ECDC Rapid Risk Assessment: Plague In Madagascar

 

# 9416

 

A couple of weeks ago, in WHO: Plague Returns To Madagascar, we looked at what has become an annual occurrence – a spike in plague cases on that island country of 22 million people.  Plague (Yersinia Pestis) is a bacterial infection transmitted by fleas, carried by infected rats. 

 

The most common presentation is Bubonic plague, however in rare cases, Pneumonic Plague may develop, where the victim develops severe pneumonia and may spread the disease from human-to-human by coughing.

 

Even the United States sees a handful of cases each year, primarily in the Western states (see Colorado DPH Statement On 4 Cases Of Plague). Since plague is fairly easily treated with antibiotics, it is pretty well controlled in the developed world.

 

Yesterday the ECDC published a Rapid Risk Assessment on the most recent outbreak in Madagascar, which has begun earlier in the fall than usual.  As we’ve come to expect, it provides excellent historical context and background information on the disease.

The risk beyond Madagascar is considered low, and the risk on that island is primarily in the higher elevations (above 800 m), where the disease has become well entrenched in the local rat population.  There have been at least two recent cases reported in the heavily populated capital of Antananarivo, which has increased concerns.

 

First, a look at the latest ECDC Communicable Disease Threat’s update, then a link to the Rapid Risk Assessment.

 

Plague outbreak - Madagascar – 2014

Opening date: 24 November 2014 Latest update: 27 November 2014

Epidemiological summary

Since January 2014 and as of 5 December, 138 cases of plague including 47 deaths (CFR 34%) have been reported. Two percent of the reported cases have been of the pneumonic form. Sixteen districts of seven regions of Madagascar are affected.

Two cases including one death have been reported in the capital, Antananarivo, from two densely populated neighbourhoods.

Web sources: WHO | Media |

ECDC assessment
Cases of bubonic and pneumonic plague are not unexpected events in Madagascar. However, the recent occurrence of cases in the capital city highlights the risk of a rapid spread of the disease when occuring in densely populated areas with poor sanitation and a weak healthcare system.

Based on information currently available to ECDC, the risk of contracting plague for EU travellers to the affected area in Madagascar is considered to be unchanged and very low. The risk to visitors is very limited if they limit the risk of contact with rats and fleas.

Actions

ECDC published a rapid risk assessment on 5 December 2014.

 

 

RAPID RISK ASSESSMENT

Plague outbreak, August–November 2014, Madagascar

4 December 2014

Main conclusions and recommendations

In Madagascar an outbreak of plague has been evolving since 31 August 2014; as of 16 November 2014,
40 people have died from the disease.

The ongoing plague outbreak in Madagascar with 119 cases reported to the World Health Organization (as of
16 November 2014) was not an unexpected event. However, the recent occurrence of two cases in
Antananarivo, Madagascar’s capital, poses a potential risk of a rapid spread of the disease due to the city’s high population density, poor sanitation, deficient garbage collection, and the overall weakness of the healthcare
system.

Despite the risk of further spread, the risk of contracting plague for EU travellers to the affected area in
Madagascar is considered to be very low.

The local authorities are experienced in responding to plague outbreaks and have set up a control coordination committee with dedicated funding to support response measures. There is no restriction of movement in and out of Antananarivo, where the two urban cases occurred, which is consistent with the standard response to plague outbreaks in Madagascar.

Resistance of Yersiniapestisto antibiotics seems very limited. However, circulating strains are monitored to
provide accurate public health information on Y. pestis antimicrobial susceptibility.

WHO does not recommend any travel or trade restrictions based on the current information available for this
outbreak.

(Continue . . . )

 

Xinhua News: Plague Quarantine Lifted In NW China

Credit CDC

 

 

# 8861

 

 

Last Friday, while writing about the Colorado DPH Statement On 4 Cases Of Plague, I also mentioned the report of a single case of pneumonic plague in Gansu Province in North Central China (see CHP notified by NHFPC of plague case in Gansu ).

 

Yesterday it was widely reported that parts of one (or more) cities were `sealed off’ or under quarantine (see Reuters Parts of Chinese city in quarantine after plague death: Xinhua). 

 

While they make great copy, reports such as these out of China are difficult to verify. In researching this report, I found several conflicting stories in the Chinese press going back 5 or 6 days.  

