Textbook and Image Attributions
Sabeti Lab
Textbook Graphic Design
Textbook Direction: Pardis Sabeti
Art Execution Production: Eugenia Rojas
Puente (Lead), Pardis Sabeti, Molly Kemball, Tomi Siyanbade
Art Direction: Lily Chylek
Art Direction Support: Eugenia Rojas
Puente
Layout Design Support: Eugenia Rojas
Puente
Chapter Cover Design: Lily Chylek
Unit Divider Design: Lily Chylek
Textbook Conceptual Cover Design: Lily Chylek
Textbook Figures
Illustration Support: Lily Chylek
Conceptual Scientific Content: Lily Chylek, Molly Kemball, Eugenia Rojas Puente, Pardis
Sabeti, Tomi Siyanbade.
Textbook Licensing and Attributions
Image Licensing: Alexis Gaab (Lead), Molly
Kemball, Eugenia Rojas Puente
Image Attributions Production: Alexis Gaab (Lead), Jess Frith, Curtis Hoffmann, Geranah Nerette
Vick’s Video Corner
Videos: Written and performed by Vick Krishna
Icon Design: Lily Chylek
QR Code Design: Curtis Hoffmann
Thought Café
Art Direction & Layout Design: Suzanna Brusikiewicz
Design Producer: Julia Nadeau
Design: Chara Ho, Michael Fan, Michelle Habib
Illustration: Eric Diotte
Illustration Support: Max Sebesta, Jess Leung
Textbook Cover Illustration: Eric Diotte
Unit Divider Design: Ashly Batista
Chapter Cover Design: Michael Fan, Suzanna Brusikiewicz
Textbook and Chapter Covers
Lily Chylek, Thought Café
Chapter 1
Figure 1.0: Conceptual illustration of an outbreak unfolding across the globe. [Adapted from: Fathom Information Design, with permission. || Adapted from: Unsplash. Photo by Vince S. on Unsplash. “white and gray tiled room.”]
Chapter 2
Figure 2.0: WiFi location data used to investigate the spread of SARS-CoV-2 at a public university. [Adapted from: Taylor BrockFisher and Bryn Loftness, with permission.]
Chapter 3
Figure 3.0: A physician examining the chest x-ray of a tuberculosis patient. [Adapted from: CDC, 1958, PHIL, https://phil.cdc.gov/, via Unsplash. Photo by CDC on Unsplash. https://unsplash. com/photos/a-man-and-a-woman-lookingat-a-chest-x-ray-0Sk3qI4oI0c.]
Chapter 4
Figure 4.0: Photo 51, showing the x-ray diffraction pattern that was used to determine the structure of DNA. [Adapted from: King’s College London: College Archives, KING’S COLLEGE LONDON: Department of Biophysics records, Glass and acetate slides: Medical Research Council (MRC) Biophysics Research Unit, 1949-1984 KDBP/1/1.]
Chapter 5
Figure 5.0: Microscopy image of the bacteria Treponema pallidum. [Adapted from: NIAID. “Treponema Pallidum Bacteria (syphilis).” CC BY 2.0 DEED, https://creativecommons.org/ licenses/by/2.0/, via Flickr.]
Chapter 6
Figure 6.0: Digitally colored scanning electron microscopy images of natural killer cells. [Adapted from: NIAID. “Human Natural Killer Cell.” CC BY 2.0 DEED, https://creativecommons.org/licenses/by/2.0/, via Flickr.]
Chapter 7
Figure 7.0: Composite of microscopic images of blood smears showing red blood cells infected with Plasmodium vivax trophozoites. [Adapted from: CDC / Dr. Mae Melvin, 1966, PHIL, https://phil.cdc.gov/Details. aspx?pid=20380. || Adapted from: CDC / Dr. Mae Melvin, 1966, PHIL, https://phil.cdc.gov/ Details.aspx?pid=20381.]
Chapter 8
Figure 8.0: An illustration of the Cinchona plant, a natural source of the antimalarial drug quinine. [Adapted from: Lambert, Aylmer Bourke, 1761-1842, Vahl, M. (Martin), 1744-1804, Bauer, Ferdinand, 1760-1826, B. and J. White [printer], Dumbarton Oaks Rare Book Collection, Dumbarton Oaks Research Library and Collection, Trustees for Harvard University, Washington, DC.]
Chapter 9
Figure 9.0: Herd immunity protects a community from disease, much like a herd of animals protecting each other from danger. [Adapted from: Arabacı, Osman. “Herd of Horses in Nature.” Pexels, 28 Jan. 2024.]
Chapter 10
Figure 10.0: New Orleans flooded after Hurricane Katrina. Following the hurricane, an outbreak of norovirus occurred in evacuation shelters. [Adapted from: “Aerial photo of flooded New Orleans following Hurricane Katrina by staff photographer Smiley N. Pool.” Copyright 2023 The Dallas Morning News, Inc.]
Chapter 11
Figure 11.0: A building in La Condesa, Mexico City, during COVID-19. [Adapted from: Mexico during Covid © Jordi Ruiz Cirera. Panos Publications Ltd.]
Chapter 12
Figure 12.0: Smartphones displaying an illustration of SARS-CoV-2. [Adapted from: Goodsell, David S., et al. “Integrative Illustration for Coronavirus Outreach.” PLoS Biology, vol. 18, no. 8, Aug. 2020, p. e3000815, doi:10.1371/ journal.pbio.3000815. CC BY 4.0 DEED, https://
creativecommons.org/licenses/by/4.0/, via PLoS Biology. || Adapted from: Unsplash. Photo by Matteo Vella on Unsplash. “a white phone with a black frame on a pink background.”]
Chapter 13
Figure 13.0: A phase portrait of an epidemiological model. [Adapted from: Báez-Sánchez, Andres David, and Nara Bobko. “On Equilibria Stability in an Epidemiological SIR Model with Recovery-Dependent Infection Rate.” TEMA (São Carlos), vol. 21, no. 3, Dec. 2020, pp. 409–24, doi:10.5540/tema.2020.021.03.0409. CC BY 4.0 DEED, https://creativecommons. org/licenses/by/4.0/, via ResearchGate.]
Figure 1.4: NIAID 2017 world map tracking emerging pathogens. [Adapted from: “Three Decades of Responding to Infectious Disease Outbreaks.” National Institute of Allergy and Infectious Diseases (NIAID).]
Unit Dividers
Lily Chylek and Thought Café
Unit 1: Introduction to Outbreak Science
Chapter 1
Figure 1.1: Microscopy image of SARS-CoV-2 viruses. [Image credit: NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland.]
Figure 1.2: Mycobacterium tuberculosis is an example of a reemerging pathogen. [Adapted from: Gupta, Sweta. “Study Finds 4-Month Tuberculosis Treatment Noninferior to Standard of Care.” Infectious Disease Advisor, 18 June 2021.]
Figure 1.3: Sacred herd being fed by the king-priest and his acolyte. [Image credit: Uruk period, c. 3200 BC. Collection of James Buchanan Nies, Yale University. 1 January 1917, Public Domain, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:Yale_University._Uruk_period_priestking.jpg.]
Figure 1.5: Reassortment in a swine host. [Adapted from: Cleghorn, Cristina, et al. Achieving Healthy and Sustainable Diets: A Review of Recent Studies Using Optimisation Modelling. University of Otago, Wellington, www.otago.ac.nz/wellington/otago711794 pdf. || Adapted from: Pierce, Benjamin A. Genetics: A Conceptual Approach, Fifth Edition. W.H. Freeman and Company, slideplayer.com/slide/12460574/ || Adapted from: Gao, George F., and YePing Sun. “It Is Not Just AIV: From Avian to Swine-Origin Influenza Virus.” Science China Life Sciences, vol. 53, no. 1, Jan. 2010, pp. 151–153.]
Figure 1.6 World population over the last 12,000 years. [Adapted from: Max Roser, Hannah Ritchie, Esteban Ortiz-Ospina and Lucas Rodés-Guirao (2019) – “World Population Growth.” Published online at OurWorldInData.org. Retrieved from ‘https:// ourworldindata.org/world-population-growth’ (Online Resource).]
Figure 1.7: Satellite images showing deforestation in the Amazon Rainforest (Rondônia in western Brazil) over the course of 34 years. [Image credit: NASA, Images of Change.]
Figure 1.8: Artisanal mining in the DRC often necessitates close contact with animals and their environments. [Image credit: Erberto Zani / Alamy Stock Photo]
Figure 1.9: Potential transmission pathways between animals and humans. [Adapted from: Magouras, Ioannis, et al. “Emerging Zoonotic Diseases: Should We Rethink the Animal–Human Interface?” Frontiers in Veterinary Science, vol. 7, 22 Oct. 2020.]
Figure 1.10: Infection is dependent on the host’s cellular structures. [Adapted from: “Viral Attachment to Host Cell.” ViralZone.]
Figure 1.11: The three steps of HIV spillover to humans: the hunter theory. [Adapted from: Rathi, Akshat. “Will Illegal Bushmeat Bring the next Global Outbreak?” Mosaic Science, Wellcome, 28 Sept. 2016. || Adapted from: “Scientific Image - HIV-Infected Cell.” NISE Network. || Adapted from: “Know the Facts.” Duval HIVCareNow.]
