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This is a list of the largest known epidemics and pandemics caused by an infectious disease. Widespread non-communicable diseases such as cardiovascular disease and cancer are not included. An epidemic is the rapid spread of disease to a large number of people in a given population within a short period of time; in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.[1] Due to the long time spans, the first plague pandemic (6th century – 8th century) and the second plague pandemic (14th century – early 19th century) are shown by individual outbreaks, such as the Plague of Justinian (first pandemic) and the Black Death (second pandemic).
Infectious diseases with high prevalence are listed separately (sometimes in addition to their epidemics), such as malaria, which may have killed 50–60 billion people throughout history, or about half of all humans that have ever lived.[2]
Major epidemics and pandemics
By death toll
Ongoing epidemics and pandemics are in boldface. For a given epidemic or pandemic, the average of its estimated death toll range is used for ranking. If the death toll averages of two or more epidemics or pandemics are equal, then the smaller the range, the higher the rank. For the historical records of major changes in the world population, see world population.[3][4]
| Rank | Epidemics/pandemics | Disease | Death toll | Percentage of population lost | Years | Location |
|---|---|---|---|---|---|---|
| 1 | Spanish flu | Influenza A/H1N1 | 17–100 million | 1–5.4% of global population[5] | 1918–1920 | Worldwide |
| 2 | Plague of Justinian | Bubonic plague | 15–100 million | 25–60% of European population[6] | 541–549 | North Africa, Europe, and Western Asia |
| 3 | HIV/AIDS pandemic | HIV/AIDS | 43 million (as of 2024[update]) | [a] | 1981–present[7] | Worldwide |
| 4 | Black Death | Bubonic plague | 25–50 million | 30–60% of European population[8] | 1346–1353 | Europe, Asia, and North Africa |
| 5 | COVID-19 pandemic | COVID-19 | 7–35 million[9][10] (as of 2024[update]) | [a] | 2020–present[11][12][b] | Worldwide |
| 6 | Third plague pandemic | Bubonic plague | 12–15 million | – | 1855–1960 | Worldwide |
| 7 | Cocoliztli epidemic of 1545–1548 | Cocoliztli, caused by an unidentified pathogen | 5–15 million | 27–80% of Mexican population[13] | 1545–1548 | Mexico |
| 8 | Antonine Plague | Smallpox or measles | 5–10 million | 25–33% of Roman population[14] | 165–180 (possibly up to 190) | Roman Empire |
| 9 | 1520 Mexico smallpox epidemic | Smallpox | 5–8 million | 23–37% of Mexican population[13] | 1519–1520 | Mexico |
| 10 | 1918–1922 Russia typhus epidemic | Typhus | 2–3 million | 1–1.6% of Russian population[15] | 1918–1922 | Russia |
| 11 | 1957–1958 influenza pandemic | Influenza A/H2N2 | 1–4 million | – | 1957–1958 | Worldwide |
| 12 | Hong Kong flu | Influenza A/H3N2 | 1–4 million | – | 1968–1969 | Worldwide |
| 13 | Cocoliztli epidemic of 1576 | Cocoliztli | 2–2.5 million | 50% of Mexican population[13] | 1576–1580 | Mexico |
| 14 | 735–737 Japanese smallpox epidemic | Smallpox | 2 million | 33% of Japanese population[16] | 735–737 | Japan |
| 15 | 1772–1773 Persian Plague | Bubonic plague | 2 million | – | 1772–1773 | Persia |
| 16 | Naples Plague | Bubonic plague | 1.25 million | – | 1656–1658 | Southern Italy |
| 17 | 1846–1860 cholera pandemic | Cholera | 1 million+ | – | 1846–1860 | Worldwide |
| 18 | 1629–1631 Italian plague | Bubonic plague | 1 million | – | 1629–1631 | Italy |
| 19 | 1889–1890 pandemic | Influenza or human coronavirus OC43[17][18] | 1 million | – | 1889–1890 | Worldwide |
Depopulation of the Americas
Not included in the above table are many waves of deadly diseases brought by Europeans to the Americas and Caribbean. Western Hemisphere populations were ravaged mostly by smallpox, but also typhus, measles, influenza, bubonic plague, cholera, malaria, tuberculosis, mumps, yellow fever, and pertussis. The lack of written records in many places and the destruction of many native societies by disease, war, and colonization make estimates uncertain. Deaths probably numbered in the tens or perhaps over a hundred million, with perhaps 90% of the population dead in the worst-hit areas. Lack of scientific knowledge about microorganisms and lack of surviving medical records for many areas makes attribution of specific numbers to specific diseases uncertain.
