Thursday, November 08, 2012

Peru: Alert For Bubonic Plague In Ascope Region


Credit CDC


# 6704


Despite having effective medications to treat it, bubonic plague still claims a fair number of lives each year around the world. While occasionally seen in the United States, it is far more common in other parts of the world.


According to the CDC: Between 1,000 and 2,000 cases each year are reported to the World Health Organization(WHO), though the true number is likely much higher.


The illness is caused by the bacterium, Yersinia pestis, and is most often passed to humans via the bites of infected fleas carried by rodents.




A hat tip this morning goes to Gert van der Hoek on Flutrackers for posting a report from El Commercio  on what appears to be a small outbreak of bubonic plague in Ascope province, located in the La Libertad Region of Peru. A brief excerpt:


La Libertad Health Management declared green alert in all health facilities in the region, due to an epidemic outbreak of bubonic plague in the province of Ascope, located an hour from Trujillo .

The alert was given as a preventive measure, after learning that two adults and a child had been infected with the disease last week.


Another source, Correo, carries the following statement from the Health Department.


Freedom in health alert

November 7, 2012 | Trujillo -

To prevent plague generate further deaths, the health sector health alert declared in all health facilities in the region of La Libertad.


According to the resolution regional management No. 2035-2012-GR-LL-GGR-GRSS, signed by the Sector Manager, Henry Rebaza Iparraguirre, declared an epidemiological alert for fever in all health services that integrate the regional grid system Epidemiological Surveillance.


ON ALERT. According to the regional authority, has been detected as endemic areas (where the health situation has made it their living space) to the province of Ascope Cascas and three districts of Alto Chicama (Callancas, Charat and Usquil).


Ensures that the measure seeks to alert the health care network in the region, the presentation of a plague outbreak in the district of Chocope (Ascope) and other infected areas where circulation is determined Yersinia pestis (plague-causing bacteria ) in reservoirs and in areas that are still silent epidemiological department of La Libertad.


"It is necessary to strengthen health services and community participation to have an adequate response capacity and effective, for which public and private institutions must join forces with an integrated work and enterprise," he says.


Finally, said the outbreak of rats in the port of Salaverry and was treated and will be maintained Pest control in the next two weeks.


This is not the first time that bubonic plague has been reported in Peru.  In August of 2010, an outbreak was reported in the same region (Ascope), and involved all three types of plague; bubonic, pneumonic, and septicemic.


This from the World Health Organization’s GAR Alert:


Plague in Peru


10 August 2010 - As of 30 July 2010, the Ministry of Health in Peru confirmed a total of 17 cases of plague in Ascope province of Department La Libertad. Of these, four are pneumonic plague, 12 are bubonic plague and one was septicemic plague. The onset of symptoms for the last reported case of pneumonic plague was on 11 July 2010. During the investigations, 10 strains of Y. pestis were isolated from humans, rodents and domestic cats.


The control measures being implemented include insect control in households located in high risk areas, strengthening of disease surveillance and case management, contact tracing, and sensitization of the affected population.


WHO is working with the Ministry of Health in assisting La Libertad with the outbreak investigation and response activities in affected areas and the surrounding districts.


For a description of the different types of plague, we go to the CDC’s Plague Symptoms Page.



Plague symptoms depend on how the patient was exposed to the plague bacteria. Plague can take different clinical forms, but the most common are bubonic, pneumonic and septicemic.

Plague signs



Bubonic plague is the most common presentation. and is named for the characteristic swelling of the lymph nodes (buboes) seen with the illness.  Septicemic plague is an infection of the bloodstream, and can lead to multiple organ failure and death


In some cases, however, Pneumonic Plague may develop. Here the infected person develops a severe pneumonia, with coughing and hemoptysis (expectoration of blood), and may spread the disease from human-to-human.


Luckily modern antibiotics are pretty good at treating plague. Without treatment, however, mortality rates run 40%-60%.  Untreated, pneumonic plague is almost always fatal.


While rare, the United States sees about 7 cases (range 1-17) of plague each year. The CDC has some advice on how to avoid this illness, by way of this 2-page PDF file.




While there is no vaccine available, with the advent of effective antibiotics, large scale outbreaks of plague are increasingly rare. 


In 1994 - the last big plague year -India reported more than 5,000 cases (see MMWR  Human Plague -- India, 1994), but since then the numbers reported each year have been considerably reduced.


I confess to having a strong interest in Plague, which stems from my working as a paramedic in Phoenix, Arizona where plague cases are occasionally found, and my reading – at the tender age of 11 – of James Leasor’s  The Plague and The Fire.




I’ve no doubt that this account of two incredible years in London’s history (1665-1666) - which began with the Great plague, and ended with the Fire of London – have unduly influenced my life, and interests, over the past 47 years.


Proving, I guess, that we should be careful what we read at an impressionable age.

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