Global & Disaster Medicine

Archive for the ‘Plague’ Category

A Dual Vaccine against Anthrax and Plague

Pan Tao, Marthandan Mahalingam, Jingen Zhu, Mahtab Moayeri, Jian Sha, William S. Lawrence, Stephen H. Leppla, Ashok K. Chopra, Venigalla B. Rao
“…..We engineered a virus nanoparticle vaccine using bacteriophage T4 by incorporating key antigens of both B. anthracis and Y. pestis into one formulation. Two doses of this vaccine provided complete protection against both inhalational anthrax and pneumonic plague in animal models. This dual anthrax-plague vaccine is a strong candidate for stockpiling against a potential bioterror attack involving either one or both of these biothreat agents. Further, our results establish the T4 nanoparticle as a novel platform to develop multivalent vaccines against pathogens of high public health significance……”
Plague ecology in the U.S. infographic.

WHO: Prioritizing Emerging Infectious Diseases in Need of Research and Development

The World Health Organization R&D Blueprint aims to accelerate the availability of medical technologies during epidemics by focusing on a list of prioritized emerging diseases for which medical countermeasures are insufficient or nonexistent. The prioritization process has 3 components: a Delphi process to narrow down a list of potential priority diseases, a multicriteria decision analysis to rank the short list of diseases, and a final Delphi round to arrive at a final list of 10 diseases.

A group of international experts applied this process in January 2017, resulting in a list of 10 priority diseases. The robustness of the list was tested by performing a sensitivity analysis. The new process corrected major shortcomings in the pre–R&D Blueprint approach to disease prioritization and increased confidence in the results.

Multicriteria scores of diseases considered in the 2017 prioritization exercise for the development of the World Health Organization R&D Blueprint to prioritize emerging infectious diseases in need of research and development. A) Disease final ranking using the geometric average of the comparison matrices. B) Disease final ranking using the arithmetic average of the raw data. Error bars correspond to SD, indicating disagreement among experts. C) Disease final ranking using the SMART Vaccines

Multicriteria scores of diseases considered in the 2017 prioritization exercise for the development of the World Health Organization R&D Blueprint to prioritize emerging infectious diseases in need of research and development. A) Disease final ranking using the geometric average of the comparison matrices. B) Disease final ranking using the arithmetic average of the raw data. Error bars correspond to SD, indicating disagreement among experts. C) Disease final ranking using the SMART Vaccines prioritization tool (56). P1, Ebola virus infection; P2, Marburg virus infection; P3, Middle East Respiratory Syndrome coronavirus infection; P4, severe acute respiratory syndrome; P5, Lassa virus infection; P6, Nipah virus infection; P7, Rift Valley fever; P8, Zika virus infection; P9, Crimean-Congo hemorrhagic fever; P10, severe fever with thrombocytopenia syndrome; P11, South American hemorrhagic fever; P12, plague; P13, hantavirus infection.

Si Mehand M, Millett P, Al-Shorbaji F, Roth C, Kieny MP, Murgue B. World Health Organization methodology to prioritize emerging infectious diseases in need of research and development. Emerg Infect Dis. 2018 Sep [date cited]. https://doi.org/10.3201/eid2409.171427


Peru: Un hombre de 42 años, murió a consecuencia de la peste bubónica

RPP

“…..the patient, who
had been living in the USA for 7 years, was admitted to the Regional
Hospital of Lambayeque, where doctors confirmed bubonic plague, which
later developed into septicemic plague. The specialist said that the
citizen had high fever and malaise…..”


The number of reported cases of disease from mosquito, tick, and flea bites has more than tripled in the USA (2004-2016)

CDC

More cases in the US (2004-2016)

  • The number of reported cases of disease from mosquito, tick, and flea bites has more than tripled.
  • More than 640,000 cases of these diseases were reported from 2004 to 2016.
  • Disease cases from ticks have doubled.
  • Mosquito-borne disease epidemics happen more frequently.

More germs (2004-2016)

  • Chikungunya and Zika viruses caused outbreaks in the US for the first time.
  • Seven new tickborne germs can infect people in the US.

More people at risk

  • Commerce moves mosquitoes, ticks, and fleas around the world.
  • Infected travelers can introduce and spread germs across the world.
  • Mosquitoes and ticks move germs into new areas of the US, causing more people to be at risk.