Figure 1.12: Modes of disease transmission. [Adapted from: “Methods of Disease Transmission.” National Geographic Society.]
Figure 1.13: Interconnected world and human contact. [Adapted from: Badger, Emily. “We’ve Been Looking at the Spread of Global Pandemics All Wrong.” Bloomberg.com, 25 Feb. 2013.]
Figure 1.14: Olga Vyatkina is seen adorning the grave of her son. [Image credit: With permission from Lynn Johnson, https://www. lynnjohnsonphoto.com/. Via Kupferschmidt, Kai. “Anthrax Genome Reveals Secrets about a Soviet Bioweapons Accident.” Science, Aug. 2016, doi:10.1126/science.aah7194.]
QR Code: Our World in Data Covid-19 tracker. [Roser, Max, and Hannah Ritchie. “Coronavirus Disease (COVID-19).” Our World in Data, vol. 1, no. 1, 4 Mar. 2020.]
QR Code: Epidemic Tracker. [Ginkgo Biosciences. “Concentric by Ginkgo: Epidemic Tracking and Data Science.”]
Public Domain, via Wikimedia Commons, https://commons.wikimedia.org/wiki/ File:John_Snow.jpg. || Image credit: Original Cholera map made by John Snow, 1854. Public Domain, via Wikimedia Commons, https://commons.wikimedia.org/wiki/ File:Snow-cholera-map-1.jpg.]
Figure 2.2: Experiment that refuted the spontaneous generation theory. [Adapted from: Kahraman, Satirdan. “Türkçe: Biyogenez Deney.” Wikimedia Commons, 2019.]
Figure 2.3: Index case. [Adapted from: Doherty, B, and Marin-Ferrer. INFORM Epidemic Risk Index Support Collaborative Risk Assessment for Health Threats. 2018. https://www.unisdr. org/preventionweb/files/62241_informepidemicriskindextechnicalrep.pdf.]
Figure 2.4: Environmental factors affecting pathogen transmissibility. [Adapted from: Leung, Nancy H. L. “Transmissibility and Transmission of Respiratory Viruses.” Nature Reviews Microbiology, vol. 19, 22 Mar. 2021, pp. 1–18.]
Figure 2.5: US Weekly COVID-19 cases reported to CDC. [Adapted from: “COVID Data Tracker Weekly Review.” Coronavirus Disease 2019, Centers for Disease Control and Prevention (CDC), 2023.]
Figure 2.6: “Flattening the curve.” [Adapted from: Roberts, Siobhan. “Flattening the Coronavirus Curve.” The New York Times, 27 Mar. 2020.]
Chapter 2
Figure 2.1: Dr. John Snow and his famous ‘dot map’ of Golden Square. [Image credit: John Snow, Autotype 1856, Published 1887.
Figure 2.7: Prevalence and incidence describe different phenomena that contribute to the same system. [Adapted from: Steward, Karen. “Incidence vs Prevalence.” Technology Networks, 8 Jan. 2020.]
Figure 2.8: The reproduction number reflects the transmissibility of the disease. [Adapted
from: Adam Kleczkowski, The Conversation. “After the ‘R Number,’ There’s a New Symbol to Understand Covid-19 Spread.” Scroll.in.]
Figure 2.9: Small changes to the reproduction number have major effects on the number of cases of a particular disease. [Thought Café]
Figure 2.10: Superspreader events. [Adapted from: “How You Can Prevent ‘Superspreader’ Events This Fall and Winter.” Colorado School of Public Health.]
Figure 2.11: Super-shedding individuals expel higher amounts of infectious material. [Adapted from: Msomi, Nelisiwe. “Scientists Looked at What Makes a Person a Covid-19 Super Spreader - What They Found.” News 24: Life.]
Figure 2.12: Local newspaper featuring Mary Mallon as “Typhoid Mary.” [Image credit: Unknown artist, New York American article, June 20, 1909. Public Domain, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:Mallon-Mary_01.jpg.]
Figure 2.13: A flow chart detailing how researchers may choose which type of study to employ. [Thought Café]
Figure 2.14: Unconscious bias. [Adapted from: “Unconscious Bias Training.” Center for DEIB Excellence.]
Figure 2.15: Confounding variables. [Adapted from: Russell, Ginny. “Risks during Conception, Pregnancy and Birth.” The Rise of Autism, Taylor & Francis Group, 2020, pp. 124–50.]
Figure 2.16: Blood-draw during the severely unethical Tuskegee Syphilis Study. [Image Credit: From the National Archives and Records Administration with National Archives Identifier (NAID) 956104, https://
catalog.archives.gov/id/956104. 31 October 2006, Public Domain, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:Tuskegee_study.jpg.]
Stop to Think Answer: Per Capita Consumption of Mozzarella Cheese correlates with Civil Engineering Doctorates Awarded. [Adapted from: Vigen, Tyler. Spurious Correlations. Hachette UK, 2015, https://www.tylervigen. com/spurious-correlations.]
QR Code: John Snow’s Cholera Map. [Rogers, Simon. “John Snow’s Cholera Map of London Recreated.” The Guardian, 15 Mar. 2013.]
QR Code: Delta Variant Scientific Publication. [Siddle, Katherine J., et al. “Transmission from Vaccinated Individuals in a Large SARS-CoV-2 Delta Variant Outbreak.” Cell, vol. 185, no. 3, Feb. 2022, pp. 485-492.e10, doi: 10.1016/j.cell.2021.12.027.]
QR Code: CDC COVID Data Tracker. [CDC. “CDC COVID Data Tracker.” Covid.cdc.gov, 2022.]
QR Code: R0 and Disease. [Petty, Alex. “R0 New Cases Interactive.”]
QR Code: Epidemic Calculator. [Goh, Gabriel. “Epidemic Calculator.” Gabgoh.github.io.]
Chapter 3
Figure 3.1: A portrait of Thomas Eric Duncan. [Image Credit: Wilmot Chayee / Adapted from: Merchant, Nomaan, and EMILY SCHMALL Associated Press. “Family That Hosted Ebola Patient Confined to Home.” Hendersonville Times-News, 3 Oct. 2014.]
Figure 3.2: Review of systems for patient assessment. [Adapted from: Phillips, Angela, et al. “A Detailed Review of Systems: An
Educational Feature.” The Journal for Nurse Practitioners: JNP, vol. 13, no. 10, Nov. 2017, pp. 681–86, doi:10.1016/j.nurpra.2017.08.012.]
Figure 3.3: The color of mucus and phlegm provides information about the type of infection. [Adapted from: “What Is Mucus? Surprising Facts about Your Boogers.” UPMC HealthBeat, 25 Jan. 2018.]
Figure 3.4: Lymphatic traffic jam: an analogy for lymphadenopathy. [Thought Café]
Figure 3.5: Communicating the management plan is a clinical provider’s responsibility. [Thought Café]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Bubonic Plague [Image credit: CDC / William Archibald, 1977, Public Health Image Library (PHIL), https://phil.cdc.gov/Details. aspx?pid=17968.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Cholera [Image credit: CDC, 1971, PHIL, https://phil. cdc.gov/Details.aspx?pid=19201.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Lassa Fever. [Image credit: Banswalhemant. CC BY-SA 4.0, https://creativecommons.org/ licenses/by-sa/4.0/deed.en, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:Conjunctivitis_disease.jpg.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Lyme Disease. [Image credit: CDC / James Gathany, 2007, PHIL, https://phil.cdc.gov/ Details.aspx?pid=9875.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment.
Lymphatic Filariasis, “Elephantiasis.” [Image credit: CDC, 1962, PHIL, https://phil.cdc.gov/ Details.aspx?pid=373.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Measles. [Image credit: CDC / Heinz F. Eichenwald, M.D., 1958, PHIL, https://phil.cdc.gov/Details. aspx?pid=3187.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Smallpox. [Image credit: CDC / John Noble, Jr., M.D., 1968, PHIL, https://phil.cdc.gov/ Details.aspx?pid=12557.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Streptococcal pharyngitis, (aka Strep Throat). [Adapted from: Ben-Joseph, Elana Pearl. “Strep Throat.” Nemours KidsHealth, Reviewed March 2023.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Tuberculosis. [Image credit: James Heilman, MD. CC BY-SA 4.0, https://creativecommons. org/licenses/by-sa/4.0/deed.en, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:PulmonaryTBCXR.png.]
Table 3.1: Infectious diseases and their symptomatology for clinical discernment. Zika. [Image credit: AP Photo/Felipe Dana.]
Icon 3.1: Coughing. [Thought Café]
Icon 3.2: Diarrhea. [Thought Café]
Icon 3.3: Fever. [Thought Café]
Icon 3.4: Rashes. [Thought Café]
Icon 3.5: Pathognomonic Indications. [Thought Café]
QR Code: Clinical Presentation of Some Infectious Diseases. [“Infectious Diseases
Multimedia.” Physical Diagnosis PDX.]
