The Staggers

The Staggers is a disease originating in Marivar, where it was most common in the northern provinces of the Marivan Empire as an endemic disease, where it was most common in the over 60s and where around a tenth of the population beyond that age would experience it in one form or another before they died. It was generally recognised as being infectious though a long incubation period before symptoms emerged delayed recognition of this.

Causes

The disease is passed by a parasite - a worm that inhabits the gut and secretes low levels of neurotoxins that vcause the progression of the illness. Violent purging therefore can work to remove the worm but not necessarily to counteract the damage done. The oily fish diet allows the toxin to be stripped from the body which, if the damage done is limited allows the appearance of a cure. As the diet does not harm the worm it needs to be maintained to keep the disease in remission, at least until the worms are purged from the gut.
Because it is sread by poor hygeine it is common in dense populations, though periodic gatherings can be enough to give significant spread. Those with descent from northern Marivans are generally more resistant to infection and the effects of the toxin than those who have not co-existed with the worm and this explains the ravages that the disease wrought on the Taru.

Symptoms

The staggers can remain symptomless for many years. The symptoms begin with a loss of muscle control in the limbs and balance, producing the staggering walk that gives the disease its name. Deliberate movements are rarely affected but the small, unconscious movements needed to maintain balance when standing, especially in unstable conditions are where the impact is first seen. As the disease progresses these become more pronounced and gradually the disease begins to affect other types of muscles, progressing to the muscles of the gut and eventually the heart, at which point it is usually fatal.

Treatment

The disease is treatable and if caught in the earliest stages a complete recovery is possible. A diet heavy in oily fish is the most usual treatment but other methods are practised in inland areas. A hot dry climate also appears to stem the progress of the disease and impede its transmission.

Prognosis

Left untreated the disease gradually progresses from the voluntary to the involuntary muscles. With moderate care and support from others this stages impacting voluntary muscles are not too troublesome, though falls and resulting injuries are an increasing risk. With the loss, or inconsistent control of gut muscles the problems become more severe and these often accelerate death by other causes before the inevitably fatal spread of the impairment to breathing and the heart. In the northern Marivaran areas where it originates this progress from first onset of symptoms to direct fatality takes 15 to 20 years however in the Taru populations of Tarusia, who seem to lack the levels of resistance to infection and progression of the disease seen in those of north Tarusian descent, symptoms can emerge in a matter of weeks from infection with death from heart failure as little as 3 months later.

Sequela

If treated early, recovery is complete and lasting damage is minimal - a slightly impaired sense of balance being noticeable in around half of effectively treated patients. If treatment is delayed then the condition stabilises but full recovery is rare.

Affected Groups

Appears to only affect humans with significant racial variations in the impact. It also appears to be limited to temperate and sub-arctic areas as it is not encountered in the southern parts or Marivar or Tarusia.

Prevention

Prevention or cure? The high fish diet used to treat the early stages of the disease also appears to provide some protection, probably by treating as yet asymptomatic cases rather than by preventing infection in the first place.

Epidemiology

The infectious nature of the disease was unnoticed for many years due to the typically long asymptomatic period during which people can often be infectious. It is spread by coughs and sneezes resulting from other infections and appears to have limited ability for indirect transmission. Infectiousness is greatest during the staggering phase of the disease but seems to drop off rapidly as it begins to affect the digestive tract.

History

Known among the people of northern Marivar for many years the disease was, in conjunction with The Sweats largely responsible for the elimination of the Taru from the northern parts of Tarusia following the arrival of migrants from Marivar.

Cycle

Chronic, Acquired