By Michelle Forman, Senior Media Specialist, APHL
Anyone who was in grade-school in the mid-1980s and 1990s likely remembers The Oregon Trail, a computer game where you had to navigate the treacherous conditions faced by American pioneers who used this lone passageway to travel from Independence, Missouri to Oregon City, Oregon. If you ask anyone who played the game what they learned, however, it was that the Apple II had terrible graphics. They also likely remember fording the river, hunting buffalo, and losing a family member to dysentery. What many children may not have realized as they played this game is that the experiences were real. The Oregon Trail was real and so were the many diseases faced by those who traveled it.
You have died of dysentery. Everyone has cholera. Susie has measles. As a young player, these messages would pop up on our screen and result and in “Aw, man!” They meant that your trek was delayed or even over. You had to find more food or water or just wait out whatever the disease was that had infected someone in your wagon. But what are these diseases? And do they still exist?
Three deadly diseases featured in The Oregon Trail – typhoid fever, cholera and dysentery– were caused by poor sanitation. Luckily, those of us living in industrialized nations (United States, Canada, Japan, Western Europe, etc.) have access to sophisticated modern sanitation and water treatment systems, which make these diseases so rare that they are nearly non-existent. But the “deadly three” are not rare in developing nations. Americans traveling to these destinations are often encouraged to get vaccinated and to be extra careful to thoroughly wash their hands, avoid tap water and consume only cooked foods.
If typhoid fever, cholera and dysentery are left untreated, they can become deadly, causing severe dehydration. In industrialized nations, anyone who contracts these diseases is protected by the medical and public health systems, and the spread of disease is halted. If an outbreak is suspected, public health laboratories test samples to positively identify the agent that is causing the disease, while epidemiologists and public health nurses work in coordination with sanitarians to identify the source of the infection. This quick action is what stops further transmission.
- Typhoid fever is caused by Salmonella Typhi, a bacterium that is contracted by consuming contaminated food or drink. Once a person has Typhoid fever, they can shed the bacteria in their stool or urine for days to weeks and potentially make others ill. Typhoid fever is rare in the United States – there are approximately 400 cases each year and 75% of those are acquired while traveling internationally.
- Cholera is a diarrheal illness caused by a toxigenic form of a bacterium called Vibrio cholera. The bacteria are generally transmitted in water or food that has been contaminated with infected feces. You may remember the cholera outbreak in Haiti following the deadly earthquake there. The quake caused serious damage to the nation’s infrastructure which led to deteriorated sanitation and public health systems. Cholera spreads rapidly in areas where drinking water is contaminated. That was the problem for those on the Oregon Trail just as it was in Haiti.
- Dysentery is also a diarrheal illness and is often caused by Shigella species (bacillary dysentery) or Entamoeba histolytica (amoebic dysentery). Like cholera and Typhoid fever, dysentery is contracted when people consume food or water that is contaminated with infected feces. In developed nations, dysentery is often more quickly identified, treated and the spread controlled.
The other diseases that plagued those traveling on – or playing – The Oregon Trail were highly contagious infectious diseases. When an entire family was living in their Conestoga wagon for months at a time, disease spread very quickly. Fortunately, widespread use of vaccines has all but wiped out these diseases.
- Diphtheria is caused by the bacteria Corynebacterium diphtheriae. It is spread person-to-person generally by respiratory droplets (that is, a cough or a sneeze) or cutaneous lesions (do NOT do a Google image search for that – trust me). Prior to the introduction of the vaccine, between 100,000-200,000 people in the U.S. contracted diphtheria each year. The vaccine (DTaP: diphtheria, tetanus, and pertussis) is routinely given to children in the U.S. and other industrialized nations. Thanks to this, there has not been a single CDC confirmed case of diphtheria in the United States since 2003. It is still endemic in certain developing nations so travelers are encouraged to check that their DTaP booster is up to date.
- Measles is a highly contagious respiratory disease caused by a virus called rubeola that is spread person-to-person. It is so contagious, that a child who is exposed to it and is not immune will almost certainly contract the disease. Now there is a vaccine available to all children in the United States (MMR: measles, mumps, and rubella) although there has recently been a decline in the number of people seeking vaccination. Prior to the vaccine being available, hundreds of Americans died annually and thousands experienced severe complications. Once the vaccine was made available, there was a dramatic decrease in cases. In fact, in 2000 CDC declared measles “eliminated” as almost all cases originated outside of the country. Now we’re seeing hundreds of cases in the U.S. – 118 cases during the first 19 weeks of 2011 (not even the entire year!). And last year there were over 26,000 cases in the World Health Organization (WHO) European Region (EUR). So while I wish I could say that measles is like the other diseases of The Oregon Trail, and is virtually nonexistent in the industrialized world, that is no longer true.
A common practice when playing The Oregon Trail was to name all of your family members for your friends. Then as the game progressed, we would all laugh when Sally got dysentery – Haha! You have dysentery! You have dysentery! It isn’t so funny now, huh? I certainly wouldn’t wish these terrible diseases on anyone, and can better understand how amazing it is that anyone made it along the Oregon Trail. It is a relief to be able to say that most of these diseases are gone, thanks to our strong public health system.
And, Sally, I’m sorry I laughed when you got dysentery.
- Hawaii’s Unique Public Health Challenges: Rat Lungworm (aphl.org)
- In response to the State of the Union: What are the labs doing? (aphl.org)