Unit 2: Biology of Pathogens and Infectious Disease
Chapter 4
Figure 4.1: Photo 51 of DNA. [Image credit: King’s College London: College Archives, KING’S COLLEGE LONDON: Department of Biophysics records, Glass and acetate slides: Medical Research Council (MRC) Biophysics Research Unit, 1949-1984 KDBP/1/1.]
Figure 4.2: Rosalind Franklin with a microscope in 1955. [Image credit: MRC Laboratory of Molecular Biology. From the personal collection of Jenifer Glynn. CC BY-SA 4.0, https:// creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons, https://commons. wikimedia.org/wiki/File:Rosalind_Franklin.jpg.]
Figure 4.3 Mendel studied different physical characteristics in pea plants and discovered that genes come in different versions or alleles. [Adapted from: Khan Academy. “Mendel and His Peas (Article) | Heredity.” Khan Academy, 2022.]
Figure 4.4: James Watson and Francis Crick with their double-helix DNA model in 1951. [Image credit: A. BARRINGTON BROWN, © GONVILLE & CAIUS COLLEGE / SCIENCE PHOTO LIBRARY]
Figure 4.5: Timeline of completed genome sequences. [Thought Café]
Figure 4.6: Ebola virus and its genome. [Adapted from: Aryal, Sagar. “Structure of Ebola Virus.” MicrobiologyInfo.com, 12 June 2018.]
Figure 4.7: The sugar-phosphate ‘backbone’ and the bases make up the chemical structure of DNA. [Adapted from: “The Chemical Structures of DNA and RNA.” CompoundChem.com, 2023.]
Figure 4.8: Key features and partial chemical structure of DNA. [Adapted from: Kumar, Vivek. “Deoxyribonucleic Acid (DNA).” Microbiology Notes, 24 Aug. 2019.]
Figure 4.9: Molecular differences between DNA and RNA. [Adapted from: “Genetic MaterialProperties and Differences between DNA and RNA.” BYJUS.]
Figure 4.10: Prokaryotic and eukaryotic cells organize their genetic information in different ways. [Adapted from: “BIL 160 - Lecture 13.” Miami University, 2023.]
Figure 4.11: Viral genomes are stored in the virus capsid. [Adapted from: Khan, Salman. The Khan Academy. Salman Khan London, UK, 2004, https://www.khanacademy. org/science/biology/biology-of-viruses/ virus-biology/a/intro-to-viruses.]
Figure 4.12: Semiconservative replication. [Adapted from: Koch-lgkoch, Lizanne. “Semiconservative Replication of DNA.” Wikimedia Commons, 12 Nov. 2009.]
Figure 4.13: Central dogma of molecular biology. [Adapted from: “The Central Dogma: DNA –> RNA –> Protein.” Perception & Intuition, 28 Dec. 2020.]
Figure 4.14: Transcription machinery. [Adapted from: Promoters. https://www.addgene.org/ mol-bio-reference/promoters/. Accessed 22 Jan. 2024.]
Figure 4.15: Transcription is carried out by RNA polymerase. [Adapted from: “Transcription.” BioNinja, 2019.]
Figure 4.16: Genetic code. [Adapted from: “IV: Protein Synthesis - The Genetic Code.” Furman University.]
Figure 4.17: SARS-Cov-2 structure. [Adapted from: “Uncovering the Role of BRD2 in COVID 19.” Cayman Chemical.]
Figure 4.18: Mutations in the genetic code. [Adapted from: Perge, Pál, and Peter Igaz. “Basic Concepts of Genetics.” Experientia. Supplementum, vol. 111, 2019, pp. 3–19, doi:10.1007/978-3-030-25905-1_1.]
Figure 4.19: Deletion mutation causing a frameshift. [Adapted from: Campbell, Molly. “Missense, Nonsense and Frameshift Mutations: A Genetic Guide.” Genomics Research from Technology Networks, 13 Jan. 2020.]
QR Code: Human Genome Project. [National Human Genome Research Institute. “The Human Genome Project.” Genome.gov, National Human Genome Research Institute, 22 Dec. 2020.]
QR Code: Viral Zone Database. [“Human Viruses Table ~ ViralZone Page.” Expasy.org, 2019.]
QR Code: Transcription and Translation. [“Transcribe and Translate a Gene.” Utah.edu, 2016. Note: This interactive may not work properly when using Firefox. Try another browser if you encounter problems.]
Chapter 5
Figure 5.1: Walter Reed and Juan Carlos Finlay y de Barrés. [Image credit: Walter Reed (1851-1902), American physician, 19th century. Public Domain, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:WalterReed.jpeg. || Image credit: Carlos Finlay (1833-1915), Cuban physician.
Public Domain, via Wikimedia Commons, https://commons.wikimedia.org/wiki/ File:Finlay_Carlos_1833-1915.jpg.]
Figure 5.2: Koch’s Postulates. [Adapted from: “Contribution of Robert Koch and Koch’s Postulates.” Microbiology Note, 24 July 2020.]
Figure 5.3: Infectious agents. [Adapted from: File:HIV.Png https://commons.wikimedia.org/ wiki/File:HIV.png. || Adapted from: Pathogens https://www.vce.bioninja.com.au/unit-four/ area-of-study-1-immunity/pathogens.html.]
Figure 5.4: Viral reproduction cycles. [Adapted from: Waechter, Christopher. Lytic Cycle vs Lysogenic Cycle. How Stuff Works. 2000, https://www.researchgate.net/profile/ Christopher-Waechter/publication/339831129/ figure/fig3/AS:867633540911104@158387136411 7/Lytic-cycle-vs-Lysogenic-cycle-C2000-HowStuff-Works.png.]
Figure 5.5: Atomic 3D model of the external structure of the SARS-CoV-2 virus which causes the coronavirus disease first identified in Wuhan, China in 2019. [Image credit: Alexey Solodovnikov & Valeria Arkhipova / N+1. CC BY-SA 4.0, https://creativecommons. org/licenses/by-sa/4.0/deed.en, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:Coronavirus._SARS-CoV-2.png.]
Figure 5.6: Bacterial cell structure. [Adapted from: “Difference between Pili and Fimbriae of Bacteria- A Comparison Table.” EasyBiologyClass | Biology Notes, PDFs, PPTs, MCQs and Old Question Papers, Easybiologyclass, 21 May 2017. / Prokaryotic Cells. https://ib.bioninja.com.au/standard-level/topic-1-cell-biology/12-ultrastructure-of-cells/prokaryotic-cells.html. Accessed 19 Oct. 2023.]
Figure 5.7A: Gram staining. [Adapted from: Dowell, V.R., Jr., “Gram-Positive and GramNegative Cell Wall.” Biology Dictionary, 2023.]
Figure 5.7B: Gram staining. [Image credit: CDC / Dr. V.R. Dowell, Jr., 1972, PHIL, https:// phil.cdc.gov/phil_images/20030203/6/ PHIL_3084_lores.jpg, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:BacteroidesFragilis_Gram.jpg.]
Figure 5.7C: Gram staining. [Image credit: “John A. Jernigan, David S. Stephens, David A. Ashford, Carlos Omenaca, Martin S. Topiel, Mark Galbraith, Michael Tapper, Tamara L. Fisk, Sherif Zaki, Tanja Popovic, Richard F. Meyer, Conrad P. Quinn, Scott A. Harper, Scott K. Fridkin, James J. Sejvar, Colin W. Shepard, Michelle McConnell, Jeannette Guarner, Wun-Ju Shieh, Jean M. Malecki, Julie L. Gerberding, James M. Hughes, Bradley A. Perkins, and members of the Anthrax Bioterrorism Investigation Team. “Bioterrorism-Related Inhalational Anthrax: The First 10 Cases Reported in the United States”. Emerging Infectious Diseases (Internet serial), 7(6), December 2001.”]
Figure 5.8: Bacterial classification based on their shape. [Adapted from: Aryal, Sagar. “Classification of Bacteria in Different 9 Ways.” Microbe Notes, Sagar Aryal, 6 June 2023.]
Figure 5.9: Binary fission. [Adapted from: “Binary Fission Diagram with Labels Stock Vector - Illustration of Binary, Diagram: 219605008.” Time. Accessed 19 Oct. 2023.]
Figure 5.10: Cross section of the E. coli cell. [Image credit: The Machinery of Life by David S. Goodsell, Springer New York, 2009, with permission.]
Figure 5.11: Protozoan cellular structure. [Adapted from: Darling, David. “Protozoan.” 2023, David Darling.]
Figure 5.12: Life cycle of the malaria causing parasite Plasmodium. [Adapted from: Lily Chylek]
Figure 5.13: Fungus cellular structure. [Adapted from: “Fungi—basic Concepts.” McGraw Hill Medical.]
Figure 5.14: Typical ringworm rash. [Image credit: “Used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.” || Image credit: United States Marine Corps (ID 090616-M-1273D-009). 13 June 2009, Public Domain, via Wikimedia Commons.]