The US is not fully prepared

  • Local and state health departments and vector control organizations face increasing demands to respond to these threats.
  • More than 80% of vector control organizations report needing improvement in 1 or more of 5 core competencies, such as testing for pesticide resistance.
  • More proven and publicly accepted mosquito and tick control methods are needed to prevent and control these diseases.

Vector-Borne Diseases Reported by States to CDC

Photo of mosquito

Mosquito-borne diseases

  • California serogroup viruses
  • Chikungunya virus
  • Dengue viruses
  • Eastern equine encephalitis virus
  • Malaria plasmodium
  • St. Louis encephalitis virus
  • West Nile virus
  • Yellow fever virus
  • Zika virus

 

Photo of Tick

Tickborne diseases

  • Anaplasmosis/ehrlichiosis
  • Babesiosis
  • Lyme disease
  • Powassan virus
  • Spotted fever rickettsiosis
  • Tularemia

 

Photo of Flea

Fleaborne disease

  • Plague

For more information: https://wwwn.cdc.gov/nndss/

Graphic: Disease cases from infected mosquitoes, ticks, and fleas have tripled in 13 years

Graphic: Disease cases from mosquitoes (2004-2016, reported)

Graphic: Disease cases from ticks (2004-2016, reported)


Human ectoparasites [(i.e. human fleas (Pulex irritans) or body lice (Pediculus humanus humanus)] were primary vectors for plague during the Second Pandemic, including the Black Death (1346–1353)

PNAS


Pneumonic Plague in Johannesburg, South Africa, 1904

EID

Volume 24, Number 1—January 2018

Historical Review

Evans CM, Egan JR, Hall I. Pneumonic Plague in Johannesburg, South Africa, 1904. Emerg Infect Dis. 2018;24(1):95-102. https://dx.doi.org/10.3201/eid2401.161817

Pneumonic Plague in Johannesburg, South Africa, 1904

Charles M. EvansComments to Author , Joseph R. Egan, and Ian Hall
Author affiliations: University of Birmingham, Birmingham, UK (C.M. Evans); Public Health England, Wiltshire, UK (J.R. Egan, I. Hall)

Main Article

Figure 3

Incidence of the 4 types of plague over the duration of the epidemic in Johannesburg, South Africa, from week ending January 2 to week ending June 16, 1904.

Figure 3. Incidence of the 4 types of plague over the duration of the epidemic in Johannesburg, South Africa, from week ending January 2 to week ending June 16, 1904.

Figure 4

A) Deaths per day resulting from primary pneumonic plague in Johannesburg, South Africa, March 7–31, 1904. B) Back-calculated number of case-patients experiencing symptom onset. Circles represent most likely values; error bars represent 95% CIs. C) Transmissibility of primary pneumonic plague as measured by reproduction number, Rt. Circles represent the most likely values, error bars represent 95% CIs, and shaded polygons represent the period over which Rt was estimated. Uncertainty in the back-

Figure 4. A) Deaths per day resulting from primary pneumonic plague in Johannesburg, South Africa, March 7–31, 1904. B) Back-calculated number of case-patients experiencing symptom onset. Circles represent most likely values; error bars represent 95% CIs. C) Transmissibility of primary pneumonic plague as measured by reproduction number, Rt. Circles represent the most likely values, error bars represent 95% CIs, and shaded polygons represent the period over which Rt was estimated. Uncertainty in the back-calculated incidence has not been accounted for in the transmission estimates, which means that the variations in the time-varying Rt are probably underestimated because the incidence curve is smoothed out somewhat by the back-calculation process (and also reduced slightly because of rounding to the nearest integer). However, because the 7-day sliding window has the effect of smoothing out the Rt estimates in any case, not accounting for the uncertainty in the back-calculation probably has a limited effect on panel C results.


Etymologia: Plague

EID

Henry R. Etymologia: Plague. Emerg Infect Dis. 2018;24(1):102. https://dx.doi.org/10.3201/eid2401.ET2401

Plague (from the Latin plaga, “stroke” or “wound”) infections are believed to have been common since at least 3000 bce. Plague is caused by the ancestor of current Yersinia (named for Swiss bacteriologist Alexandre Yersin, who first isolated the bacterium) pestis strains (Figure 1). However, this ancestral Y. pestis lacked the critical Yersinia murine toxin (ymt) gene that enables vectorborne transmission. After acquiring this gene (sometime during 1600–950 bce), which encodes a phospholipase D that protects the bacterium inside the flea gut, Y. pestis evolved the ability to cause pandemics of bubonic plague. The first recoded of these, the Justinian Plague, began in 541 ace and eventually killed more than 25 million persons (Figure 2)

Figure 1

Digitally colorized scanning electron microscopic image of a flea. Fleas are known to carry a number of diseases that are transferable to humans through their bites, including plague, caused by the bacterium Yersinia pestis. Photo: CDC, Janice Haney Carr.

