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According to UN reports, more than 120 people have already died and more than 1,300 are infected with the deadly pneumonic plague that is raging in Madagascar. The media is already writing that this epidemic can easily spread to other countries. The situation is especially difficult in the country's capital, Antananarivo.
The epidemic was reportedly caused by climatic anomalies, which were given the name "Godzilla", associated with El Niño, due to which the temperature increased and the number of rats in Madagascar skyrocketed in 2016. Subsequent forest fires drove hordes of rats, which were fleas - carriers of the plague bacillus, to human cities.
The main difference between pneumonic plague and bubonic plague, which killed people in the Middle Ages, is the presence of pneumonia. Pneumonic plague spreads through coughing. According to doctors, today's outbreak of plague kills a person within a day if he is not injected with enough antibiotics in time.
The African Department of Health is trying to contain the spread of pneumonic plague, but local authorities fear that the disease could soon spread beyond the continent.
The arrows indicate how the plague from Madagascar could spread to other regions. The Seychelles, Reunion, South Africa, Mozambique, Tanzania, Kenya, Ethiopia, Comoros and Mauritius are at risk.
It is reported that among the infected about 50 people from various humanitarian organizations. The WHO Africa branch says that 93 people have died from the plague, while 124 people have died in official UN reports.
A WHO official said in an interview that the risk of the spread of the disease is very high at the national level, because the plague is present in several cities at the same time, and this is only the beginning of the outbreak.
There have been three great plague pandemics in human history. The first, the Plague of Justinian, began in 542 and lasted 50 or even 60 years. The regions most affected by it were the center and east of Africa (from where it probably came), as well as the Mediterranean coast. First, the plague began to rage in the ports, and then the infection made its way deep into the countries. Judging by the stories of those times, the disease could have claimed the lives of 100 million people.
Madagascar is currently experiencing a significant increase in cases of plague. Since the beginning of 2017, 40 people have died and another 230 have been infected. Be that as it may, although the disease could theoretically reach Europe, it is likely to be quickly identified and treated with antibiotics.
Atlantico: Why is the plague returning to Madagascar?
Stephan Gaye: Plague is one of the most feared infectious diseases known to us. Perhaps even the scariest. The bacterium that causes it is called the plague bacillus or yersinia pestis. It is characterized by the strongest virulence, that is, the ability to multiply in the body to capture and destroy living tissues. When we talk about large-scale and fatal epidemics, we first of all call the plague and cholera. Plague is more dangerous than cholera because it only kills people who are vulnerable due to their age or poor health. The plague destroys both the strong and the weak. At the same time, cholera is more easily transmitted and spreads faster.
A pandemic is an epidemic that spans multiple continents and potentially every country in the world.
There have been three great plague pandemics in human history. The first, the Plague of Justinian, began in 542 and lasted 50 or even 60 years. The regions most affected by it were the center and east of Africa (from where it probably came), as well as the Mediterranean coast. First, the plague began to rage in the ports, and then the infection made its way deep into the countries. Judging by the stories of those times, the disease could have claimed the lives of 100 million people.
The second plague pandemic began in the 13th century in Central Asia, where a well-defined focus was formed. The epidemic raged in India, China, North Africa, the Middle East, and throughout Europe, where it is remembered as the Black Death. According to various estimates, more than a quarter of the population of Europe has died in four centuries of the pandemic. The famine and wars on the continent have certainly raised the death rate even further.
The third known plague pandemic began in the Chinese province of Yunnan in the middle of the 19th century. The development of faster modes of transport (steamboat, railroad) allowed the disease to quickly disperse and reach regions where it was not there before, beyond the Far East and India. During this pandemic, the plague came to the United States, South Africa, Latin America, and including Madagascar.
In 1894, during this pandemic, Frenchman and Pasteur follower Alexandre Yersin identified the bacterium in Hong Kong and the role of rats in its transmission. A number of Yersinia bacteria bear his name in honor of his discoveries. In 1898, another Pasteurist, Paul-Louis Simond, demonstrated the role of fleas in transferring bacteria from a sick rat to a healthy one and then to a human.
Understanding the cycle of infection allowed the development of a new control strategy, which involved the use of poisons against rodents and insects. Alexander Yersen developed an anti-plague serum based on horse blood, and Vladimir Khavkin created a vaccine from a weakened strain. Later, the advent of antibiotics provided an effective way to treat diseases.
The developed preventive and therapeutic measures made it possible to reduce the death rate from the plague and limit its spread. Many countries have recorded a reduction or complete disappearance of plague cases within a few decades, which could suggest victory over the infection.