Figure 5.15: Patient presenting lymphatic filariasis (elephantiasis) symptoms. [Image credit: CDC / CDC Connects / Caitlin M. Worrell, M.P.H., 2014, PHIL, https://phil.cdc.gov/Details. aspx?pid=20996.]
Figure 5.16: Prions. [Adapted from: Paudyal, Anuja, and Eric Gillock. “FHSU Scholars Repository Polymorphism In The PrPC Prion Protein Gene In Pigs.” Oct. 2017.]
Table 5.1: Disease-causing viruses. Ebola Virus (EBOV). [Image credit: NIAID, 2014, CDC, PHIL, https://phil.cdc.gov/Details. aspx?pid=17775.]
Table 5.1: Disease-causing viruses. Human Immunodeficiency Virus (HIV). [Image credit: NIAID, 2012, CDC, PHIL, https://phil.cdc.gov/ Details.aspx?pid=18143.]
Table 5.1: Disease-causing viruses. Human Papillomavirus (HPV). [Image credit: Angel Cid-Arregui. Courtesy of Dr. Jean_Yves Sgro, http://www.virology.wisc.edu/virusworld/
viruslist.php?virus=hpv. CC BY-NC 3.0, https:// creativecommons.org/licenses/by-nc/3.0/, via Openi National Library of Medicine.]
Table 5.1: Disease-causing viruses. Influenza A Virus (FLU A). [Image credit: CDC / Cynthia S. Goldsmith and Thomas Rowe, PHIL, https:// phil.cdc.gov/Details.aspx?pid=15674.]
Table 5.1: Disease-causing viruses. Zika Virus (ZIKV). [Image credit: CDC / Cynthia Goldsmith, 2016, PHIL, https://phil.cdc.gov/ Details.aspx?pid=20538.]
Table 5.2: Disease-causing bacteria. Neisseria gonorrhoeae. [Image credit: CDC / Antibiotic Resistance Coordination and Strategy Unit / Medical Illustrator, Alissa Eckert, 2019, PHIL, https://phil.cdc.gov/Details.aspx?pid=23244.]
Table 5.2: Disease-causing bacteria. Salmonella typhimurium. [Image credit: CDC / Bette Jensen / Janice Haney Carr, 2009, PHIL, https://phil.cdc.gov/Details.aspx?pid=10991.]
Table 5.2: Disease-causing bacteria. Staphylococcus aureus. [Image credit: CDC / Matthew J. Arduino, DRPH / Janice Haney Carr, 2001, PHIL, https://phil.cdc.gov/details. aspx?pid=11157.]
Table 5.2: Disease-causing bacteria. Streptococcal spp. [Image credit: NIAID, 2009, CDC, PHIL, https://phil.cdc.gov/Details. aspx?pid=18257.]
Table 5.2: Disease-causing bacteria. Treponema pallidum. [Image credit: CDC / Joyce Ayers, 1969, PHIL, https://phil.cdc.gov/Details. aspx?pid=2392.]
Table 5.3: Disease-causing protozoa. Entamoeba histolytica. [Image credit: CDC / Dr. Healy, 1964, PHIL, https://phil.cdc.gov/ Details.aspx?pid=22073.]
Table 5.3: Disease-causing protozoa. Giardia lamblia. [Image credit: CDC / James Archer / Illustrator, Jennifer Oosthuizen, 2016, PHIL, https://phil.cdc.gov/Details.aspx?pid=21916.]
Table 5.3: Disease-causing protozoa. Trichomonas vaginalis. [Image credit: CDC, 1986, PHIL, https://phil.cdc.gov/Details. aspx?pid=5238.]
Table 5.3: Disease-causing protozoa. Trypanosoma brucei. [Image credit: CDC / Blaine Mathison, PHIL, https://phil.cdc.gov/ Details.aspx?pid=11820.]
Table 5.3: Disease-causing protozoa. Toxoplasma gondii. [Image credit: CDC, 1970, PHIL, https://phil.cdc.gov/Details. aspx?pid=16546.]
Table 5.4: Disease-causing fungi. Aspergillus. [Image credit: CDC, 2012, PHIL, https://phil. cdc.gov/Details.aspx?pid=15145.]
Table 5.4: Disease-causing fungi. Candida. [Image credit: CDC / Dr. Lucille K. Georg, 1967, PHIL, https://phil.cdc.gov/Details. aspx?pid=21789.]
Table 5.4: Disease-causing fungi. Cryptococcus. [Image credit: CDC / Dr. Lucille K. Georg, 1968, PHIL, https://phil.cdc.gov/Details. aspx?pid=16399.]
Table 5.4: Disease-causing fungi. Pneumocystis. [Image credit: CDC / Dr. Mae Melvin, 1977, PHIL, https://phil.cdc.gov/Details. aspx?pid=16175.]
Table 5.4: Disease-causing fungi. Trichophyton. [Image credit: CDC / Dr. Lucille K. Georg, 1964, PHIL, https://phil.cdc.gov/Details. aspx?pid=22306.]
QR Code: Virus Explorer. [“Virus Explorer.” HHMI BioInteractive.]
QR Code: Bacterial Gram Stain. [Arvidson, Cindy, et al. “Gram Stain,” Michigan State University College of Human Medicine.]
QR Code: Malaria Development in Human Host. [“Malaria: Human Host.” HHMI BioInteractive, 5 Feb. 2013.]
Chapter 6
Figure 6.1: Last portraits of Gustav Klimt before passing of the 1918 flu (left) and Edith Schiele (right). Gustav Klimt, dead in his bed, 1918. [Image credit: Egon Schiele. “Gustav Klimt, dead in his bed,” 1918. Public Domain, via Wikimedia Commons. || Image credit: Portrait of the dying Edith Schiele, 1918. [Image credit: Egon Schiele. “Portrait of the dying Edith Schiele,” 1918. Public Domain, via Wikimedia Commons.]
Figure 6.2: The human immune system. [Adapted from: Lily Chylek]
Figure 6.3: Our skin is a primary barrier to pathogens. [Adapted from: “List of Skin Diseases and Conditions.” Disabled World, 8 Apr. 2020.]
Figure 6.4: The sinuses with their lining of cilia work together to provide another mechanical barrier to prevent pathogens from entering into the body. [Adapted from: Kompas Cyber Media. “Fungsi Sel Goblet Dalam Tubuh Makhluk Hidup Halaman All.” KOMPAS.com, 23 May 2022.]
Figure 6.5: Coughing is another example of a mechanical barrier provided by the innate immune system. [Adapted from: Vikash Aiyappa. “Mild Cough to Sneezing: Here Is What People Are Worried about the Most.” OneIndia.com, 11 May 2020.]
Figure 6.6: The human microbiome. [Adapted from: Evans, Kerry. “Gut Microbes, in Your Lungs? | Microbiology.” Labroots, 22 July
2016 || Adapted from: Hou, Kaijian, et al. “Microbiota in Health and Diseases.” Signal Transduction and Targeted Therapy, vol. 7, no. 1, Apr. 2022, p. 135, doi:10.1038/ s41392-022-00974-4.]
Figure 6.7: Phagocytosis is a first line of cellular defense inside the body. [Adapted from: “Cell-Cell Interactions: How Cells Communicate with Each Other (Article).” Khan Academy.]
Figure 6.8: Granulocytes are a type of phagocyte containing toxic granules used to destroy pathogens. [Adapted from: OpenStax College. “Illustration from Anatomy & Physiology, Connexions Web Site. Http://cnx. org/Content/Col11496/1.6/, June 19, 2013.” Wikimedia Commons, commons.wikimedia. org/wiki/File:1907_Granular_Leukocytes.jpg.]
Figure 6.9 Innate and adaptive immune cells. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us? https://blog.cellsignal.com/ immunology-overview-how-does-our-immune-system-protect-us.]
Figure 6.10: Cytokines enhance the immune response. [Adapted from: Owen, Judith A, et al. Kuby Immunology (6th Edition). New York, W.H. Freeman, 2007.]
Figure 6.11: Humoral and cellular immune responses of the adaptive immune system to the influenza virus. [Adapted from: Bisen, Prakash & Raghuvanshi, Ruchika. “Influenza.” Emerging Epidemics, 20 June 2013, pp. 400–454.]
Figure 6.12: B cells produce antibodies specific to a pathogen’s antigens. [Adapted from: Bio Teacher. “The Human Defence System.” Leavingbio.net, 8 Apr. 2019.]
Figure 6.13: Structure of a typical antibody. [Adapted from: Janeway CA Jr, Travers
P, Walport M, et al. Immunobiology: The Immune System in Health and Disease (5th Edition). New York: Garland Science; 2001. Available from: https://www.ncbi.nlm.nih. gov/books/NBK10757/?depth=2.]
Figure 6.14: Antibodies are produced and released into the bloodstream by B cells. [Adapted from: “# 63 Summary of Immunity.” Biology 4 A Level, 15 Apr. 2015.]
Figure 6.15: Antibodies can fight and destroy pathogens through several means, including neutralization and agglutination. [Thought Café]
Figure 6.16: Antigen presentation and T cell activation. [Adapted from: “# 63 Summary of Immunity.” Biology 4 A Level, 15 Apr. 2015.]
