From Pro Med
Feb. 19th, 2005 08:54 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
brdgtPlague in the Democratic Republic of the Congo
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As of Tue, 15 Feb 2005, WHO has received reports of 61 deaths from pneumonic plague in the district of Ituri, Oriental province, in the northern part of the country. The total number of cases is still not known. [Note this was posted to the WHO website on 18 Feb 2005.]
Preliminary results from rapid diagnostic tests in the area confirm pneumonic plague, and the cases had clinical features compatible with this disease. 40 samples have been taken and will be tested by culture and serology at the Institut de la Recherche Biomedicale, Kinshasa [Congo Rep.]. No cases of bubonic plague have been reported to date.
The cases have occurred in workers in a diamond mine in Zobia where about 7000 people work. The mine was re-opened on 16 Dec 2004 and the 1st case occurred on 20 Dec 2004.
A team from Medecins sans Frontieres (Belgium and Switzerland), Medair, WHO and Ministry of Health have been in the area to assess the situation. An additional multi-disciplinary team will be leaving for the Democratic Republic of the Congo on 19 Feb 2005.
If humanitarian access is possible given the security concerns in the area, the team will go to the affected area to provide technical support in case management and treatment of cases, intensive surveillance and tracing of possible contacts and further epidemiological investigations.
WHO: Thousands flee as plague kills 61 in Congo
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An outbreak of plague in northeastern Democratic Republic of Congo has killed 61 diamond miners and infected hundreds more, the World Health Organization (WHO) said Friday [18 Feb 2005].
Many of the 7000 miners working in Zobia, north of the city of Kisangani, have fled since the outbreak began 2 months ago, and could have spread the highly contagious disease, the United Nations agency said. "The epidemiological data is still incomplete but we are sure there are at least 61 deaths. The main problem is that due to panic, maybe two thirds of the
population, ran away from the mine," Eric Bertherat, head of the WHO team, told reporters. "There is a risk that some patients in [the] incubation [period] run away and maybe arrive in Kisangani. So it is very important to inform health care workers to alert them of the risk of admission of highly contagious patients," he said.
Kisangani is Congo's 3rd biggest city and a major trading center on the Congo River.
Plague, which is spread between rodents by fleas, can also be transmitted to people through infected rodent flea bites. It has a case-fatality rate of 50% to 60% in humans if not treated with antibiotics, WHO says. There are 3 main forms of plague in humans and the one suspected in the former Zaire is pneumonic plague, WHO said. "It is very important to quarantine, isolate these people who are sick with pneumonic plague so that the transmission is brought under control. If we can find the cases and treat them effectively, this can be stopped," said May Chu, a WHO expert.
A 10-member WHO emergency team was leaving at the weekend with supplies of antibiotics to try to stem the outbreak and ensure that health workers in the region isolate suspect cases. But the remote mine in mineral-rich Ituri, reportedly controlled by rebels, is difficult to reach and the team will require U.N. security clearances, officials said.
Cases are still occurring in the mine, where conditions are crowded and unsanitary, and 20 workers were admitted to health facilities in Zobia with symptoms Wednesday [16 Feb 2005], he added. The diagnosis of plague had been verified through testing, WHO spokesman Dick Thompson said.
[By Stephanie Nebehay]
[As implied in the posting, the epidemic curve and analysis are needed to discover the potential cause of the outbreak. Cases have apparently been reported over almost 2 months, so it is likely that several generations of primary pulmonary plague have occurred, assuming the diagnosis is correct.
Primary pneumonic plague (1 percent of natural plague presentations) arises as a result of inhalation of plague bacilli in infectious aerosols, such as would be produced when there are pneumonic complications in bubonic plague. It is also the form of disease contracted from infected cats. This is, importantly, the form of the disease that would be most likely if _Yersinia pestis_ were to be used in an aerosol as a biological weapon. Such an aerosol would likely be used in an indoor setting to avoid the outdoor UV radiation inactivation of the organism.
Primary plague pneumonia has a short incubation period of 1-3 days, after which there is sudden onset of flu-like symptoms including fever, chills, headache, generalized body pains, weakness and chest discomfort. A cough develops with sputum production, which may be bloody, and increasing chest pain and difficulty in breathing. As the disease progresses, hypoxia (low oxygen concentration in the blood) and hemoptysis (coughing up blood) are prominent. The disease is invariably fatal unless antimicrobial therapy commences within 24 hours of exposure.
Patients with primary pneumonic plague generate large quantities of infectious aerosols that pose a significant risk to close contacts. CDC guidelines identify contacts within 2 meters as being at greatest risk and do not consider the organism likely to be carried through air ducts or vents. Persons who have been in contact with pneumonic plague patients or handling potentially infectious body fluids or tissues without appropriate protection should receive preventive
antimicrobial therapy. The preferred antimicrobial agents for prophylaxis are tetracyclines, quinolones, or chloramphenicol.
Incidence of plauge in region in the past 4 year:
2004
----
Plague - Congo DR (Ituri)
Plague - Uganda (Arua, Nebbi)
2003
----
Plague - Uganda (Arua, Nebbi)
Plague - Uganda (Arua, Nebbi)
Plague - Algeria (Oran)
Plague, bubonic - Algeria (Oran)
Plague - Uganda (Arua)
2002
----
Plague - Uganda (Nebbi District)
Plague - Uganda (Arua, Nebbi)
Plague, bubonic - Malawi (Nsanje)
Plague, bubonic - Malawi, Mozambique
2001
----
Plague - Uganda (Arua, Nebbi)
Plague - Uganda (Okoro County)
Plague, suspected - Congo DR
Plague - Uganda (Okoro County)
----------------------------------------------
As of Tue, 15 Feb 2005, WHO has received reports of 61 deaths from pneumonic plague in the district of Ituri, Oriental province, in the northern part of the country. The total number of cases is still not known. [Note this was posted to the WHO website on 18 Feb 2005.]
