title: Cultural factors that affected the spatial and temporal epidemiology of kuru.
abstract: Kuru is a prion disease which became epidemic among the Fore and surrounding linguistic groups in Papua New Guinea, peaking in the late 1950s. It was transmitted during the transumption (endocannibalism) of dead family members at mortuary feasts. In this study, we aimed to explain the historical spread and the changing epidemiological patterns of kuru by analysing factors that affected its transmission. We also examined what cultural group principally determined a family's behaviour during mortuary rituals. Our investigations showed that differences in mortuary practices were responsible for the initial pattern of the spread of kuru and the ultimate shape of the epidemic, and for subsequent spatio-temporal differences in the epidemiology of kuru. Before transumption stopped altogether, the South Fore continued to eat the bodies of those who had died of kuru, whereas other linguistic groups, sooner or later, stopped doing so. The linguistic group was the primary cultural group that determined behaviour but at linguistic boundaries the neighbouring group's cultural practices were often adopted. The epidemiological changes were not explained by genetic differences, but genetic studies led to an understanding of genetic susceptibility to kuru and the selection pressure imposed by kuru, and provided new insights into human history and evolution.
authors.affiliation: MRC Prion Unit and Department of Neurodegenerative Diseases , UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery , Queen Square, London WC1N 3BG , UK.
authors.forename: J T
authors.identifier: 0000-0003-4878-0897
authors.initials: JT
authors.lastname: Whitfield
authors.affiliation: Papua New Guinea Institute of Medical Research , PO Box 60, Goroka, Eastern Highlands Province , Papua New Guinea.
authors.forename: W H
authors.initials: WH
authors.lastname: Pako
authors.affiliation: MRC Prion Unit and Department of Neurodegenerative Diseases , UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery , Queen Square, London WC1N 3BG , UK.
authors.forename: J
authors.initials: J
authors.lastname: Collinge
authors.affiliation: MRC Prion Unit and Department of Neurodegenerative Diseases, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; International Health Research, Curtin University, Room 108, Shenton Park Campus, GPO Box U1987, Perth, Western Australia 6845, Australia; Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province, Papua New Guinea.
authors.forename: M P
authors.initials: MP
authors.lastname: Alpers
keywords: cannibalism; epidemiology; kuru; mortuary rites; prion; transumption