Plague Epidemic Spreading at “Alarming Rate” in Madagascar

70+ Percent of the reported cases are highly virulent pneumonic plague: Health officials

The deadly disease outbreak has hit Madagascar’s two biggest cities, Antananarivo and Toamasina, and it’s spreading at an “alarming rate,” health officials said

“Normally, people who catch the plague live in poor areas, but people in every place in society are catching the disease,” Madagascar’s director of health promotion said.

More than 1,150 cases have been confirmed since August, with a fatality rate of about 10%.

About 70 per cent of the reported cases are pneumonic plague, a more virulent form of the disease that spreads through the inhalation of respiratory droplets/small particles produced by an infected person.

“Plague can be a very severe disease in people, with a case-fatality ratio of 30% to 60% for the bubonic type, and is always fatal for the pneumonic kind when left untreated,” said WHO.

Outbreak of Marburg virus disease (MVD)

An outbreak of Marburg virus disease (MVD) that has appeared in eastern Uganda on the border with Kenya, according to WHO.

“At least one person is confirmed to have died of MVD and several hundred people may have been exposed to the virus at health facilities and at traditional burial ceremonies in Kween District, a mountainous area 300 kilometres northeast of Kampala.”

More…

Outbreak of Pneumonic Plague Kills Dozens in Madagascar

Ninety percent of the cases are pneumonic plague

“There is an epidemic in Madagascar which is currently affecting five districts [out of 112.] Eighty-six people have been inflicted by the plague, of which 39 have died,” the health ministry was reported as saying.

Pneumonic plague is a severe type of lung infection caused by the bacterium Yersinia pestis, and is more virulent and rarer than bubonic plague.

Although the deadly disease claimed its first victim sometime in October, the authorities didn’t declare the plague outbreak until November 23, said reports.

In 2012, plague killed more than 60 people in Madagascar, the highest toll globally.

What’s Plague?

Plague is an infectious disease caused by bacteria called Yersinia pestis. The bacteria are found mainly in rodents, particularly rats, and in the fleas that feed on them. Other animals and humans usually contract the bacteria from rodent or flea bites, the US National Institute of Health (NIH) said. The bacteria can also spread from person to person through the air by coughing. When transmission occurs through the air, Y. pestis infects the lungs. [See below for the disease forms.]

Historically, plague destroyed entire civilizations. In the 1300s, the “Black Death,” as it was called, killed approximately one-third (20 to 30 million) of Europe’s population. In the mid-1800s, it killed 12 million people in China. Today, thanks to better living conditions, antibiotics, and improved sanitation, current World Health Organization statistics show there were only 2,118 cases in 2003 worldwide.

About 20 people in the United States are diagnosed with bubonic plague each year caused by flea or rodent bites—mostly from infected prairie dogs—in countryside in the southwestern United States, according to NIH.  “About 1 in 7 of those infected die from the disease. There has not been a case of person-to-person infection in the United States since 1924.”

There have also been small plague outbreaks in Asia, Africa, and South America.

What’s Pneumonic Plague?

Image: Yersinia pestis. Fluorescence antibody positivity is seen as bright, intense green staining around the bacterial cell. [Source: CDC]

Facts about Pneumonic Plague [Information Sourced from CDC]

Image: Wayson stain of Yersinia pestis. Wayson stain of Yersinia pestis. Note the characteristic “safety pin” appearance of the bacteria. [Source: CDC]

Plague is an infectious disease that affects animals and humans. It is caused by the bacterium Yersinia pestis. This bacterium is found in rodents and their fleas and occurs in many areas of the world, including the United States.

Y. pestis is easily destroyed by sunlight and drying. Even so, when released into air, the bacterium will survive for up to one hour, although this could vary depending on conditions.