Figure 6.17: The 1918 influenza pandemic is an example in which the virus ignited an autoimmune response in a specific group of the population. [Adapted from: “Influenza Epidemics: From Past to Present.” Duke University Infectious Disease: Superbugs, Science, & Society.]
Figure 6.18: Immunologic basis of allergies. [Adapted from: Lewis, Ricky. Life (3rd edition). The McGraw-Hill Companies, 1996. Found in: “Beta-Glucan vs. Allergies.” Sofislife Corporation.]
Table 6.1: WBCs: key players of the immune system. Dendritic Cells. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us? https:// blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
Table 6.1: WBCs: key players of the immune system. Macrophages. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us?
https://blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
Table 6.1: WBCs: key players of the immune system. Neutrophils. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us? https:// blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
Table 6.1: WBCs: key players of the immune system. Eosinophils. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us? https:// blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
Table 6.1: WBCs: key players of the immune system. Basophils. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us? https:// blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
Table 6.1: WBCs: key players of the immune system. NK Cells. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us? https:// blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
Table 6.1: WBCs: key players of the immune system. B cells. [Adapted from: Lowell, April. Immunology Overview: How Does Our Immune System Protect Us? https:// blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
Table 6.1: WBCs: key players of the immune system. T Cells. [Adapted from: Lowell,
April. Immunology Overview: How Does Our Immune System Protect Us? https:// blog.cellsignal.com/immunology-overview-how-does-our-immune-system-protect-us.]
QR Code: Macrophage Engulfing Cells. [Tsai, Richard. “Macrophage engulfs foreign cells,” NIBIB/NIH, 2013.]
Unit 3: Outbreak Countermeasures
Chapter 7
Figure 7.1: Dr. Ameyo Stella Adadevoh, Ebola victim. [Image Credit: With permission from Bankole Cardoso.]
Figure 7.2: An ancient diagnostics approach. [Adapted from: OpenLearnCreate 9.8.1 Urine tests for diabetes, https://www.open. edu/openlearncreate/mod/oucontent/view. php?id=39§ion=9.10.1.]
Figure 7.3: Viewing blood samples of patients under a microscope allow for the detection of malaria parasites. [Image credit: With permission from Bobbi S. Pritt, MD, MSc, FCAP, DTMH.]
Figure 7.4: Bacterial culture is a common whole pathogen diagnosis test for the detection of bacterial infections. [Adapted from: Tankeshwar, Acharya. “Pour Plate Method: Principle, Procedure, Uses, and (Dis) Advantages.” Microbeonline, 16 Oct. 2016.]
Figure 7.5: PCR components. [Adapted from: “PCR Overview.” Goldbio.com.]
Figure 7.6: DNA amplification through PCR involves three steps — denaturation, annealing, and extension. [Adapted from: “PCR Overview.” Goldbio.com.]
Figure 7.7: DNA amplification during PCR demonstrates exponential growth. [Adapted from: “Genetic Analysis | FoodChain ID, Inc.” GMO Testing.]
Figure 7.8: RT-qPCR is a molecular test used to diagnose SARS-CoV-2 and other RNA viruses. [Adapted from: “COVID-19 Testing FAQs.” ASM.org.]
Figure 7.9: Antigen test mechanisms of action, results and interpretation. [Adapted from: “COVID-19 Testing FAQs.” ASM.org || Conceptual Scientific Content, Sabeti Lab: Pardis Sabeti, Sameed Siddiqui, Lily Chylek, Molly Kemball, Eugenia Rojas.]
Figure 7.10: Biomarkers can be used to determine the patient’s health state. [Adapted from: “Translational Biomarkers Core - Center for American Indian and Rural Health Equity.” Montana State University.]
Figure 7.11: Diagnostic tests can be classified as non-invasive, minimally invasive and invasive according to the procedure involved. [Adapted from: “Detecting Urinary Tract Infections.” HealthyChildren.org. || Adapted from: Greater, Mclaren. “Home Lab Draws Add Convenience, Access to Homebound Patients.” Lansing, 17 Apr. 2015. || Adapted from: Szumlinski, Angie. “FDA – Instructions – Self-Collection.” HealthCap USA, HealthCap, 24 June 2021.]
Figure 7.12: Point-of-need diagnostic tests permit consumers to self-administer at home. [Adapted from: Anthes, Emily. “How Accurate Are At-Home Covid Tests? Here’s a Quick Guide.” The New York Times, 3 Jan. 2022. || Adapted from: “At-Home Coronavirus Tests: When to Take Them, How to Get Them and More.” The Washington Post, 28 Aug. 2021.]
Figure 7.13: A pooled testing approach for 100 individuals, tested in 20 pools of 5. [Adapted from: Hedt, Stephanie. “A Testing Strategy to Get Americans back to Work and School.” USC Schaeffer, 5 May 2020.]
Figure 7.14: Accurate and inaccurate diagnostic test outcomes in diagnostic testing. [Thought Café]
Figure 7.15: Access to health care providers is determined by financial resources and infrastructure. [Image credit: Max Pixel, https:// www.maxpixel.net/Doctor-For-Poor-RuralHealth-Care-Doctor-Rural-6235356.]
QR Code: Wastewater COVID-19 Tracking. [MWRA. “Wastewater COVID-19 Tracking,” Massachusetts Water Resources Authority: BioBot Data.]
QR Code: Broad Institute Covid-19 Testing. [Eisenstadt, Leah. “How Broad Institute Converted a Clinical Processing Lab into a Large-Scale COVID-19 Testing Facility in a Matter of Days.” Broad Institute, 27 Mar. 2020.]
QR Code: Polymerase Chain Reaction Interactive. [University of Utah. “PCR.” Utah. edu, 2000.]
Chapter 8
Figure 8.1A: Alexander Fleming and “The Penicillin Girls.” [Image credit: “Synthetic Production of Penicillin,” TR 1468, Ministry of Information Second World War Colour Transparency Collection, Imperial War Museum, United Kingdom Government. 1943, Public Domain, via Wikimedia Commons.]
Figure 8.1B: Alexander Fleming and “The Penicillin Girls.” [Image credit: Sir William
Dunn School of Pathology, University of Oxford; © Bodleian Libraries, University of Oxford.]
Figure 8.2: Salicin, the precursor to aspirin. [Thought Café]
Figure 8.3: The use of dyes to stain microorganisms revealed new ways to target microbes. [Adapted from: Stefan Walkowski, January 2020. CC BY-SA 4.0, https://creativecommons. org/licenses/by-sa/4.0/deed.en, via Wikimedia Commons, https://commons.wikimedia.org/ wiki/File:UPEC_adhered_to_BEC.jpg.]
Figure 8.4: Rational drug design [Adapted from: Lily Chylek]
Figure 8.5: Nucleoside analogs and molecular screening for drug discovery. [Adapted from: File:Guanosine Aciclovir Comparison. svg https://commons.wikimedia.org/wiki/ File:Guanosine_aciclovir_comparison.svg. || Adapted from: Lily Chylek]
Figure 8.6: Recombinant DNA technologies. [Adapted from: Lily Chylek]
Figure 8.7: Convalescent plasma therapy [Adapted from: Nussbaum, Abraham M. “The Wayback Machine.” Perspectives in Biology and Medicine, vol. 65, no. 3, 2022, pp. 484–98, doi:10.1353/pbm.2022.0039. || Adapted from: Lily Chylek]
Figure 8.8: Anti-SARS-CoV-2 monoclonal antibodies. [Adapted from: Lily Chylek]
Figure 8.9: FMT. [Adapted from: Stone, CtsBala. “Fecal Microbiota Transplantation (FMT).” AGA GI Patient Center, 13 July 2021. || Adapted from: Lily Chylek]
Figure 8.10: Components of common foods can affect pathogen metabolism. [Adapted from: Lily Chylek]
Figure 8.11: Bacterial cell targets of antibiotics. [Adapted from: Milken Institute School of Public Health, The George Washington University | Antibiotic Resistance Action Center. 4 Ways Antibiotics Affect Bacterial Cells https://onlinepublichealth.gwu.edu/wp-content/uploads/ sites/47/2021/03/4-ways-antibiotics-affect-bacterial-cells.png. || Adapted from: Lily Chylek]
Figure 8.12: Fungal cell targets of antifungals. [Adapted from: Themes, U. F. O. “Antifungal Agents.” Basicmedical Key, 22 July 2016.]
Figure 8.13: Parasitic cell targets of antiparasitics. [Adapted from: Lily Chylek]
Figure 8.14: Viral and host cell targets for antiviral agents. [Adapted from: Lily Chylek]
Figure 8.15: ORT [Thought Cafe]
Figure 8.16: FDA regulation of medical claims and substances. [Image credit: “1906 Pure Food and Drugs Act, ©1998 United States Postal Service®. All Rights Reserved. Used with Permission.”]
Figure 8.17: High-throughput experiments screen multiple drugs. [Adapted from: Lily Chylek]
Figure 8.18: Complete timeline for the drug development process established by the FDA. [Adapted from: Process of new drug development https://www.seikagaku.co.jp/ en/development/flow.html.]