Figure 1. Digitally colorized scanning electron microscopic image of a flea. Fleas are known to carry a number of diseases that are transferable to humans through their bites, including plague, caused by the bacterium Yersinia pestis. Photo: Centers for Disease Control and Prevention (CDC), Janice Haney Carr.

Figure 2

Plague warning signs posted in regions where plague has been discovered. In remote areas with little human habitation, the most appropriate action may be to post signs on the roads entering the epizootic area to warn people, and provide information on personal protection and plague prevention. Photo, CDC, 1993.

Figure 2. Plague warning signs posted in regions where plague has been discovered. In remote areas with little human habitation, the most appropriate action may be to post signs on the roads entering the epizootic area to warn people, and provide information on personal protection and plague prevention. Photo, CDC, 1993.


The death of a patient from septicemic plague in China

China

“…..The patient, a herder from Jiuquan’s Subei Mongolian autonomous county, died on Tuesday afternoon despite efforts by medical personnel……. The patient’s gender was not disclosed.

Experts said tests had confirmed at 11 pm that the patient died of septicemic plague that evolved from bubonic plague, which was reported as a suspected plague case at 5:30 pm.

Authorities said they had placed 12 people who had close contact with the patient under quarantine, and no abnormalities had been found……”


Is Madagascar winning the battle against the Plague?

WHO

Plague – Madagascar

Disease outbreak news
15 November 2017

Since 1 August 2017, Madagascar has been experiencing a large outbreak of plague. As of 10 November 2017, a total of 2119 confirmed, probable and suspected cases of plague, including 171 deaths (case fatality rate: 8%), have been reported by the Ministry of Health of Madagascar to WHO.

From 1 August through 10 November 2017, 1618 (76%) cases and 72 deaths have been clinically classified as pneumonic plague, including 365 (23%) confirmed, 573 (35%) probable and 680 (42%) suspected cases. In addition to the pneumonic cases, 324 (15%) cases of bubonic plague, one case of septicaemic plague, and 176 unspecified cases (8%), have been reported to WHO (Figure 1). Eighty-two healthcare workers have had illness compatible with plague, none of whom have died.

Figure 1: Number of confirmed, probable and suspected plague cases in Madagascar reported by date of illness onset from 1 August through 10 November 2017 (n=2119)1

1 Date of onset is missing for 295 cases

From 1 August through 10 November, 16 (out of 22) regions of Madagascar have reported cases. Analamanga Region has been the most affected, reporting 72% of the overall cases (Figures 2 and 3).

Figure 2: Geographical distribution of confirmed and probable pneumonic plague cases in Madagascar from 1 August through 12 November 2017

Figure 3: Geographical distribution of confirmed and probable bubonic plague cases in Madagascar from 1 August through 12 November 2017

As of 10 November 2017, 218 out of 243 (90%) contacts under follow-up were reached and provided with prophylactic antibiotics. Since the beginning of the outbreak, a total of 7122 contacts were identified, 6729 (95%) of whom have completed their 7-day follow up and a course of prophylactic antibiotics. Only nine contacts developed symptoms and became suspected cases.

Laboratory confirmation of plague is being conducted by the Institut Pasteur of Madagascar, National WHO Collaborating Center for plague in Madagascar. Twenty-five isolates of Yersinia pestis have been cultured and all are sensitive to antibiotics recommended by the National Program for the Control of Plague.

The number of new cases and hospitalizations of patients due to plague is declining in Madagascar. The last confirmed bubonic case was reported on 24 October and the last confirmed pneumonic case was reported on 28 October.

Since plague is endemic to parts of Madagascar, WHO expects more cases to be reported until the end of the typical plague season in April 2018. It is therefore important that control measures continue through to the end of the plague season.

Public health response

The Ministry of Public Health of Madagascar is coordinating the health response, with the support of WHO and other agencies and partners.

The Ministry of Public Health of Madagascar has activated crisis units in Antananarivo and Toamasina and all cases and contacts have been provided access to treatment or prophylactic antibiotics at no cost to themselves.