Be that as it may, since the reservoir of bacteria is formed by wild rodents, mostly rats, in theory the disease cannot disappear. The fact is that the size of rats, their speed of reproduction and incredible adaptability make this natural reservoir inexhaustible. If the rat population is controlled and the houses are protected from rodent entry, the chance of a person being bitten by a rat flea is negligible. This explains the fact that the plague has in fact disappeared in countries with a high standard of living. Madagascar, on the contrary, belongs to the poorest countries in the world, and rats often get into housing there.
The World Health Organization recorded nearly 50,000 cases of human infection with plague from 1990 to 2015 in 26 countries in Africa, Asia and the Americas. Central Africa is most affected, in particular the Democratic Republic of the Congo, Uganda and Madagascar, where there are the highest number of human cases of plague in humans worldwide (between 250 and 500 per year). In Asia, the most active leverage is found in China. In America, this is Peru, but there are also cases in the USA: we are talking about the indigenous population on the west coast. This means that the plague cannot be eradicated even with a high standard of living. In Oceania (Australia, New Zealand, Melanesia, Micronesia and Polynesia) and Europe, there have been no recent cases of infection. In France, the last incident of this kind occurred in 1945 in Corsica.
The spread of the plague depends on meteorological conditions: it needs heat and humidity. The capital of Madagascar, Antananarivo, is located in the center of the country in a temperate climate zone, and Toamasina is on the east coast in a humid climate zone. In addition, the dry season ends and the rainy season begins. All climatic conditions have been created for the spread of the plague. The focus of a recent epidemic was in a man from Toamasina, who then went to the capital.
In other words, it is not surprising that the plague persists in Madagascar and periodically erupts into epidemics, facilitated by heat and humidity.
"Should I be worried about the return of the plague to Europe?" Is an epidemic possible?
Context
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Mashregh 01/07/2015 — The plague has killed many people, continues to kill now and will continue to do so in the future. This extremely dangerous disease will remain a threat due to the large and uncontrolled natural reservoir of rats. They can eat almost anything and have the highest adaptability to different conditions. Landfills attract them with the smell of rotting, and scavenger strikes encourage their reproduction. They are great at climbing and swimming. They are probably even able to swim against the current of sewer water and enter housing through toilets ...The plague further exacerbated the fear that rats cause in people. In addition, they can carry other bacteria, such as leptospirosis and sodoka, which, of course, are not as dangerous as the plague, but still pose a big threat.
This infectious disease is primarily a zoonosis, that is, a disease of animals. Rats infect each other through fleas. A flea, like a mosquito in the case of malaria, becomes infected from the blood of a sick rat and transmits the bacterium when it bites a healthy one. Thus, plague is septicemia, that is, blood poisoning. After a flea bite, a plague bubo forms in a person, that is, inflammation of the lymph nodes: a huge, reddened and painful formation occurs. All this is accompanied by a high temperature and a general change in state. Sometimes everything is limited to bubo, and the person recovers, but more often everything leads to septicemia and lung damage. Pneumonic plague is always fatal if left untreated. A person affected by pneumonic plague can transmit the bacterium through a cough that contains microparticles filled with it. As you might guess, in that case, the disease can lead to an epidemic among people without the participation of rats.
It is always possible that a person with pneumonic plague in the incubation period will arrive in Europe by plane and subsequently develop the disease and infect other people through coughing. Be that as it may, the disease is likely to be quickly identified and treated with antibiotics. Fortunately, the causative bacterium is very susceptible to a variety of antibiotics. Hospitalization of a patient with pneumonic plague requires additional precautions against the spread of microparticles (formerly "respiratory isolation") to prevent infecting others. It is likely that imported pneumonic plague could infect others and form a small focus of infection, but it will be quickly dealt with in Europe.
- The WHO is trying to cope with the problem of sending antibiotics to Madagascar. Is this enough to end the infection? If yes, how long will it take? If not, what else needs to be done to eradicate the plague?
“As we have already said, the plague bacterium is fortunately susceptible to antibiotics, which have completely changed the sanitary strategy for dealing with the epidemic. The Madagascar hotbed, like all the previous ones, will be brought under control in the near or slightly more distant future. However, the disease cannot be eradicated. You can only cope with the current epidemic. Then the order will return, up to the appearance of a new hearth. A zoonosis like the plague that relies on a reservoir of rats is a big problem for scientists.
In comparison, rabies is also a zoonotic disease, but it is caused by a virus, not a bacterium. This means that the pathogen has no resistance to the external environment, while the plague-causing bacterium can survive in the carcasses of rats and in the soil. In addition, foxes are the refugee reservoir in Europe, and scientists have developed an oral vaccine for these animals. The vaccine was dispersed from a helicopter in fox population areas, as a result of which rabies in France was eradicated. Vaccinating rats, apparently, is impossible. This is clearly a utopia.
