For my next Shadowrun campaign, I'm working on an alt-history setting, set in 2032. This is the first piece of background I've completed, an encyclopedia entry about VITAS (annotated in familiar Shadowrun fashion).

Why VITAS? Because, in my alt-history, it began the wave of changes that lead to the world of 2032, and I needed an in-depth explanation of exactly what the disease was.

Here it is. Comments welcome.

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VITAS (Virally Induced Toxic Allergy Syndrome)

VITAS, Virally Induced Toxic Allergy Syndrome, is an unique auto-immune disease which causes the body to become allergic to previously innocuous allergens. (Unique as no other autoimmune disease provokes allergic—Type I Hypersensitivity—responses.) These new allergies cause anaphylactic reactions in the infected, the observed anaphylaxis symptoms varying from mild—syncope (i.e. loss of consciousness), rashes, shortness of breath—to lethal—myocardial infarction or asphyxiation.

In normal circumstances, most people display no severe allergies. VITAS alters this dynamic as all infected become sensitive to a few allergens, and many became allergic to a multitude of allergens. Common allergens include wheat or milk, metal or vinyl, pet dander or dust mite excretions. VITAS can cause sensitivity to these and nearly any other allergen. The dangers to specific individuals vary according to which allergens they became sensitive to and how severe their anaphylaxis symptoms are.

> Something not mentioned, but important: these allergies were acquired for life. The virus changed the host’s body so you became allergic, and the allergies stuck around after the disease was cured.

Talk to anyone who survived the plague, and ask them what’s it’s like to be allergic to half a dozen random things, like metal or vinyl. Know how many things are made out of metal? Imagine that every time you touched a spoon or a car you got a rash, or fainted, or had an asthma attack. Plus, each time you’re exposed, you have a good chance of your reaction becoming stronger. Touch metal too much, and you can find your windpipe closing or your heart stopping. VITAS is still killing people, decades after the disease went away.
- Orc Rights Crusader

> Catch that? “Unique disease.” Let me translate that for you: no other disease in human history, before or since, has provoked allergic reactions. None. There are simply no other diseases that operate like this one does. That’s not natural. Don’t let anyone tell you otherwise.
- Paranoid w/ Enemies

> Let me guess. Vampires, Elves, Dragons, Big Pharma, Big Brother, Stuffer Shack, and NERPS are out to get you and engineered this virus to do just that, “Paranoid w/out Braincells”. Thanks for the heads-up.

Look kids, there are a lot of unknowns in biology and medicine, a lot of mysteries and idiosyncrasies. And that was before magic entered the picture. So, hey, how about tamping down the insanity? Sometimes, sh*t just happens.
- Lost Cause

Transmission

VITAS in an air-borne virus, simply breathing the same air as an infectious individual can transmit the disease. Once contracted, the disease has a latent period of 3-6 days, during which the carrier is infected but not symptomatic. The first symptoms are extremely mild, consisting of a light rash, shortness of breath, or lightheadedness. Severe symptoms, present in roughly half of all patients, usually begin 12-24 hours later. In most cases, VITAS infections last 5-6 weeks from the onset of first frank symptoms.

VITAS has an infectiousness of 75%; 3 in 4 individuals exposed to the virus become ill. Among those infected, it has a untreated lethality of approximately 55%. Between 5 and 6 out of of 10 infected but untreated people die.

> So, where did it go? Like a lot of lethal pandemics, it just burned itself out. It spread too fast, killed too often. Evolutionarily speaking, it was just too vicious to survive. Thank God.
- Global Anarchist

Treatment

VITAS treatment is entirely symptom-based; physicians manage the symptoms until the disease has run its course. VITAS-induced anaphylaxis can be treated with either steroids or, in acute cases, epinephrine. As steroids suppress the immune system, this often leaves the subject open to opportunistic infections (which require antibiotics to treat). Use of antibiotics strengthens the immune system, which can make VITAS symptoms worse. Physicians balance the dangers of both diseases when fashioning a course of treatment. Each case requires an approach tailored to that individual.