Figure 8.19: Therapeutic Window (Index). [Adapted from: Concentration of Drug X in Plasma (mg/L) and Percent of Patients Responding https://ars.els-cdn.com/content/ image/3-s2.0-B9780123868824000189 -f18-07-9780123868824.jpg.]
Figure 8.20: Determining TD50, ED50, and therapeutic index of a drug. [Adapted from: Lily Chylek]
Figure 8.21: Common routes of administration for therapeutics. [Adapted from: Lily Chylek]
Figure 8.22: Therapeutic price exploitation. [Adapted from: Senate, R. P. C. Drug Pricing. https://www.rpc.senate.gov/imo/media/ image/Drug-Pricing_v3_WEB.png.]
Icon 8.1: Antipyretics. [Thought Café]
QR Code: How Food Affects How You Fight Off Infection. [Wang, Andrew et al. “Opposing Effects of Fasting Metabolism on Tissue Tolerance in Bacterial and Viral Inflammation.” Cell vol. 166,6 (2016): 15121525.e12. doi:10.1016/j.cell.2016.07.026.]
QR Code: DrugBank. [DrugBank Online. “DrugBank.” 2022.]
QR Code: Clinical Trials for Drug Discovery. [National Cancer Institute. “What Are Clinical Trial Phases?” YouTube: Understanding Clinical Trials, 9 Feb. 2016.]
Chapter 9
Figure 9.1: Historical account of the Smallpox Inoculated in New England. [Image credit: “Boylston, Zabdiel. An Historical Account of the Small-pox Inoculated in New England, Upon All Sorts of Persons, Whites, Blacks, and of All Ages and Constitutions: With Some Account of the Nature of the Infection in the Natural and Inoculated Way, and Their Different Effects on Human Bodies: with Some Short Directions to the Unexperienced in this Method of Practice / Humbly Dedicated to Her Royal Highness the Princess of Wales. London: Printed for S. Chandler, at the
Cross-Keys in the Poultry, MDCCXXVI [1726]; [Boston in N.E.]: Re-printed at Boston in N.E. for S. Gerrish in Cornhil, and and T. Hancock at the Bible and Three Crowns in Annstreet, MDCCXXX [1730].” 1730, Public Domain, via Wikimedia Commons.]
Figure 9.2: Jenner’s Reports of the First Cowpox Vaccination. [Image credit: “The hand of Sarah Nelmes infected with the cowpox,” Edward Jenner (1749-1823), on Wellcome Collection, https://wellcomecollection.org/ works/aq3qrvnw. CC BY 4.0, https://creativecommons.org/licenses/by/4.0/deed.en, via Wikimedia Commons.]
Figure 9.3: Pediatric Polio Patient in an Iron Lung. [Image credit: © World Health Organization / Paul Palmer, 1956. Before the first poliovirus vaccine in 1955, children affected by polio depended on an iron lung for their survival.]
Figure 9.4: Polio cases in the US and vaccine introduction. [Adapted from: “Polio.” Vaccines, ProCon.org, 2 Feb. 2023.]
Figure 9.5: Timeline of vaccine milestones. [Adapted from: Lily Chylek]
Figure 9.6: Vaccines induce a protective immune response. [Adapted from: Lily Chylek]
Figure 9.7: Booster shots are needed for some vaccines to stimulate sufficient antibody production. [Adapted from: Patel, Cyra, et al. “Should I Get My COVID Vaccine Booster? Yes, It Increases Protection against COVID, Including Omicron.” The Conversation, Dec. 2021.]
Figure 9.8: Types of vaccines. [Adapted from: Lily Chylek]
Figure 9.9: Different types of COVID-19 vaccines. [Adapted from: Lily Chylek]
Figure 9.10: Vaccine ingredients. [Adapted from: Ghattas, Majed, et al. “Vaccine Technologies and Platforms for Infectious Diseases: Current Progress, Challenges, and Opportunities.” Vaccines , vol. 9, no. 12, Dec. 2021, doi:10.3390/vaccines9121490.]
Figure 9.11: Vaccine routes administration. [Adapted from: Lily Chylek]
Figure 9.12: Phases of Vaccine Development. [Adapted from: Process of new drug development . https://www.seikagaku.co.jp/en/ development/flow.html . || Adapted from: Lily Chylek.]
Figure 9.13: The domino effect of an outbreak. [Adapted from: “ Illustration about Line of White Falling Dominoes That Stop at the Red One That Forms a Safety Gap - a 3d Image. Illustration of Concept, Piece, Balance - 13143555. ” Time . Illustration 13143555 © Vasileios Barkayannis, https:// www.dreamstime.com/billbarkas_info , Dreamstime.com, https://www.dreamstime. com/stock-photos .]
Figure 9.14: Herd immunity is achieved when the majority of the population is immune to the disease. [Adapted from: Wilburn, Thomas, and Richard Harris. “ How Herd Immunity Works — And What Stands In Its Way. ” NPR , 18 Feb. 2021.]
Figure 9.15: Smallpox vaccine promotion poster. [Image credit: CDC, PHIL, https:// phil.cdc.gov/ , 1966-1979. Public Domain, via Wikimedia Commons, https://commons. wikimedia.org/wiki/File:Poster_for_vaccination_against_smallpox.jpg .]
Figure 9.16: Post-Vaccination Finger Dye. [Adapted from: Hassan, Asif. “ In This Photograph Taken on February 16 a Pakistani Health Worker. ” Getty Images .]
Figure 9.17: A health care worker in Aden, Yemen vaccinating children against measles and rubella in 2019. [Image credit: © UNICEF/ UN0284455/Fadhel.]
Figure 9.18: The long road to vaccination. [Adapted from: Now Is the Time to Pave the Way for Equitable Vaccine Distribution. 28 July 2020, https://www.gavi.org/ vaccineswork/now-time-pave-way-equitable-vaccine-distribution.]
QR Code: Measles Vaccination. [Kurzgesagt –In a Nutshell. “Measles Explained — Vaccinate or Not?” YouTube, 24 Feb. 2015.]
QR Code: Interview with mRNA Vaccine Revolutionaries. [TED. “Uğur Şahin and Özlem Türeci: Meet the Scientist Couple Driving an MRNA Vaccine Revolution.” YouTube, 3 Aug. 2021.]
among Children and Teens https://info. primarycare.hms.harvard.edu/review/ racial-disparity-mortality-covid-children.]
Figure 10.5: The achievement gap. [Adapted from: Robelen, Erik W. “NAEP Report: A Closer Look at Trends in the Achievement Gap.” Education Week, 28 June 2013.]
Figure 10.6: World map of healthcare coverage by geographical region. [Adapted from: File:Universal Health Care July 2018. Png. https://commons.wikimedia.org/wiki/ File:Universal_Health_Care_july_2018.png.]
Figure 10.7: A Rwandan refugee camp in east Zaire (current Democratic Republic of the Congo). [Image credit: CDC. “Refugee camp for Rwandans in Kimbumba, eastern Zaire (current Democratic Republic of the Congo), following the Rwandan genocide.” 1994. Archived on 01.16.2009 by the Internet Archive.]
Unit 4: Social Outbreak Response
Chapter 10
Figure 10.1: Kenema, a city in Sierra Leone, West Africa, an epicenter of the 2014 Ebola outbreak. [Adapted from: Sierra Leone – the Dorothy Springer Trust http://dst.org.uk/ sierraleone.html.]
Figure 10.2: Dr. Sheik Humarr Khan, a national hero from Sierra Leone who treated more than one hundred Ebola patients. [Image credit: With permission from Pardis Sabeti.]
Figure 10.3: An individual’s health outcome is determined by social drivers and biological factors. [Adapted from: Lily Chylek]
Figure 10.4: Pediatric COVID-19 deaths by race and ethnicity in the US. [Adapted from: Pathak, Elizabeth B., et al. Racial and Ethnic Disparities in COVID-19 Mortality
Figure 10.8: Number of new HIV cases by race and ethnicity in the US, as of 2019. [Adapted from: CDC. “HIV in the United States by Race/ ethnicity: HIV Incidence.” Centers for Disease Control and Prevention, 26 June 2023.]
Figure 10.9: Residents of Flint, Michigan protest the ongoing water crisis, 2015. [Image credit: Danny Miller / The Flint Journal-MLive.com via AP.]
Figure 10.10: Visitors viewing the AIDS Memorial Quilt on the National Mall in Washington DC, USA, on 11 October 1987. [Image credit: CAROL M. HIGHSMITH ARCHIVE, LIBRARY OF CONGRESS/SCIENCE PHOTO LIBRARY.]
Figure 10.11 COVID-19 hospitalization rates increased with age. [Adapted from: Garg, Shikha, et al. “Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus
Disease 2019 - COVID-NET, 14 States, March 1-30, 2020.” MMWR. Morbidity and Mortality Weekly Report, vol. 69, no. 15, Apr. 2020, pp. 458–64, doi:10.15585/mmwr.mm6915e3.]
