as a result, end up dying. The graph below shows the above statistics, indicating the number of reduced deaths after the application of the vaccine.

The antigen contained in the sera is specific for antibodies and, as a result, the two form a conjugate that provides a distinct white color.

Discussion

The treatment of measles became in the Roman Empire after focusing on methods that were specifically founded in immunology. The immune system in the body acts to defend the body against the presence of any foreign materials. In the above case, the virus was isolated from the blood of the individuals who had been suffering from the disease (Habibullah, Ashraf, & Mullick, 2016). Centrifugation of the blood separated all important components in the blood, specifically red blood cells and other cells, to the bottom of the tubes, while the serum containing the antibodies of interest were left in the supernatant (Habibullah et al., 2016). When this serum was applied to rabbits, it elicited the production of antibodies within the rabbit. Antibodies are normally specific to a particular antigen and in the above case this is exactly what happened. The antibodies are produced in the thymus, but their maturation takes place in the lymph glands. It is at this point that the antibodies were collected at the lymph glands. Since these antibodies were specific for the above condition, they were applied to individuals already suffering from it (Gould, 2015). Moreover, since these antibodies are specific in all of the above individuals, they would attach to the measles antigen present in the body and would present the antigen to the body’s defense mechanism, which would effectively kill the virus.

In the second case, the virus was isolated from the blood and it was killed with heat, resulting in the formation of live attenuated viruses. In essence, the virus could still infect an individual, but with a reduced effect. The virus was then injected into individuals who had not suffered from measles (Gould, 2015). In two to three days, they would also show the symptoms like people suffering from the condition. Fever levels and other conditions in these individuals would be less pronounced as compared to individuals infected directly by the virus. In essence, it means that injection of the virus in a less reduced form would result in a primary response from the body, which will essentially fight off the virus (Gould, 2015). Since the virus is not as lethal as the other one, the effects are normally decreased. Memory cells present in the body note the presence of the virus so that when there is a second infection, the secondary response is much greater and, as a result, the virus is easily eliminated from the body. These memory cells ensure that whenever there is a bout of measles in the body, the effects are readily dealt with without necessarily causing more harm to the body (Gould, 2015). The application of the above two methods started in March and April and this is why there is a decrease in the number of cases.

The effects of some cultural practices affected the treatment of the above diseases. Some Romans believed that measles was a punishment from their gods and, as a result, refused to take the vaccine. At the end, it resulted in a small population of people that did not want to embrace change that would ideally assist their communities with getting over the disease. This indicates the role culture has in affecting treatment and management of specific conditions.

Conclusion

Passive immunization and other techniques based on the interaction and specificity of antigen and antibody reactions could have been utilized to decrease the rates of measles during the Antonine Plague. Passive immunization ensures that the memory cells are present within the cell to remind the cell of any reaction involving specific microorganisms. As a result, the secondary response produced by the cell is greater and clears any foreign material from the cell. Antigen-antibody interaction in the body results in the activation of various systems that ultimately cause activation of other essential elements in the immune system such as the complement system that results in the clearing of microorganisms. Although the management of the disease is a key, other factors such as cultural beliefs affect the application of treatment regimens and it is, therefore, important to keep an eye on such issues.