Due to the difficulty of managing a treatment regimen, the length of time required, and the expense of sustained care, the disease usually proves lethal to those manifesting severe symptoms. In the vast majority of cases, those who survived never developed severe symptoms.

> VITAS was not a disease that could be treated conventionally. Those who progressed to severe symptoms—about half the infected—died 99% of the time, whether medicines were administered or not. Even after the CDC and USAMRIID understood the disease well enough to devised a treatment, attending physicians had to constantly monitor the patient’s condition for a month and a half, balancing steroids and antibiotics, without making any mistakes. Most of them failed, no surprise. In short order, it became common to triage those with severe symptoms as untreatable. They were given pain meds and allowed to pass away.

And, since there were no known medications that could prevent the onset of severe anaphylaxis, it became a “pray-and-hope” disease. VITAS is considered the modern Black Death for good reason: we were just as vulnerable to it as Europe was to the Black Death. No prevention, no treatment, no cure.
- Broke-Down Back-Country Doc

Outbreak

The VITAS outbreak of summer 2010 began in a remote region of India, on the Chinese border, and was first reported to the World Health Organization by workers in outlying Indian villages. (Though later investigation showed that it was simultaneously spreading among Chinese peasants, the Chinese government failed to report any cases until the first mass graves were dug, sometime in late August.) It soon spread to several neighboring countries and the United Kingdom. Within a month, it became a global pandemic.

Once the disease entered the population most countries experienced death rates of 35% to 40%. (Though certain regions experienced greater or lesser death rates.) Worldwide, this translated to approximately 2.3 billion deaths, making VITAS the most lethal pandemic in human history. During the height of the plague years, from 2010-2011, the world population decreased from 6.5 billion to 4.2 billion.

> VITAS was a lot like the Black Death in other ways. BD caused massive political and cultural upheaval, so did VITAS. It was the proximate cause of the Balkanization of China, the breakup of the EU, and the birth of the NAN (among other things). The current global climate was shaped by two events: VITAS and the Awakening. And we haven’t seen the end of either’s effects.
- PoliSci Perpetrator

“VITAS” in The American Encyclopedia, 2021 Online Edition. Dr. William Kohl, MD; Pathologist, USAMRIID.

I like it so far. Nice detail.

A few things I would alter to make it more in line with medicine, at least as far as I am educated. I am not a medical professional, but if you know one, this would be awesome to run by them.

**addendum, this is an amateurs opinion who has been independently interested in this topic. This is research I have read, which does not guarantee the veracity of my conclusions, or the validity of the source.

An Auto-immune disease is defined as a bodily system in which its defenses, it's anti-bodies, attack healthy cells, causing them to swell. It is not an "allergy" in the classic sense though, and requires no stimulus whatsoever, and can happen in hypo-allergenic conditions. This is not an allergy. You would need to decide if this truly relies on a second irritant, like allergens, or if it's auto-immune. Also, I believe that auto-immune diseases, while often triggered by a virus, require a genetic predisposition. That being the case, if VITAS was an auto-immune trigger in those without a predisposition, it would have to be a retrovirus. I'd actually suggest allergy sensitivity.

Allergic reactions, as I am aware, do not typically result in slow moving symptoms, and the external symptoms are almost entirely secondary to the primary reaction, which is swelling. Anaphylaxis suffocation is a result in the swelling of tissue surrounding the esophagus. Symptoms involving air loss would happen all at once; rather than shortness of breath or lightheadedness coming on soon. Respiratory reactions for standard allergens would be more appropriate; think "common cold" that won't go away, but no fever from an allergic reaction.

Toxic by-products are another possibility, though less in line with your symptoms. Toxic-allergic pneumonopathy, or allergic reaction infecting the lungs directly, would be most in line I think.

You might also consider Toxic Shock Syndrome type advance, which is also in-line with the pneumonopathy above: new allergic reactions creates an infection vector for an otherwise mild or non-lethal bacterial strain, and the bodies inability to fight it by location can lead to death. Originally it was found that foreign objects lead to climates ideal for and infection vectors for Staph. Tampons was the first well publicized case I know of.



