Recent results on the spatiotemporal modelling and comparative analysis of Black Death and bubonic plague epidemics

Background: This work demonstrates the importance of spatiotemporal stochastic modelling in constructing maps of major epidemics from fragmentary information, assessing population impacts, searching for possible etiologies, and performing comparative analysis of epidemics. Methods: Based on the theory previously published by the authors and incorporating new knowledge bases, informative maps of the composite space-time distributions were generated for important characteristics of two major epidemics: Black Death (14th century Western Europe) and bubonic plague (19th-20th century Indian subcontinent). Results: The comparative spatiotemporal analysis of the epidemics led to a number of interesting findings: (1) the two epidemics exhibited certain differences in their spatiotemporal characteristics (correlation structures, trends, occurrence patterns and propagation speeds) that need to be explained by means of an interdisciplinary effort; (2) geographical epidemic indicators confirmed in a rigorous quantitative manner the partial findings of isolated reports and time series that Black Death mortality was two orders of magnitude higher than that of bubonic plague; (3) modern bubonic plague is a rural disease hitting harder the small villages in the countryside whereas Black Death was a devastating epidemic that indiscriminately attacked large urban centres and the countryside, and while the epidemic in India lasted uninterruptedly for five decades, in Western Europe it lasted three and a half years; (4) the epidemics had reverse areal extension features in response to annual seasonal variations. Temperature increase at the end of winter led to an expansion of infected geographical area for Black Death and a reduction for bubonic plague, reaching a climax at the end of spring when the infected area in Western Europe was always larger than in India. Conversely, without exception, the infected area during winter was larger for the Indian bubonic plague; (5) during the Indian epidemic, the disease disappeared and reappeared several times at most locations; in Western Europe, once the disease entered a place, it lasted a time proportional to the population and then disappeared for several years (this on-and-off situation Lasted more than three centuries); and (6) on average, Black Death moved much faster than bubonic plague to reach virgin territories, despite the fact that India is only slightly larger in area than Western Europe and had a railroad network almost instantly moving infected rats, fleas, and people from one end of the subcontinent to the other. Conclusions: These findings throw new light on the spatiotemporal characteristics of the epidemics and need to be taken into consideration in the scientific discussion concerning the two devastating diseases and the lessons learned from them. (c) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.