 

Today Xinhua News is reporting that – after 9 days – that quarantine has been lifted, while appearing to downplay (or omit) the size of the quarantine action. 

 

Plague quarantine lifted in NW China

English.news.cn   2014-07-24 11:53:15

LANZHOU, July 24 (Xinhua) -- Yumen City in northwest China's Gansu Province on Thursday lifted a nine-day quarantine on an area in which plague caused one death.

A total of 151 people who had close contact with the infected man had been put in quarantine and under medical observation. None of them has reported symptoms of the disease, according to a report submitted by the local authorities and approved by the provincial government.

Plague is categorized as a Class A infectious disease, the most serious under China's Law on the Prevention and Treatment of Infectious Diseases.

A 38-year-old man in Yumen died of plague on July 16. He had been in contact with a dead marmot, a member of the squirrel family.

During the quarantine, local authorities aided with disease prevention, and control specialists sent by the National Health and Family Planning Commission carried out disinfection and rat extermination and educated locals on how to guard against plague.

The experts said plague is currently in a communicable, "active" phase among the local rat population.

 

 

As the Chinese press often indulges in euphemisms, so `disinfection, rat extermination & educating locals’ could entail a litany of strong, proactive steps by local public health authorities. 

 

Whatever the truth of the matter, for now this event appears to be under control.

Colorado DPH Statement On 4 Cases Of Plague

Credit CDC

 

 

# 8849

 

Last week in Family Pets, Zoonoses & An Upcoming COCA Call, we briefly discussed a recent story of a man, and his dog, who had contracted plague in Colorado.  While rare – the United States sees perhaps a dozen human cases each year. 

 

But what made this case doubly unusual is that the man was diagnosed with pneumonic plague.

 

Bubonic Plague (Yersinia Pestis) is a bacterial infection transmitted by fleas, carried by infected rats.   The infection generally sets up in the lymphatic system, resulting in the tell-tale buboes, or swollen lymph glands in the the groin, armpits, and neck. 

Credit CDC

In rare cases 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.

 

Since plague is fairly easily treated with antibiotics, it isn’t much of a public health menace in the developed world. In areas where treatment isn’t readily available, however, mortality rates run 40%-60% and untreated pneumonic plague is almost always fatal.

Today, the Colorado Department of Public Health has announced that three contacts of the originally infected dog developed mild infections, but have recovered following antibiotic therapy.   

 

It isn’t entirely clear from this release the type of plague infection (bubonic, septicemic, or pneumonic) that these contacts developed but a Denver Post story (Three more cases of plague identified in Colorado) indicates two developed the pneumonic version.

 

First the statement, then I’ll be back with just a bit more:

 

News release: Three additional Colorado residents identified with plague

FOR IMMEDIATE RELEASE:  July 18, 2014

CONTACT:

Mark Salley, Communications Director

303-692-2013

mark.salley@state.co.us

The Colorado Department of Public Health and Environment has identified three additional Colorado residents with plague, for a total of four cases. The investigation of the original case identified three individuals, each of whom had direct contact with the previously reported dog that had died of plague. They all had mild symptoms, were treated with appropriate antibiotics, recovered, and no longer are contagious. The initial patient remains hospitalized.

The dog likely was exposed to a prairie dog or rabbit with plague-infected fleas in eastern Adams County.

Tri-County Health Department officials, the Centers for Disease Control and Prevention and the Colorado Department of Public Health and Environment are continuing to work together to investigate these cases and prevent further illnesses. Although person-to-person transmission of plague is extremely rare, individuals who may have been exposed through close contact with the four cases have been identified, and have received antibiotic treatment or are being monitored for symptoms when indicated. 

Plague is spread by fleas from rodents, most commonly prairie dogs. Flea samples recently collected from eastern Adams County tested positive for plague bacteria. Tri-County Health Department staff members have gone door-to-door in the area with information about plague and to assess prairie dog populations. People and pets walking in open spaces and trails should avoid contact with prairie dogs, rabbits and other rodents.

Contact your physician if you develop a high fever and other plague symptoms following a fleabite or direct contact with dead rodents, or exposure to a sick cat or dog that may have had contact with plague-infected rodents. Symptoms of plague include a sudden onset of high fever, muscle pain, nausea and vomiting, or a general feeling of being ill. Individuals with pneumonic plague (the lung form) develop fever, headache, weakness, shortness of breath, chest pain and coughing, which can lead to respiratory failure. Pneumonic plague is the most serious form of the disease and is the only form of plague that can be spread from person to person (by infectious droplets from coughing). Although human cases occur infrequently, plague can be severe and potentially life-threatening if not detected and quickly treated with common antibiotics.