Infectious diseases with high prevalence
There have been various major infectious diseases with high prevalence worldwide, but they are currently not listed in the above table as epidemics/pandemics due to the lack of definite data, such as time span and death toll.
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- Malaria has had multiple documented temporary epidemics in otherwise non-affected or low-prevalence areas, but the vast majority of its deaths are due to its constant prevalence in affected areas.[2]
- Tuberculosis (TB) became epidemic in Europe in the 18th and 19th century, showing a seasonal pattern, and is still taking place globally.[20][21][22] The morbidity and mortality of TB and HIV/AIDS have been closely linked, known as "TB/HIV syndemic".[22][23] According to the World Health Organization, approximately 10 million new TB infections occur every year, and 1.5 million people die from it each year – making it the world's top infectious killer (before COVID-19 pandemic).[22] However, there is a lack of sources which describe major TB epidemics with definite time spans and death tolls.
- Hepatitis B: According to the World Health Organization, as of 2019[update] there are about 296 million people living with chronic hepatitis B, with 1.5 million new infections each year. In 2019, hepatitis B caused about 820,000 deaths, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).[24] In many places of Asia and Africa, hepatitis B has become endemic.[25] In addition, a person is sometimes infected with both hepatitis B virus (HBV) and HIV, and this population (about 2.7 million) accounts for about 1% of the total HBV infections.[24]
- Hepatitis C: According to the World Health Organization, there are approximately 58 million people with chronic hepatitis C, with about 1.5 million new infections occurring per year. In 2019, approximately 290,000 people died from the disease, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).[26] There have been many hepatitis C virus (HCV) epidemics in history.[27][28][29]
Chronology
Events in boldface are ongoing.
| Event | Years | Location | Disease | Death toll (estimate) | Ref. |
|---|---|---|---|---|---|
| 1350 BC plague of Megiddo | c. 1350 BC | Megiddo, land of Canaan | Amarna letters EA 244, Biridiya, mayor of Megiddo complains to Amenhotep III of his area being "consumed by death, plague and dust" | Unknown | [30] |
| Hittite Plague/"Hand of Nergal" | c. 1330 BC | Near East, Hittite Empire, Alashiya, possibly Egypt | Unknown, possibly Tularemia. Mentioned in Amarna letter EA 35 as the "Hand of Nergal", cause of death of Šuppiluliuma I. | Unknown | |
| Plague of Athens | 430–426 BC | Greece, Libya, Egypt, Ethiopia | Unknown, possibly typhus, typhoid fever or viral hemorrhagic fever | 75,000–100,000 | [31][32][33][34] |
| 412 BC epidemic | 412 BC | Greece (Northern Greece, Roman Republic) | Unknown, possibly influenza | 473,000 (10% of the Roman Population) | [35] |
| Antonine Plague | 165–180 (possibly up to 190) | Roman Empire | Unknown, possibly smallpox | 5–10 million | [36][37] |
| Jian'an Plague | 217 | Han Dynasty | Unknown, possibly typhoid fever or viral hemorrhagic fever | 2 Million | [38][39] |
| Plague of Cyprian | 249–262 | Europe | Unknown, possibly smallpox | 310,000 | [40][41] |