The point is, the allergic reactions weaken immune system and allows for bacterial infection.

This is, at the end of the day, a fictional disease. I'd just be careful to pick one approach.

Thanks for the compliment, the info, and the questions. It's exactly the kind of feedback I was looking for.

Detailing the disease was my goal, for good reason—it allows me to develop the campaign world in more detail. For example:

The campaign is set in 2032, 21 years after VITAS. Per the writeup, about 2/5ths of the population older than 21 caught the virus and survived. This means that many people will suffer from several moderate to severe allergies to different substances. And those 31 or older lived through a time where about 37% of the population—friends, relatives, public figures—died, and civilization came close to collapsing. All of this is background color (aka "meaningless fluff") but it does inform what the world is like, including PC's and NPC's.

The downside of detail is that, in many cases, it means the details don't quite match with reality. And, I freely admit, that the VITAS writeup description probably doesn't. But, I do have answers for some of the questions you asked, and I think they clarify things.

First, real-world medicine: There are a certain class of substances (called allergens) which can prompt an inappropriate immune response, resulting in anaphylaxis. Anaphylaxis can cause many different reactions (some of which I included in the writeup) ranging from annoying to lethal. Most people aren't susceptible to anaphylactic responses, they're not allergic to any given allergen.

All of the preceding paragraph is, so far as I know, actual medicine. On to the fiction.

VITAS is a virus that modifies the body's immune system, via mechanisms that aren't fully understood (even in 2032). It causes the body to become susceptible to new allergens, and increases the severity of anaphylactic response to all allergens. It can even cause the body to become allergic to substances that aren't, strictly speaking, allergens.

The disease itself isn't lethal. Instead, it makes the body vulnerable to a condition that can be: anaphylaxis. Only when a person encounters an allergen do they suffer symptoms, the rest of the time they are asymptomatic. If a patient were kept from contacting any allergen, they would be perfectly safe. The disease makes this impossible, however, as it can cause the body to react to nearly anything as if it were an allergen.

Real medicine (AFAIK): Allergies are acquired in two stages. The first time someone encounters an allergen they could be susceptible to, there is no visible reaction. Instead, the body preps itself to defend against the allergen, as if it were a parasite or infection. The second exposure triggers anaphylaxis, usually a mild reaction. Further exposures to the allergen usually causes the reactions to worsen.

VITAS causes the body to become susceptible to allergens that its immune system would normally ignore. As the individual comes into contact with more and more allergens, VITAS causes more and more immune reactions. The second exposure to any given allergen prompts an anaphylactic response.

Thus, the course of the disease: when first infected, you are asymptomatic for 3-6 days. During this time, the disease is spreading through your system and you are gaining new allergies (as you encounter allergens). The first mild anaphylactic reactions begin occurring after this period, as you encounter the allergens a second time.

Further contact with any given allergen causes more and more severe anaphylaxis (in roughly 50% of patients) and, due to environmental factors, severe reactions usually occur 12-24 hours after the first frank symptoms. (If the person comes into contact with an allergen at least twice in 3-6 days, the chances they will encounter it a third time are pretty high.) Any occurrence of severe anaphylaxis is a death sentence. First because the anaphylaxis itself is usually lethal (causing asphyxiation or heart attacks) and second because it means that any other allergens they encounter will cause similar reactions.

I shouldn't have defined VITAS as an autoimmune disease. It is a disease that affects the immune system, but not an auto-immune disease. I'll clarify that.

The limited research I did indicated that these were examples of mild anaphylactic reactions. I built the entire disease around the idea that it caused anaphylaxis, in severities running from mild to lethal. All of the symptoms and disease progression assume induced allergies to various substances, leading to anaphylaxis. This wasn't clear in the original post, however, and I need to correct that.

True. And your point is well-taken: even if fictional, it should be more-or-less consistent with medical facts. I did do some research to try and achieve that, even if it may not seem like it.

I hope the above clarify what I intended the disease to be. For my part, I will go back and revise the writeup to make the above points more apparent.

Thanks for taking the time to comment.