Figure 10.12: Rates of poverty by race and ethnicity in the US from 1990 to 2020. [Adapted from: Poverty Rate by Race and Ethnicity. https://www.pgpf.org/ chart-archive/0255_poverty_by_race.]
Figure 10.13: Paid leave for new parents. [Adapted from: Livingston, Gretchen. “Among 41 Countries, Only U.S. Lacks Paid Parental Leave.” Pew Research Center, 16 Dec. 2019.]
Figure 10.14: Medical distrust. [Adapted from: Lily Chylek]
Figure 10.15: Ebola safe burial. [Adapted from: Global, C. D. C. File:Ebola Illustration- Safe Burial (15573264517).jpg https://commons. wikimedia.org/wiki/File:Ebola_illustration-_safe_burial_%2815573264517%29.jpg. || Adapted from: Maxmen, Amy. “How the Fight Against Ebola Tested a Culture’s Traditions.” National Geographic, Jan. 2015.]
Figure 10.16: Adequate sleep. [Adapted from: CDC. “How Much Sleep Do I Need?” Centers for Disease Control and Prevention, 14 Sept. 2022.]
Figure 10.17: US deaths by drug-involved overdose among all ages, by gender from 1999 to 2021. [Adapted from: National Institute on Drug Abuse. “Drug Overdose Death Rates.” National Institute on Drug Abuse, 30 June 2023.]
Icon 10.1: Education. [Thought Café]
Icon 10.2: Employment. [Thought Café]
Icon 10.3: Income & Wealth. [Thought Café]
Icon 10.4: Health Insurance & Healthcare. [Thought Café]
Icon 10.5: Housing. [Thought Café]
Icon 10.6: Ethnicity. [Thought Café]
Icon 10.7: Race. [Thought Café]
Icon 10.8: Sex. [Thought Café]
Icon 10.9: Gender. [Thought Café]
Icon 10.10: Sexual Orientation. [Thought Café]
Icon 10.11: Age. [Thought Café]
Icon 10.12: Disability. [Thought Café]
Icon 10.13: Healthy Behaviors. [Thought Café]
QR Code: US Poverty. [“Maps & Data.” Poverty USA.]
Chapter 11
Figure 11.1: Dr. Donald A. Henderson, an American medical doctor, epidemiologist, and educator. [Image credit: Wikifier at English Wikipedia. Photo of Dr. /10Donald Henderson a week after receiving the Presidential Medal of Freedom in Summer 2002. 15 January 2009, Public Domain, via Wikimedia Commons, https://commons. wikimedia.org/wiki/File:DAHenderson.jpg.]
Figure 11.2: The Black Death. [Image credit: Pierart dou Tielt. “Miniature by Pierart dou Tielt illustrating the Tractatus quartus bu Gilles li Muisit (Tournai, c. 1353). The people of Tournai bury victims of the Black Death. ms. 13076 - 13077 fol. 24v.” Circa 1353, Public Domain, via Wikimedia Commons. Adapted from original source and accessed via Wikimedia Commons, CC BY 4.0 Deed, https://creativecommons.org/licenses/ by/4.0/, “Gilles Li Muisis, Antiquitates Flandriae (Tractatus Quartus).” BALaT KIK-IRPA.]
Figure 11.3: Christenings and mortality numbers in the United Kingdom for the years
1605 and 1606. [Adapted from: Wikipedia contributors. “File:Bill of Mortality 1606. Jpg.” Bill of Mortality for 1606, Retrieved from The Collection of the Bills of Mortality from the archive from the The Ohio State University. Public Domain. Wikipedia, The Free Encyclopedia.]
Figure 11.4: Mary Mallon in isolation in the Long Island Sound. [Image credit: New York Public Library / SCIENCE PHOTO LIBRARY.]
Figure 11.5: The 10 essential public health services. [Adapted from: CDC. “10 Essential Public Health Services.” Public Health Professionals Gateway, 31 May 2024.]
Figure 11.6: Public health primary areas of intervention. [Adapted from: Ware, Andy. “Health Departments: The Key to Furthering the Mission of Public Health.” Fairbanks School of Public Health Blog.]
Figure 11.7 Risk of COVID-19 infection and mask-wearing. [Adapted from: Stay Safe - Mask Up! https://www.valleyhealth.com/ trending/stay-safe-mask.]
Figure 11.8: Public signs during the 1918 influenza pandemic. [Image credit: “1918 Historical Image Gallery,” March 2, 2018, Centers for Disease Control and Prevention, https://www.cdc.gov/, National Center for Immunization and Respiratory Diseases (NCIRD), https://www.cdc.gov/ncird/index. html CDC Archives.]
Figure 11.9. Public health goals for prevention and control of infectious disease. [Adapted from: Lily Chylek, Taylor Brock-Fisher, Molly Kemball, and Eugenia Rojas Puente.]
Figure 11.10: Collaborative Public Health Response. [Adapted from: Lily Chylek, Taylor Brock-Fisher, Molly Kemball, and Eugenia Rojas Puente.]
Figure 11.11: Classification of public health agencies. [Adapted from: Lily Chylek]
Figure 11.12: Infection rates after reopening of businesses and schools. [Adapted from: Bruckhaus, Alexander, et al. “Post-Lockdown Infection Rates of COVID-19 Following the Reopening of Public Businesses.” Journal of Public Health (Oxford, England), vol. 44, no. 1, Oxford University Press (OUP), Mar. 2022, pp. e51–e58, doi:10.1093/pubmed/fdab325.]
Figure 11.13: Public trust in public health. [Adapted from: Lily Chylek]
Icon 11.1: Personal Protective Equipment (PPE). [Thought Café]
Icon 11.2: Social Distancing. [Adapted from: Lily Chylek]
Icon 11.3: Healthcare Workers and Research Scientists. [Adapted from: Lily Chylek]
Icon 11.4: Epidemiologists. [Adapted from: Lily Chylek]
Icon 11.5: Public Health Officials. [Adapted from: Lily Chylek]
Icon 11.6: Public Health Policymakers. [Adapted from: Lily Chylek]
Icon 11.7: The Public. [Adapted from: Lily Chylek]
Icon 11.8: Public Health Tooklit for Outbreak Response. [Adapted from: Eric Diotte, Lily Chylek, Xinyi Christine Zhang, Taylor BrockFisher, Eugenia Rojas Puente, Elizabeth Heppenheimer, Pardis Sabeti]
Icon 11.9: Navigating Outbreak Response. [Adapted from: Lily Chylek, Taylor BrockFisher, Eugenia Rojas Puente]
Icon 11.10: Navigating an Outbreak as an Individual. [Adapted from: Cathy Happi]
Icon 11.11: Wash Your Hands. [Adapted from: Cathy Happi]
Icon 11.12: Your Toolkit for Outbreak Response. [Adapted from: Eric Diotte, Lily Chylek, Taylor Brock-Fisher, Molly Kemball, Eugenia Rojas Puente, Pardis Sabeti]
Icon 11.13: The Future of Outbreak Prevention and Response. [Thought Café]
QR Code: Outbreaks Near You. [Outbreaks Near Me, 2024, https://outbreaksnearme.org/us/ en-US.]
QR Code: 2025 National Notifiable Conditions (Historical) [Centers for Disease Control and Prevention (CDC), 2025, https://ndc.services. cdc.gov/search-results-year/]
QR Code: HealthMap [HealthMap, 2025, https:// www.healthmap.org/en/.]
Chapter 12
Figure 12.1: Laurie Garrett, an American explanatory journalist and author. [Image credit: With permission from Laurie Garrett.]
Figure 12.2 Scroll texts. [Image credit: “Byzantine liturgical parchement scroll, 13th century. Exhibited in the Byzantine and Christian Museum in Athens. Picture by Giovanni Dall’Orto, November 12, 2009.” 12 November 2009, Public Domain, via Wikimedia Commons.]
Figure 12.3: Micrographia book by Robert Hooke. [Image credit: Robert Hooke. “MICROGRAPHIA or some physiological descriptions of minute bodies made by magnifying glasses with observations and inquiries thereupon.” Title page, 1665. Public Domain, via Wikimedia Commons. || Image credit: Robert Hooke. “MICROGRAPHIA or some physiological descriptions of minute bodies made by magnifying glasses with
observations and inquiries thereupon.” Schem. XXXIII, 1665. Public Domain, via Wikimedia Commons.]
Figure 12.4: Lynn Poole, creator and host of the Science Review TV show. [Image credit: Special Collections, Sheridan Libraries, Johns Hopkins University.]
Figure 12.5: Science communication timeline. [Adapted from: Lily Chylek, Sellers Hill, Molly Kemball, Pardis Sabeti, and Eugenia Rojas]
Figure 12.6: The network of science communication. [Adapted from: Lily Chylek, Sellers Hill, Pardis Sabeti, Eugenia Rojas]
Figure 12.7: From the bench to publication. [Adapted from: Lily Chylek]
Figure 12.8: Scientific collaboration and science communication during outbreaks. [Adapted from: Lily Chylek]
Figure 12.9: Primary news source by age in the US population in 2018. [Adapted from: Shearer, Elisa. “More than Eight-in-Ten Americans Get News from Digital Devices.” Pew Research Center, 12 Jan. 2021.]