| Plague of Justinian (beginning of first plague pandemic) | 541–549 | Europe and West Asia | Bubonic plague | 15–100 million | [6][42][43] |
| 580 Dysentery Epidemic in Gaul | 580 | Gaul | Dysentery or possibly smallpox | 450,000 (10% of the Gaul population) | [44] |
| Roman Plague of 590 (part of first plague pandemic) | 590 | Rome, Byzantine Empire | Bubonic plague | Unknown | [45] |
| Plague of Sheroe (part of first plague pandemic) | 627–628 | Bilad al-Sham | Bubonic plague | 25,000+ | |
| Plague of Amwas (part of first plague pandemic) | 638–639 | Byzantine Empire, West Asia, Africa | Bubonic plague | 25,000+ | [46] |
| Plague of 664 (part of first plague pandemic) | 664–689 | British Isles | Bubonic plague | Unknown | [47] |
| Plague of 698–701 (part of first plague pandemic) | 698–701 | Byzantine Empire, West Asia, Syria, Mesopotamia | Bubonic plague | Unknown | [48] |
| 735–737 Japanese smallpox epidemic | 735–737 | Japan | Smallpox | 2 million (approx. 1⁄3 of Japanese population) | [16][49] |
| Plague of 746–747 (part of first plague pandemic) | 746–747 | Byzantine Empire, West Asia, Africa | Bubonic plague | Unknown | [46] |
| Black Death (start of the second plague pandemic) | 1346–1353 | Eurasia and North Africa | Bubonic plague | 75–200 million (30–60% of European population and 33% percent of the Middle Eastern population) | [50] |
| Sweating sickness (multiple outbreaks) | 1485–1551 | Britain (England) and later continental Europe | Unknown, possibly an unknown species of hantavirus | 10,000+ | [51] |
| 1489 Spain typhus epidemic | 1489 | Spain | Typhus | 17,000 | [52] |
| 1510 influenza pandemic | 1510 | Asia, North Africa, Europe | Influenza | Unknown, around 1% of those infected | [53] |
| 1520 Mexico smallpox epidemic | 1519–1520 | Mexico | Smallpox | 5–8 million (40% of population) | [13] |
| Cocoliztli epidemic of 1545–1548 | 1545–1548 | Mexico | Possibly Salmonella enterica | 5–15 million (80% of population) | [54][55][56][57] |
| 1557 influenza pandemic | 1557–1559 | Asia, Africa, Europe, and Americas | Influenza | 2.5–5 Million (10% of the infected) | |
| 1561 Chile smallpox epidemic | 1561–1562 | Chile | Smallpox | 120,000–150,000 (20–25% of native population) | [58] |
| 1563 London plague (part of the second plague pandemic) | 1563–1564 | London, England | Bubonic plague | 20,100+ | [59] |
| Cocoliztli epidemic of 1576 | 1576–1580 | Mexico | Possibly Salmonella enterica | 2–2.5 million (50% of population) | [54][55][56][57] |
| 1582 Tenerife plague epidemic (part of the second plague pandemic) | 1582–1583 | Tenerife, Spain | Bubonic plague | 5,000–9,000 | [60] |
| 1592–1596 Seneca nation measles epidemic | 1592–1596 | Seneca nation, North America | Measles | Unknown | [61] |
| 1592–1593 Malta plague epidemic (part of the second plague pandemic) | 1592–1593 | Malta | Bubonic plague | 3,000 | [62] |
| 1592–1593 London plague (part of the second plague pandemic) | 1592–1593 | London, England | Bubonic plague | 19,900+ | [63] |
| 1596–1602 Spain plague epidemic (part of the second plague pandemic) | 1596–1602 | Spain | Bubonic plague | 600,000–700,000 | [64] |
| 1600–1650 South America malaria epidemic | 1600–1650 | South America | Malaria | Unknown | [citation needed] |
| 1603 London plague (part of the second plague pandemic) | 1603 | London, England | Bubonic plague | 40,000 | [65][66][67] |