Dr. Jennifer House, public health veterinarian at the Colorado Department of Public Health and Environment, encourages people take the following precautions to prevent plague exposure:

• Do not directly handle any dead rodents, including prairie dogs, rabbits, squirrels, mice and rats.
• Keep pets away from wildlife, especially dead rodents.
• Don’t let dogs or cats hunt prairie dogs or other rodents.
• Don’t allow pets to roam freely.
• Treat pets for fleas according to a veterinarian's advice.
• Do not feed prairie dogs or other rodents. This attracts them to your property, brings them in close contact with other rodents and increases the risk of disease transmission.
• Be aware of rodent populations in your area, and report sudden die-offs or multiple dead animals to your local health department.

Plague often is identified when there is an unusual die-off of prairie dogs in an area. When an infected animal dies, the fleas leave the carcass to find another host, thus spreading the disease. Most human plague cases occur when humans are bitten by infected fleas. Less commonly, people are infected by direct contact with blood or tissues from an infected animal or from pets (primarily cats) that become infected and transmit the disease. Since 1957, Colorado has identified 60 cases of human plague, nine (15 percent) of which were fatal.

Additional information on plague can be found at: http://www.cdc.gov/plague

Contact CO-HELP (Colorado Health Education Line for the Public) at 303-389-1687, or outside the metro area call 1-877-462-2911 for more information or to report a dead prairie dog.

 

 

The last major urban outbreak of plague in the United States occurred in 1924-25 in Los Angeles.  Since then, only scattered cases have been reported, with about 7-15 cases each year in the U.S..

 

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 last really big plague outbreak was in India nearly 20 years ago, as summarized by the WHO, where  a total of 5150 suspected pneumonic or bubonic plague cases and 53 deaths were reported from eight states of India, primarily in the south-central and southwestern regions.

 

Although there is no vaccine available, with the advent of effective antibiotics, large scale outbreaks of plague are increasingly rare.  Still, the risk of infection is not zero, and so the CDC has some advice on how to avoid this illness by way of this 2-page PDF file.

 

Pneumonic plague is uncommon enough that today Hong Kong’s CHP carried a rare report of a single case from Gansu Province in North Central China (see CHP notified by NHFPC of plague case in Gansu )

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.

 

Symptoms

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.

 

 

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.

A Pathogen That Still Plagues Mankind

 

 

 

# 6382

 

 

In 1975, after completing my paramedic training in Florida, I was offered an ALS (Advance Life Support) ambulance job in Phoenix, Arizona.

 

On my first day there, I was given an orientation, which included information about threats I hadn't dealt with in my home state of Florida: Scorpion stings, Gila Monster bites, and bubonic plague.

 

Albeit rarely, bubonic plague still occurs in the United States. This map, from the CDC, shows areas of the world where plague is endemic, mostly in rodents.

 

 

The last major urban outbreak of plague in the United States occurred in 1924-25 in Los Angeles.  Since then, only scattered cases have been reported, with about 10-15 cases each year.

 

Globally, the World Health Organization reports between 1,000 and 3,000 cases occur each year.

 

Today the Associated Press is reporting on an Oregon man who is hospitalized in critical condition with what appears to be septicemic plague.

 

Plague: Central Ore. man contracts rare disease

PRINEVILLE, Ore. (AP) — A central Oregon man in his 50s is in critical condition at a Bend hospital after a form of plague infected his blood, according to a Crook County health official.

 

The disease can spread through contact with a sick animal or a bite from an infected flea. The man, who has not been identified, had contact with a sick cat.

(Continue . . . )

 

 

Plague is caused by a gram negative bacteria called Yersinia pestis. There are three types of plague (all caused by the same pathogen); bubonic, septicemic & pneumonic.