Preventive control of plague involves ensuring clean housing and effective protection against rats so as to make their contact with humans impossible. In addition, it includes the widespread control of these rodents. Of course, we are not talking about their complete destruction, since they play a role in the ecosystem, and their amazing qualities are widely used in scientific laboratories (although for the most part they are white rats). The control of these rodents is the main component of measures to prevent plague.
The materials of InoSMI contain only assessments of foreign media and do not reflect the position of the editors of InoSMI.
To residents of developed countries with a clinic nearby and an ambulance at the first call, the plague seems like a mythical disease. "People-birds" in outlandish costumes with beaks became a picture on motivators, and "black death" - something distant, from the Middle Ages. But the plague still kills people, and there are countries where it does it regularly, not at all being some kind of special exotic. This fall, the plague swept through Madagascar, infected more than 2 thousand people, more than 100 died - and this is in the age of antibiotics and vaccines. Whether one should be afraid of the plague today, even if trips to Madagascar are not planned, MedAboutMe figured out.
Mankind has been familiar with the plague for more than 2.5 millennia. According to scientists, the first outbreak of the disease occurred in China more than 2,600 years ago. From there, about 600 years ago, the infection spread along the Silk Road through Central Asia to Europe. In the Middle Ages, the plague wiped out a third of the population of European countries, and in the 15th century reached Africa. At the end of the 19th century, through Hawaii, the infection entered the territory of the current United States. The first cases of plague were noted in the ports of San Francisco and Los Angeles, after which the spread of the plague bacterium began inland.
Today, plague bacteria are among the microbes most likely to be used as biological weapons, along with anthrax, Ebola, smallpox, and foot-and-mouth disease.
Plague bacteria and types of disease
Plague is caused by the bacteria Yersinia pestis, which is spread by infected fleas that live on rats and other rodents. Rats are a natural reservoir of infection. This means that, firstly, it is almost impossible to completely eradicate the disease, because it is impossible to completely rid the world of rats. Secondly, if in developed countries it is possible to reduce the risk of the spread of plague among people to a minimum, then in the poorest countries of the world, where the worlds of man and rat are in close contact, this cannot yet be achieved. The situation is also complicated by the fact that plague bacteria love a warm and humid climate, which is just characteristic of some "plague" countries in Africa, Asia, and Oceania.
Three forms of plague are possible:
- bubonic form.
After being bitten by an infected flea, the bacteria enter the skin. Previously, it was believed that Yersinia needed to penetrate the host cell in order to then get into the lymph node with it. However, this is a rather slow process, given that the bacteria do not enter the blood immediately, but are located after the bite in the intradermal layer. And it has recently been proven that 1-2 bacteria out of every ten independently rush to the lymph nodes - and within 5-10 minutes after infection they find themselves inside them. In the lymph nodes, Yersinia rapidly multiply, which leads to softening of the contents and the formation of large amounts of pus. Enlarged lymph nodes are called buboes. Mortality in the bubonic form in the absence of treatment is 40-70%.
- septic form.
If the infection enters the bloodstream, it spreads throughout the body, affecting all organs. At the same time, symptoms of sepsis develop. Without treatment, the person usually dies.
- Lung form..
If bacteria infect the lungs, a pulmonary form develops, in which a person becomes a source of infection for others. This form has a rapid course and, without treatment, kills its prey.
So, the bacterium can enter the human body through the blood, skin and mucous membranes. On average, before the advent of antibiotics, plague claimed the lives of 66-93% of the sick. Streptomycin and gentamicin, which are used today to treat all three forms, have reduced the mortality rate to 11%.
The development of vaccines against the "black death" is in full swing. As early as the beginning of the 19th century, a vaccine was created from dead plague bacteria, but it was effective only against the bubonic form. In 1934, the Russian scientist M.P. Pokrovskaya developed a vaccine based on live Yersinia and even tested it on herself. There have been several other relatively successful anti-plague vaccines in the history of pharmaceuticals.
Attempts to create an effective drug continue. So far, Russia has been using a domestic live vaccine based on a non-virulent strain that protects against all forms of plague, but only for a year after vaccination. In addition, with its introduction, local and general reactions (fever, headaches, general malaise) are possible. The Food and Drug Administration (FDA) did not approve the Russian vaccine precisely because of its side effects.
In 2016, American scientists announced the development of a vaccine against pneumonic plague based on genetically modified plague bacteria. According to them, the new drug is well tolerated by humans and does not cause acute reactions of the body.
Plague in Madagascar
The plague was brought to Madagascar by rats from Indian steamships in 1898. It seemed that the disease was gone - for 60 years, since 1960, no cases of plague were recorded. And in the past few years, reports of cases of plague in Madagascar have lost their touch of novelty. Actually, the plague did not leave Madagascar - the question was only in scale. The plague usually kills an average of 400 people a year, and the most common is bubonic plague, caused by the bites of infected fleas spread by rats.