This patient presented with symptoms of plague that included gangrene of the right hand causing necrosis of the fingers. In this case, the presence of systemically disseminated plague bacteria Y. pestis, i.e. septicemia, predisposed this patient to abnormal coagulation within the blood vessels of his fingers. Photo: CDC 1975. Caption: CDC/ CDC/Dr. Jack Poland

Pneumonic plague is one of several forms of plague. Depending on circumstances, these forms may occur separately or in combination:

• Pneumonic plague occurs when Y. pestis infects the lungs. This type of plague can spread from person to person through the air. Transmission can take place if someone breathes in aerosolized bacteria, which could happen in a bioterrorist attack. Pneumonic plague is also spread by breathing in Y. pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague. Becoming infected in this way usually requires direct and close contact with the ill person or animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs.
• Bubonic plague is the most common form of plague. This occurs when an infected flea bites a person or when materials contaminated with Y. pestis enter through a break in a person’s skin. Patients develop swollen, tender lymph glands (called buboes) and fever, headache, chills, and weakness. Bubonic plague does not spread from person to person.
• Septicemic plague occurs when plague bacteria multiply in the blood. It can be a complication of pneumonic or bubonic plague or it can occur by itself. When it occurs alone, it is caused in the same ways as bubonic plague; however, buboes do not develop. Patients have fever, chills, prostration, abdominal pain, shock, and bleeding into skin and other organs. Septicemic plague does not spread from person to person.

Symptoms and Treatment

This patient presented with symptoms of plague that included gangrene of the right foot causing necrosis of the toes. In this case, the presence of systemically disseminated plague bacteria Y. pestis, i.e. septicemia, predisposed this patient to abnormal coagulation within the blood vessels of his toes. Photo CDC. Caption: CDC/William Archibald

With pneumonic plague, the first signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum. The pneumonia progresses for 2 to 4 days and may cause respiratory failure and shock. Without early treatment, patients may die.

Early treatment of pneumonic plague is essential. To reduce the chance of death, antibiotics must be given within 24 hours of first symptoms. Streptomycin, gentamicin, the tetracyclines, and chloramphenicol are all effective against pneumonic plague.

Antibiotic treatment for 7 days will protect people who have had direct, close contact with infected patients. Wearing a close-fitting surgical mask also protects against infection.

A plague vaccine is not currently available for use in the United States.

Plague Information: Infection Control

During the 1975 Rhodesian, (now Zimbabwe), Marburg epidemiologic investigation, health officials came across this African farmer with an inguinal bubo. Photo: CDC 1975. Caption: CDC/ Dr. J. Lyle Conrad

The epidemiologists uncovered an outbreak of plague amongst the local farmers, and treated these patients with oral antibiotics. Sanitarians were quickly dispatched to spray huts for fleas, and then trap rats carrying the pathogenic agent, Yersinia pestis bacterium.

• Plague: Prevention & Control
  From the CDC Plague Home Page, provided by the Division of Vector-Borne Infectious Diseases, NCID, CDC
• Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness
  Planning guide to help state, county, & local officials meet federal requirements to prepare for public health emergencies. Outlines five components of mass prophylaxis response to epidemic outbreaks. Addresses dispensing operations using a comprehensive operational structure for Dispensing/Vaccination Centers (DVCs) based on the National Incident Management System (NIMS). (Developed by Weill Medical College of Cornell University for the Agency of Healthcare Research & Quality [AHRQ].)
• Recognition of Illness Associated with the Intentional Release of a Biologic Agent (PDF 168 KB/20 pages)
• Bioterrorism Readiness Plan: A Template for Healthcare Facilities (PDF 1.5 MB/34 pages) See Section II: Agent-Specific Recommendations, Plague; pages 19-25.

