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| Credit CDC |
#14,524
Last June, in WHO WER: Plague Around The World, we looked at a WHO WER (Epidemiological Weekly Record) review of the 2017 Madagascar Plague outbreak which saw hundreds of confirmed and probable cases.
Globally, a couple of thousand plague cases are reported each year, mostly in rural areas of Africa, Asia, and South America, with Madagascar the hardest, and most consistently hit region.
Bubonic Plague (Yersinia Pestis) - carried by rats and
transmitted by fleas - sets up in the lymphatic system, resulting in the
tell-tale buboes, or swollen lymph glands in the the groin, armpits,
and neck.
Bubonic plague is the most common - and most treatable - presentation, however in rare cases, Pneumonic Plague may develop.
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| Credit CDC |
Here the infected person develops a severe pneumonia, with coughing and hemoptysis (expectoration of blood), and may spread the disease by droplets from human-to-human.Last May, two people reportedly died from bubonic plague in Mongolia - where plague is endemic in rodents - and over the past couple of days a new report of two cases of pneumonic plague from Mongolia have appeared in the Chinese and International press (see Crof's report).
Today, Hong Kong's CHP has published the following notification, which provides a little more information on these cases plus it provides some travel advice as well.
Modern medicine, particularly the advent of effective antibiotics, makes plague far less fearsome than it once was, but Madagascar's recent epidemics, and a large 1994 India outbreak that infected more than 5,000 people (see WHO Summary), show that large urban outbreaks are still possible.
The Centre for Health Protection (CHP) of the Department of Health today (November 14) received notification from the National Health Commission of two cases of pneumonic plague affecting a man aged 48 and a woman aged 46 in Inner Mongolia.
The male patient is a herder while the female patient is his wife. According to epidemiological investigations and clinical presentations, the couple were diagnosed to have pneumonic plague on November 12.
A spokesman for the CHP said, "Plague is transmitted from an infected animal (mainly rodents) to humans through the bite of its fleas. Plague can also be contracted when cuts or other breaks in the skin come into contact with the body fluid or tissue of infected animals."
Pneumonic plague is a kind of plague which is highly contagious. It can spread between humans by inhalation of respiratory droplets from an infected person. The incubation period of the disease is commonly between one and four days. Symptoms of pneumonic plague include fever, chills, cough with blood-stained sputum, and difficulty in breathing. Infections can cause rapid fatality if not treated immediately.
The spokesman reminded travellers to avoid visiting plague-endemic areas. They should also heighten vigilance on rodents and prevent flea bites. Insect repellents against mosquitoes may equally prevent flea bites and blood-sucking insects. Formulations in lotions or sprays should contain DEET, IR3535 or icaridin (also known as picaridin) as active ingredients. The public should refer to the CHP's tips for using insect repellents.
"Travellers returning from affected areas with sudden onset of fever, shaking chills, body pains or chest discomfort should seek medical advice as soon as possible and reveal their travel history for prompt investigation and management. Plague is a statutorily notifiable disease and doctors should report suspected or confirmed cases to the CHP for investigations and control," the spokesman added.
Travellers should take heed of the health advice below during travel:Travellers may visit the CHP's plague page, Travel Health News and the Food and Environmental Hygiene Department's advice on rodent control for details.
- Prevent flea bites by wearing long-sleeved shirts and trousers, and applying insect repellent/insecticide. DEET-containing insect repellent can be applied to exposed skin and clothing, while insecticide containing permethrin can be applied to clothing, not the skin;
- Avoid going to rural areas, camping or hunting;
- Never touch rodents, dead animals and their tissues or contaminated materials;
- Avoid close contact with patients, especially those with cough or chest infection;
- Avoid going to crowded areas;
- Seek medical care immediately in case of sudden onset of fever, chills, painful lymph nodes, difficulty in breathing with coughing and/or blood-tainted sputum; and
- Consult a doctor immediately after contact or exposure to pneumonic plague patients or high-risk exposures, such as bites from fleas or direct contact with body fluids or tissues of potentially infected animals, for prompt assessment of the need for preventive medication.
Ends/Thursday, November 14, 2019
The US reports an average of seven human plague cases each year (range: 1–17 cases per year) - mostly bubonic - and almost always in the Western states. The last major urban outbreak of plague in the United States occurred in 1924-25 in Los Angeles.
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| CREDIT CDC |
A highly recommended read (if you can find a copy) for both history and epidemic aficionados.