Preliminary results from rapid diagnostic tests in the area confirm pneumonic plague, and the cases had clinical features compatible with this disease. 40 samples have been taken and will be tested by culture and serology at the Institut de la Recherche Biomedicale, Kinshasa [Congo Rep.]. No cases of bubonic plague have been reported to date.
The cases have occurred in workers in a diamond mine in Zobia where about 7000 people work. The mine was re-opened on 16 Dec 2004 and the 1st case occurred on 20 Dec 2004.
A team from Medecins sans Frontieres (Belgium and Switzerland), Medair, WHO and Ministry of Health have been in the area to assess the situation. An additional multi-disciplinary team will be leaving for the Democratic Republic of the Congo on 19 Feb 2005.
If humanitarian access is possible given the security concerns in the area, the team will go to the affected area to provide technical support in case management and treatment of cases, intensive surveillance and tracing of possible contacts and further epidemiological investigations.
WHO: Thousands flee as plague kills 61 in Congo
-----------------------------------------------
An outbreak of plague in northeastern Democratic Republic of Congo has killed 61 diamond miners and infected hundreds more, the World Health Organization (WHO) said Friday [18 Feb 2005].
Many of the 7000 miners working in Zobia, north of the city of Kisangani, have fled since the outbreak began 2 months ago, and could have spread the highly contagious disease, the United Nations agency said. "The epidemiological data is still incomplete but we are sure there are at least 61 deaths. The main problem is that due to panic, maybe two thirds of the
population, ran away from the mine," Eric Bertherat, head of the WHO team, told reporters. "There is a risk that some patients in [the] incubation [period] run away and maybe arrive in Kisangani. So it is very important to inform health care workers to alert them of the risk of admission of highly contagious patients," he said.
Kisangani is Congo's 3rd biggest city and a major trading center on the Congo River.
Plague, which is spread between rodents by fleas, can also be transmitted to people through infected rodent flea bites. It has a case-fatality rate of 50% to 60% in humans if not treated with antibiotics, WHO says. There are 3 main forms of plague in humans and the one suspected in the former Zaire is pneumonic plague, WHO said. "It is very important to quarantine, isolate these people who are sick with pneumonic plague so that the transmission is brought under control. If we can find the cases and treat them effectively, this can be stopped," said May Chu, a WHO expert.
A 10-member WHO emergency team was leaving at the weekend with supplies of antibiotics to try to stem the outbreak and ensure that health workers in the region isolate suspect cases. But the remote mine in mineral-rich Ituri, reportedly controlled by rebels, is difficult to reach and the team will require U.N. security clearances, officials said.
Cases are still occurring in the mine, where conditions are crowded and unsanitary, and 20 workers were admitted to health facilities in Zobia with symptoms Wednesday [16 Feb 2005], he added. The diagnosis of plague had been verified through testing, WHO spokesman Dick Thompson said.
[By Stephanie Nebehay]
[As implied in the posting, the epidemic curve and analysis are needed to discover the potential cause of the outbreak. Cases have apparently been reported over almost 2 months, so it is likely that several generations of primary pulmonary plague have occurred, assuming the diagnosis is correct.
Primary pneumonic plague (1 percent of natural plague presentations) arises as a result of inhalation of plague bacilli in infectious aerosols, such as would be produced when there are pneumonic complications in bubonic plague. It is also the form of disease contracted from infected cats. This is, importantly, the form of the disease that would be most likely if _Yersinia pestis_ were to be used in an aerosol as a biological weapon. Such an aerosol would likely be used in an indoor setting to avoid the outdoor UV radiation inactivation of the organism.
Primary plague pneumonia has a short incubation period of 1-3 days, after which there is sudden onset of flu-like symptoms including fever, chills, headache, generalized body pains, weakness and chest discomfort. A cough develops with sputum production, which may be bloody, and increasing chest pain and difficulty in breathing. As the disease progresses, hypoxia (low oxygen concentration in the blood) and hemoptysis (coughing up blood) are prominent. The disease is invariably fatal unless antimicrobial therapy commences within 24 hours of exposure.
Patients with primary pneumonic plague generate large quantities of infectious aerosols that pose a significant risk to close contacts. CDC guidelines identify contacts within 2 meters as being at greatest risk and do not consider the organism likely to be carried through air ducts or vents. Persons who have been in contact with pneumonic plague patients or handling potentially infectious body fluids or tissues without appropriate protection should receive preventive
antimicrobial therapy. The preferred antimicrobial agents for prophylaxis are tetracyclines, quinolones, or chloramphenicol.
Incidence of plauge in region in the past 4 year:
2004
----
Plague - Congo DR (Ituri)
Plague - Uganda (Arua, Nebbi)
2003
----
Plague - Uganda (Arua, Nebbi)
Plague - Uganda (Arua, Nebbi)
Plague - Algeria (Oran)
Plague, bubonic - Algeria (Oran)
Plague - Uganda (Arua)
2002
----
Plague - Uganda (Nebbi District)
Plague - Uganda (Arua, Nebbi)
Plague, bubonic - Malawi (Nsanje)
Plague, bubonic - Malawi, Mozambique
2001
----
Plague - Uganda (Arua, Nebbi)
Plague - Uganda (Okoro County)
Plague, suspected - Congo DR
Plague - Uganda (Okoro County)