This patient acquired a plague infection through abrasions on his upper right leg. Bubonic plague is transmitted through the bite of an infected flea, or as in this case, exposure to inoculated material through a break in the skin. Symptoms include swollen, tender lymph glands known as buboes. Photo: CDC 1975. Caption: CDC/ CDC/Dr. Jack Poland

This photograph depicts the shaved anterior thoracoabdominal region of a rock squirrel, Spermophilus variegatus, formerly known as Citellus variegatus, which is afflicted with the plague. This squirrel is displaying a petechial rash, which is similar in appearance to those found on humans also afflicted with Yersinia pestis. A petechial rash refers to small, pinpoint, flat lesions of the skin and mucous membranes that are associated with hemorrhages beneath the skin surface. Photo: CDC 1977. Caption: CDC/ William Archibald; Laboratory/ Ft. Collins

Related Links

• Epidemic of Pneumonic Plague in Ukraine? October 30, 2009
• Pneumonic Plague Strikes Chinese Town August 2, 2009

Plague-infected Squirrel Found in Los Angeles-area Campground

Squirrel tests positive for plague in Angeles National Forest North of LA

A ground squirrel has tested positive for plague after it was trapped in the Angeles National Forest during “routine surveillance activities,” said the Los Angeles County Department of Public Health.

The LA County has released the following health advisory:

HEALTH ADVISORY: Closures Posted for Broken Blade, Twisted Arrow, and Pima Loops of the Table Mountain Campgrounds Due to Plague Found in a Ground Squirrel

Closure signs posted in the Angeles National Forest near Wrightwood

LOS ANGELES – Los Angeles County Department of Public Health and U.S. Forestry Service officials have closed the Broken Blade, Twisted Arrow, and Pima Loops of the Table Mountain Campgrounds in the Angeles National Forest after tests confirmed that one ground squirrel trapped on July 16, 2013 during routine surveillance activities tested positive on July 23, 2013 for plague. The sites were officially closed at 1:00 p.m. today, and will be closed for at least 7 days. Campers at the site have been notified of the closure by Forest Service officials. The campgrounds and recreational areas are located near Wrightwood. In coordination with the Los Angeles County Department of Agriculture/Weights and Measures, the squirrel burrows in the area will be dusted for fleas. Further testing of squirrels will be done before the area is re-opened to the public.

“Plague is a bacterial infection that can be transmitted to humans through the bites of infected fleas, which is why we close affected campgrounds and recreational areas as a precaution while preventive measures are taken to control the flea population,” said Jonathan E. Fielding, M.D., M.P.H., Director of Public Health and Health Officer. “It is important for the public to know that there have only been four cases of human plague in Los Angeles County residents since 1984, none of which were fatal.”

Plague has been known to reside in the ground squirrels population in the San Gabriel Mountains. Previous routine surveillance identified one plague-positive ground squirrel in 2010 from the Los Alamos campgrounds in Gorman; one in 2007 and two in 1996 from the Stoneyvale Picnic Area near La Cañada/Flintridge; and one plague- positive ground squirrel from an adjacent campground in Vogel Flats in 1995.

Transmission of plague through flea bites causes bubonic plague, with symptoms including enlargement of lymph glands (buboes) near the flea bite and rapid onset of fever and chills. Untreated bubonic plague can progress to infection of the blood, or rarely, the lungs, causing pneumonic plague. All forms of the disease can be fatal if not treated; however, most patients respond well to antibiotic therapy.

Individuals visiting recreational areas near the Broken Blade, Twisted Arrow, and Pima Loops of the Table Mountain Campgrounds need to take certain precautions to avoid contact with wild animals that could be carrying plague- positive fleas. Visitors to recreational areas should not feed wild animals, not leave edible trash out where wild animals can get to it, avoid camping or picnicking in the immediate vicinity of ground squirrel burrows, and should avoid taking pets into areas where they could be exposed to fleas. If you must take your pet into areas with fleas, please ensure your pet has appropriate flea control and vaccinations, as recommended by a veterinarian.

“Protection with an insect repellant containing DEET is also recommended for persons visiting the Angeles National Forest and engaging in outside recreational activities in other areas of LA County,” said Dr. Fielding. Insect repellant can help protect people against fleas, mosquitoes, and ticks. Products containing DEET are not safe for use on pets.”

Members of the public who see dead ground squirrels in recreational areas, or who want more information about precautions should contact the LA County Department of Public Health, Vector Management Program at (626) 430-5450.

The Department of Public Health is committed to protecting and improving the health of the nearly 10 million residents of Los Angeles County. […]

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