 

From the CDC’s brochure Protect Yourself From Plague, we get the following definitions:

• Bubonic plague is the most common form of the disease and typically occurs after the bite of an infected lea. The hallmark of bubonic plague is a swollen, painful lymph gland, called a “bubo,” usually in the groin, armpit, or neck. Other symptoms include fever, chills, headache, and extreme exhaustion. A person usually becomes ill with bubonic plague 2 to 7 days after being infected. If not treated early, the bacteria can spread from the bubo to other parts of the body.
• Septicemic plague occurs when bacteria multiply within the bloodstream. This may occur if bubonic plague is left untreated, but it can also occur in patients without a bubo. Symptoms include high fever, exhaustion, light-headedness and abdominal pain. Septicemic plague can rapidly result in shock and organ failure.
• Pneumonic plague occurs when the plague bacterium infects the lungs. This happens when bacteria spread through the bloodstream to the lungs or, less often, when bacteria are inhaled directly into the lungs. Symptoms include high fever, chills, cough, breathing difficulty, and bloody sputum. Pneumonic plague is almost always fatal if not treated rapidly.

 

 

Although most people are aware that plague is transmitted by the bites of infected fleas (who obtain the plague bacteria from rodents), it can also on rare occasions be transmitted from human-to-human (via droplet or saliva), and and can be contracted from contact with an infected animal, such as a mouse or squirrel. 

 

While it is uncommon, people can sometimes contract plague from their pets. Cats, which may have contact with infected rodents while roaming, can either bring back infected fleas, or become infected themselves.

 

 

The CDC offers the following advice on avoiding plague:

 

The good news is - that if diagnosed and treated early - plague responds well to several common antibiotics. 

 

My interest in plague began at the tender age of 11 when I read 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 45 years.

 

A cautionary note, I suppose, regarding what one ought to read at an impressionable age.

 

 

While Yersinia Pestis is assumed by most scientists to have been the cause of the Black Death of the Middle ages, there remains some controversy on that topic (see EID Journal: A Scholarly Debate).

 

Last year, Ed Yong, writing for Discover Magazine took a fresh look at the debate in The lost plague – London graveyards suggest that Black Death strain may be extinct.

 

While not a common disease in the United States, there have been some concerns that climate change could exacerbate the spread of Yersinia infected rodents, and increase the risks of infection (see Climate Change Eyed As Spreading Diseases).

 

For more on Plague, the CDC’s  DVBID (Division of Vector-Borne Diseases) maintains an extensive website on the pathgoen at:

 

http://www.cdc.gov/ncidod/dvbid/plague/

Uganda Outbreak Identified As Plague: Officials

 

 

UPDATED:  This story has been updated, and the diagnosis remains in doubt.   See OCHA: The Ugandan Outbreak By The Numbers

# 5123

 

After more than a month of speculation by local health officials and the media, we are seeing reports that officials have tentatively identified the outbreak of disease in the northern Ugandan district of Kitgum as pneumonic plague.

 

Previous blog entries on this outbreak include:

Updating Uganda’s Mystery Outbreak

Uganda: Unidentified Hemorrhagic Outbreak

 

 

A link to the Reuters report (h/t Shiloh on FluTrackers):

 

Pneumonic plague outbreak in Uganda: officials

 

Tue Dec 7, 2010 10:19am EST

KAMPALA (Reuters) - Pneumonic plague has broken out in northern Uganda, killing 38 people and putting dozens in hospital, a senior health official said Tuesday.

(Continue . . . )

 

 

Treyfish, posting on this FluTrackers thread, has another report from the Newvision website.

 

Mysterious Acholi disease is plague

By Conan Businge
and Chris Ocowun

PLAGUE, a disease that affects rodents but can be spread to humans and other animals by infected fleas, has hit the northern Ugandan district of Kitgum, the health ministry has confirmed.

(Continue . . .)

 

 

Although few people are aware of it, plague cases still occur and claim lives every year around the world. Even on rare occasions, in the United States.

 

In 1975, after completing my paramedic training in Florida, I was offered an ALS (Advance Life Support) ambulance job in Phoenix, Arizona.

 

On my first day there, I was given an orientation, which included information about threats I hadn't dealt with in my home state of Florida: Scorpion stings, Gila Monster bites, and bubonic plague.

 

This map, from the CDC, shows areas of the world where plague is endemic, mostly in rodents.

 

 

The last major urban outbreak of plague in the United States occurred in 1924-25 in Los Angeles.  Since then, only scattered cases have been reported, with about 10-15 cases each year.

 

Worldwide, on average, anywhere between 1,000 and 3,000 cases are reported each year.