The last outbreak started in August and ended in October 2017. It started with a 31-year-old man who visited the village of Ankazobe County on August 27, after which he took a minibus to Tanatawa. The bus made a stop in Antananarivo. During the trip, the man became ill, he ended up in the nearest hospital on the route in Moramanga and died in a matter of days. And on September 11, a woman from Antananarivo died of pneumonic plague. Of those who came into contact with the first patient, 31 fell ill and 4 of them died. As of September 28, 51 cases of pneumonic plague and 12 deaths from it were already known, as well as 53 cases of bubonic plague and 7 deaths.
The epidemic covered almost half of the country's regions - 51 out of 114. In total, 2217 cases of plague were noted during this period of the epidemic. On November 14, the disease claimed the lives of 113 people. In 62% of cases, it was pneumonic plague, only in 15% of cases - about bubonic and only in 1 case - about septic. In 428 patients, doctors found it difficult to accurately determine the form of the disease. Among the doctors, 71 people fell ill - all are alive.
According to statistics, this is one of the largest epidemics of pneumonic plague since the end of the 19th century. At the same time, scientists assess the risks of spreading the infection outside the country as extremely low.
WHO experts in their comments on the plague in Madagascar note: “Plague is a“ disease of the poor ”, since the risks of infection with it are to a large extent associated with living conditions. But pneumonic plague affects everyone: not only the poor living in poor areas, but also well-to-do citizens, professors, directors, people from all walks of life.”
If you do not live permanently in the territory of countries where cases of plague are regularly recorded, you should not. Even if a European travels to Madagascar, becomes infected with the pneumonic plague there, brings it to Europe and infects a certain number of people from his environment, in the conditions of developed medicine, both he and the people affected by contact with him will be quickly identified and cured.
However, certain safety rules must be followed. So, when visiting countries where cases of plague are regularly recorded, one should avoid contact with infected people and dead animals, and also use all possible means to protect against fleas.
If a person has a fever, swollen lymph nodes, chills, shortness of breath, cough and streaks of blood in the sputum, you should immediately consult a doctor. Doctors warn that self-medication delays the start of treatment and can cause fatal consequences.
If such symptoms appeared already at home, some time after returning from Madagascar or any other "plague" country, then you should definitely mention your trip to the doctors - this will reduce the time to search for the cause of the disease and allow you to start treatment faster. It should be understood that although we live in an age of antibiotics, people on the planet continue to die from the plague.
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Doctors who are fighting the plague in Madagascar are also forced to deal with the fears of patients. Residents of the infected area are not accustomed to hospitals and are terrified of injections. Doctors fear that the islanders' lack of awareness of the deadly disease will lead to its rapid spread.
Dr. Marielle Zaramisy shared her experience in an interview with . According to her, patients stubbornly do not recognize the fact of infection, even when they find characteristic symptoms in themselves.
The head of the medical service at the Central Anti-Plague Hospital Ambohimindra added that many run away from hospitals at the sight of syringes: "People here are not used to hospitals."
Jean Benoit Manhes, deputy spokesman for Unicef, said: "The mere availability of medicines and hospitals will not help stop the plague. What good are hospitals if people don't go to them?"
Doctors trying to stop a deadly disease also have to deal with the fears of patients. Many islanders believe that a visit to the hospital will lead to death: if you are not sick, you will definitely catch the disease there. They prefer local shamans and healers to certified doctors.
Rumors have also circulated on the island that the plague is a government conspiracy to secure donations for next year's elections.
Already 165 people have died, and the deadly disease is spreading rapidly. Doctors called the outbreak in Antananarivo (Antananarivo) and Toamasina (Toamasina) the largest in the last 50 years.
In most cases, doctors diagnose a particularly dangerous pneumonic plague, which is transmitted by airborne droplets: when coughing, sneezing, or through spitting.
For reference. In order to prevent the possible spread of the disease to other regions and countries, Antananarivo International Airport has introduced enhanced screening measures for passengers upon departure. Passengers with symptoms comparable to those of pneumonic plague are immediately isolated at the airport and not allowed to fly. The WHO GOARN team (US Centers for Disease Control and Prevention (CDC) and L "Institut de veille sanitaire / Santé publique France (InVS / SPF)) provides technical assistance at the airport.
Nine countries and overseas territories in the African Region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, Reunion (France), Seychelles, South Africa and Tanzania) have been identified as being most at risk of spreading the disease due to their trade and tourism links with Madagascar. The governments of these countries are taking measures to prepare for a possible outbreak of the epidemic. Epidemiological surveillance has been strengthened, and citizens are being carefully screened at points of entry and exit.