Public health response measures include:

  • Investigation of new cases
  • Isolation and treatment of all pneumonic cases
  • Enhanced case finding
  • Active finding, tracing and monitoring of contacts and provision of free prophylactic antibiotics
  • Strengthened epidemiological surveillance in the all affected districts
  • Disinsection, including rodent and vector control
  • Raising public awareness on prevention for bubonic and pneumonic plague
  • Raising awareness among health care workers and providing information to improve case detection, infection control measures and protection from infection
  • Providing information about infection control measures during burial practices.

Enhanced measures for exit screening have been implemented at the International Airport in Antananarivo. These measures include: filling a special departure form at the airport (to identify passengers at risk); temperature screening of departing passengers, and referring passengers with fever to airport physicians for further consultation; passengers with symptoms compatible with pneumonic plague are immediately isolated at the airport and investigated using a rapid diagnostic test and notified according to the response alert protocol. Symptomatic passengers are not allowed to travel. A WHO GOARN team, consisting of US Centers for Disease Control and Prevention (CDC) and L’Institut de veille sanitaire/ Santé publique France (InVS/SPF), is providing technical support at the airport.

Nine countries and overseas territories in the African region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La Réunion (France), Seychelles, South Africa, and Tanzania) have been identified as priority countries for plague preparedness and readiness by virtue of their trade and travel links to Madagascar. These countries are implementing readiness activities, including increased public awareness of plague, enhancing surveillance for the disease (particularly at points of entry), and prepositioning of equipment and supplies.

WHO risk assessment

Since mid-October, the number of new cases of plague, the number of hospitalizations of patients due to plague, and the number of geographic districts reporting plague has decreased. While the declining trend in new plague case reports and reduction in hospitalizations due to plague are encouraging signs, WHO expects more cases of plague to be reported from Madagascar until the typical plague season ends in April 2018.

The decline in case reports suggests that the epidemic phase of the outbreak is ending, however sustaining ongoing operations is critical to minimize bubonic plague infections and human-to-human transmission of pneumonic plague.

The trend in the number of new cases of plague has been declining for more than a month, indicating that measures taken to contain the outbreak have been effective. WHO is working with the Ministry of Health in Madagascar and other partners to maintain ongoing outbreak control efforts, including active case finding and treatment, comprehensive contact identification, follow-up and antibiotic treatment, rodent and flea control, and safe and dignified burials through this outbreak and the plague season into 2018, and to outline a longer term strategy for plague preparedness and control.

Since the beginning of this outbreak, the vast majority of cases, and more than 7000 contact persons, have been treated and have recovered. As of 15 November 2017, only 12 people are hospitalized for plague. There has been no international spread outside the country.

Based on available information and response measures implemented to date, WHO estimates the risk of potential further spread of the plague outbreak at national level remains high. The risk of international spread is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures and advice to travellers to Madagascar, and scaling up of preparedness and operational readiness activities in neighbouring Indian Ocean islands and other southern and east African countries. The overall global risk is considered to be low. WHO is re-evaluating the risk assessment based on the evolution of the outbreak and information from response activities.

Advice on prevention and control measures and treatment options has been provided to Madagascar and to priority countries in the region.

WHO travel advice

Based on the available information to date, the risk of international spread of plague appears very low. WHO advises against any restriction on travel or trade on Madagascar. To date, there are no reported cases related to international travel.

International travellers arriving in Madagascar should be informed about the current plague outbreak and the necessary protection measures. Travellers should protect themselves against flea bites, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague. In case of sudden symptoms of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum, travellers should immediately contact a medical service. Travellers should avoid self-medication, even if for prophylaxis. Prophylactic treatment is only recommended for persons who have been in close contact with cases, or with other high risk exposures (such as bites from fleas or direct contact with body fluids or tissues of infected animals). Upon return from travel to Madagascar, travellers should be on alert for the above symptoms. If symptoms appear, travellers should seek medical care and inform their physician about their travel history to Madagascar.


Madagascar: UN officials now put the ever changing case tally in the epidemic that began on August 1 at 1,947 confirmed, probable and suspected cases of plague through Nov. 3.

Outbreak News

  • 1,437 (74%) were clinically classified as pulmonary plague
  • 295 (15%) were bubonic plague
  • one was septicemic
  • 211 were not yet classified (further classification of cases is in process).
  • The death count has risen to 143.

CDC-PHIL


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