 

Bubonic Plague (Yersinia Pestis) is a bacterial infection transmitted by fleas, carried by infected rats.   The infection generally sets up in the lymphatic system, resulting in the tell-tale buboes, or swollen lymph glands in the the groin, armpits, and neck.

 

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

 

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

 

In 1994, the last big plague year, 5000 suspected cases of bubonic plague and pneumonic plague occurred in Surat, India, with 100 deaths. 

EID Journal: A Scholarly Debate

 

 

# 4902

 

 

As I’ve pointed out many times in the past, science isn’t absolute, nor is scientific progress linear.   Sometimes the things we think we `know’ turn out to be wrong.

 

Throughout history we’ve accounts of epidemics and plagues for which medical historians have tried to determine a cause.   Some, like the high mortality `English Sweats’ of the 1500s, remain a mystery to this day.

 

Since viable tissue samples from victims hundred of years ago are rarely available, and contemporary medical science was practically non-existent, the case for some of these determinations is largely circumstantial.

 

Roughly 660 years ago a disease swept through Europe killing – in just a matter of five years – between a third and a half of the population.   Some estimates put the toll at between 100 and 200 million deaths.

 

It was known as the `Black Death’, because of the characteristic dark bubboes (swelling of the lymph nodes) in the neck, armpit, and groin. 

 

Over the next 500 years, more than 100 smaller outbreaks occurred across Europe and Asia. 

 

For more than 100 years the cause of this horrific event has been widely accepted as coming from the bites of fleas carrying a bacteria called Yersinia pestis – which they acquired from infected rats. 

 

Rats that arrived in Europe from the recently opened trade routes from the Orient, where Y. Pestis is endemic in small rodents (the bobak marmot).

 

This tidy, and widely accepted theory came from the research of scientists who visited Hong Kong in 1994 1894 to investigate an outbreak of plague.  Among them was Alexandre Yersin, from whose name we get Yersina, or Y. pestis.

 

Over the next ten years, a theory on how the disease was vectored (rats to fleas to human) was developed.

 

In 1893, before this research began, historian F. A. Gasquet linked the Black Death of the 1300s to the modern outbreaks of plague. Fifteen years later, he was able to adopt the intervening research on Y. Pestis to complete his theory, which is widely accepted today.

 

Widely . . . but not universally accepted, that is. 

 

For more than 40 years, contrarian voices have suggested that Y. Pestis – while the cause of modern plague – may not have been behind the Black Death of 660 years ago.

 

Additionally, new research strongly suggests that body lice might be another vector for Y. Pestis as well.  

 

All of which brings us to a fascinating debate going on in the pages of the CDC’s EID Journal this month, in a series of letters under:

 

Body Lice, Yersinia pestis Orientalis, and Black Death

Welford M, Bossak B. Body lice, Yersinia pestis Orientalis, and Black Death [letter]. Emerg Infect Dis [serial on the Internet]. 2010 Oct [date cited]. http://www.cdc.gov/EID/content/16/10/1649.htm
DOI: 10.3201/eid1610.100683

McLean RG, Fall MW. Body lice, Yersinia pestis Orientalis, and Black Death [letter]. Emerg Infect Dis [serial on the Internet]. 2010 Oct [date cited]. http://www.cdc.gov/EID/content/16/10/1649.htm
DOI: 10.3201/eid1610.100822

Drancourt M, Raoult D. Body lice, Yersinia pestis Orientalis, and Black Death [letter]. Emerg Infect Dis [serial on the Internet]. 2010 Oct [date cited]. http://www.cdc.gov/EID/content/16/10/1649.htm
DOI: 10.3201/eid1610.100946

 

 

These are short, easy to follow letters debating this medical mystery and raise a lot of questions – some of which have public health implications today.  

 

Although the debate isn’t settled here, if you like your science just a a tad on the messy side, you’ll want to read them.

 

Bubonic plague still occurs around the world, of course, although rarely in the United States.  

 

This map, from the CDC, shows areas of the world where plague is endemic, mostly in rodents.

 

 

The last major urban outbreak of plague in the United States occurred in 1924-25 in Los Angeles.  Since then, only scattered cases have been reported, with about 10-15 cases each year.

 

Worldwide, on average, anywhere between 1,000 and 3,000 cases are reported each year.

 

Today, modern antibiotics are very effective against the plague, and so outbreaks are usually quickly contained.

 

My interest in Plague stems from 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 45 years.

 

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