Figure 12.10: A map showing the levels of respiratory illness reported in each US state. [Adapted from: CDC. “Weekly US Map: Influenza Summary Update.” Centers for Disease Control and Prevention, 19 Jan. 2024.]
Figure 12.11: Illustrated guidelines for how to wear a mask effectively to reduce the spread of airborne pathogens. [Adapted from: Masking. https://sonomacounty.ca.gov/ health-and-human-services/health-services/ divisions/public-health/disease-control/ covid-19/masking.]
Figure 12.12: Examples of different visual communication approaches used in science and public health. [Adapted from: CDCTB. “Reported TB in the U.s., 2020- National Data.” Centers for Disease Control and Prevention, 26 Oct. 2021. || Adapted from: Infographics 7 Nov. 2023, https://www.cdc.gov/tb/publications/infographic/default.htm. || Adapted from: TB Transmission (1/2) https://www.cdc. gov/tb/webcourses/tb101/page1699.html. ||
Adapted from: Tuberculosis Photos. 23 May 2023, https://www.cdc.gov/vaccines/vpd/tb/ public/photos.html.]
Figure 12.13: An example of a subtly misleading illustration of the history of infectious disease outbreaks. [Adapted from: Deputy Prime Minister and Chancellor of the Duchy of Lancaster by Command of His Majesty. UK Biological Security Strategy https://assets. publishing.service.gov.uk/government/ uploads/system/uploads/attachment_data/ file/1161970/UK_Biological_Security_Strategy. pdf. Parliament. || Originally appeared as part of: LePan, N. “Infographic: The History of Pandemics, by Death Toll.” Visual Capitalist, 2020.]
Figure 12.14: Mary Mallon’s obituary, published in a prominent newspaper on November 13, 1938. [Image credit: With permission from The San Diego Union-Tribune, https://www.sandiegouniontribune.com/ news/local-history/story/2020-03-13/ recalling-typhoid-mary.]
Figure 12.15: Infodemic response in our connected world. [Adapted from: Lily Chylek]
Figure 12.16: Citizen science projects. [Image credit: Modified from Mosquito Alert Website, http://www.mosquitoalert.com/en/project/ what-is-mosquito-alert/, CC BY Mosquito Alert license.]
Icon 12.1: Scientists. [Adapted from: Lily Chylek]
Icon 12.2: Public Health Professionals. [Adapted from: Lily Chylek]
Icon 12.3: Journalists. [Adapted from: Lily Chylek]
Icon 12.4: Educators. [Adapted from: Lily Chylek]
Icon 12.5: Popular Science Communicators. [Adapted from: Lily Chylek]
Icon 12.6: You. [Adapted from: Lily Chylek]
Icon 12.7: Accessible. [Adapted from: Lily Chylek]
Icon 12.8: Actionable. [Adapted from: Lily Chylek]
Icon 12.9: Accurate. [Thought Café]
Icon 12.10: Clear & Concise. [Adapted from: Lily Chylek]
Icon 12.11: Timely. [Adapted from: Lily Chylek]
Icon 12.12: Relevant. [Adapted from: Lily Chylek]
Icon 12.13: Sensitive. [Adapted from: Lily Chylek]
Icon 12.14: Transparent. [Thought Café]
Icon 12.15: Managing Trade Offs. [Adapted from: Lily Chylek]
Icon 12.16: Navigating Risk Information. [Adapted from: Nadzeya_Dzivakova. “Vector Illustration of a Young Attractive Stressful Woman Surrounded.” iStock.]
Icon 12.17: Interpersonal Communications. [Adapted from: Lily Chylek]
QR Code: 1918 Flu Pandemic. [CDC Archives https://archive.cdc.gov/#/details?url=https:// www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html.]
QR Code: Ebola Genomics Data Sharing [“Data sharing: Make outbreak research open access,” Yozwiak, NL, Schaffner, SF, & Sabeti, PC, 2015.]
QR Code: USA Today Article on CDC and Covid-19 [“How the CDC failed public health officials fighting the coronavirus,” Murphy, B & Stein, L, 2021.]
QR Code: Johns Hopkins COVID-19 Dashboard. [“COVID-19 Map.” Johns Hopkins Coronavirus Resource Center.]
QR Code: Mosquito Alert Interactive Map. [“Mosquito Alert Map.” Mosquito Alert.]
Unit 5: Advanced Topics in Epidemiology
Chapter 13
Figure 13.1: A portrait of Daniel Bernoulli in 1750. [Image credit: Unbekannt. “Bernoulli, Daniel (1700-1782),” circa 1750. ETHBibliothek (Library) Zürich, Bildarchiv, Image Archive / Fotograf: Unbekannt / Portr_10971 / Public Domain Mark. Circa 1750, Public Domain, via Wikimedia Commons.]
Figure 13.2: Diagram of the SIR model. [Adapted from: Lily Chylek]
Figure 13.3: Data sources that contribute to infectious disease model construction. [Adapted from: Zelner, Jon, and Marisa Eisenberg. “Rapid Response Modeling of SARS-CoV-2 Transmission.” Science, vol. 376, no. 6593, May 2022, pp. 579–80, doi:10.1126/ science.abp9498.]
Figure 13.4: Mathematical models help predict the weather. [Adapted from: “Why Is the Weather so Hard to Predict?” Let’s Talk Science, 23 Sept. 2019.]
Figure 13.5: Exponential growth of bacterial cells. [Adapted from: Nina Parker, Shenandoah University; Mark Schneegurt, Wichita State University; Anh-Hue Thi Tu, Georgia Southwestern State University; Philip Lister, Central New Mexico Community College; Brian M. Forster, Saint Joseph’s University. Microbiology. OpenStax, Rice University, 2016, https://openstax.org/ details/books/microbiology.]
Figure 13.6 Exponential growth of bacterial cells over time. [Thought Café]
Figure 13.7: Series of random coin flips generated by a computer model. [Adapted from: Lily Chylek]
Figure 13.8: Number of heads observed within 100 consecutive flips in 10,000 simulations. [Adapted from: Walker, John. Introduction to Probability and Statistics https://www.fourmilab.ch/rpkp/experiments/statistics.html.]
Figure 13.9: A linear function describing the relationship between two variables. [Adapted from: Lily Chylek]
Figure 13.10: A nonlinear function – a parabola, where y = t2 [Adapted from: Wilson, J. “Instructional Unit The Parabola: A Graphical Approach Day 4 & 5.” J Wilson, The University of Georgia.]
Figure 13.11: Filling a leaky bucket. [Adapted from: Loney, Norman. 7-040-TankInterruptMixingModelingScenario. QUBES Educational Resources, 2022, doi:10.25334/GB6D-SR10.]
Figure 13.12: Bacterial growth curve. [Adapted from: Growth Curves: Generating Growth Curves Using Colony Forming Units and Optical Density Measurements. 27 Sept.
2019, https://www.jove.com/v/10511/ growth-curves-cfu-and-optical-density-measurements.]
Figure 13.13: Movement of individuals through the compartments of the SIR model. [Adapted from: Lily Chylek]
Figure 13.14: A simple representation of the SIR model. [Conceptual Scientific Content, Sabeti Lab: Alex Petty, Arya Rao, Ivan Specht, Kavya Shah, Molly Kemball, Tomi Siyanbade, Lily Chylek, Eugenia Rojas.]
Figure 13.15: Rates of infection and removal. [Conceptual Scientific Content, Sabeti Lab: Alex Petty, Arya Rao, Ivan Specht, Kavya Shah, Molly Kemball, Tomi Siyanbade, Lily Chylek, Eugenia Rojas.]
Figure 13.16: Differential equations for movement between populations. [Conceptual Scientific Content, Sabeti Lab: Alex Petty, Arya Rao, Ivan Specht, Kavya Shah, Molly Kemball, Tomi Siyanbade, Lily Chylek, Eugenia Rojas.]
Figure 13.17: Graphic representation of SIR populations. [Adapted from: Macal, C. M., et al. “Figure 1: Typical SIR Model Solution Showing Progression of Population.” ResearchGate.]
Figure 13.18: Movement between the Susceptible and Infected compartments of an
SIS model. [Adapted from: Anand, Abhinav, et al. “Fig. 2. A Simulated SIS Model with the Initial Values of S, I as S(0) =.” ResearchGate.]
Icon 13.1: Stochastic. [Thought Café]
QR Code: William Farr’s Original Abstract from 1840. [“Annual report of the Registrar-General of births, deaths, and marriages in England 1838 - 1839,” HathiTrust, 2023.]
QR Code: SIR Model. [Introduction: Modeling Disease Spread: HHMI BioInteractive https:// media.hhmi.org/biointeractive/click/modeling-disease-spread/introduction.html.]
QR Code: Outbreak Mitigation Strategies. [Science Animated. What Can Mathematical Models Tell Us about How Infectious Diseases Affect Our Body? Youtube, 10 Aug. 2022, https://www.youtube.com/ watch?v=eA-dKLmnosY.]