Bubonic Plague Outbreak in Madagascar Village Raises Fears That Disease Could Spread to Towns and Cities
December 11, 2013
Guardian - Once feared as the Black Death – the rodent-borne disease that wiped out a third of the world's population in the Middle Ages – bubonic plague has killed 20 villagers in Madagascar in one of the worst outbreaks globally in recent years, health experts have confirmed.
The confirmation that bubonic plague was responsible for the deaths last week near the north-western town of Mandritsara follows a warning in October from the International Committee of the Red Cross (ICRC) that the island nation was at risk of a plague epidemic.
The Pasteur Institute of Madagascar revealed on Tuesday that tests taken from bodies in the village last week showed that they had died of bubonic plague. The institute added it was concerned the disease could spread to towns and cities where living standards have declined since a coup in 2009.
The deaths are doubly concerning because the outbreak occurred both outside the island's normal plague season, which runs from July to October, and apparently at a far lower elevation than usual – suggesting it might be spreading.
Bubonic plague, which has disappeared from Europe and large parts of the globe, is spread by bites from plague-carrying rat fleas – Xenopsylla cheopis – whose main host is the black rat. In Europe the threat of the Black Death pandemic, which appeared with black rats brought by merchant ships from Asia, eventually died out as black rats were displaced by brown rats and health and hygiene improved.
For centuries rats have been blamed for spreading the Black Death, helping to consign millions of people to an agonising death. But, according to one archaeologist, the rodents are innocent. Instead, the blame for passing on the disease that wiped out a third of the population of Europe could lie with the victims themselves. The Black Death is widely thought to have been an outbreak of bubonic plague caused by bacteria carried by fleas that lived on black rats. The rodents spread the plague from China to Europe and it hit Britain in 1348. According to historian Barney Sloane, the disease spread so quickly that the rats could not be to blame. He also pointed out that rats are also killed by bubonic plague, but said there were no large deposits of rat bones from the 14th century. The epidemic, which is reckoned to have claimed 75 million lives worldwide, spread from person to person in crowded medieval cities. Dr Sloane said pneumonic plague could be spread from person to person, but this would first need to mutate from bubonic plague. [Source]Victims often develop painful swelling in the lymph nodes called buboes, flu-like symptoms and gangrene. Although the disease is treatable with antibiotics, without treatment the mortality rate is almost two-thirds of those infected, according to the US Centres for Disease Control.
Last year about 60 people died of plague in Madagascar – the highest number globally. The disease is prevalent in the island's central highlands, where between 200 and 400 confirmed cases are reported each year to the World Health Organisation – between a third and a fifth of globally reported cases.
The disease first appeared in Madagascar in 1898 and was responsible for successive outbreaks until the 1920s, largely confined to the island's ports. While it disappeared from coastal areas it spread to inland areas above an altitude of 800 metres. However, there was no serious outbreak for 60 years until 1991, when it appeared again around the coastal town of Mahajanga.
After a series of outbreaks that lasted until 1998, health experts warned almost 10 years ago that plague appeared to be spreading again to lower altitudes with men and children most susceptible.
The risk of the disease has increased, say experts, amid increasing poverty and insanitary conditions on the island, not least in its overcrowded prisons. Prisoners are usually most affected by outbreaks.
Following the warning from the ICRC in October, the organisation and Madagascan prison authorities launched a campaign against rodents in Antanimora prison in the capital, Antananarivo, where 3,000 people are behind bars, to reduce the risk of the disease spreading.
Christoph Vogt, head of the ICRC delegation in Madagascar, told the Guardian then:
"The chronic overcrowding and the unhygienic conditions in prisons can bring on new cases of the disease. That's dangerous not only for the inmates but also for the population in general.
"Rat control is essential for preventing the plague, because rodents spread the bacillus to fleas that can then infect humans. So the relatives of a detainee can pick up the disease on a visit to the prison, and a released detainee returning to his community without having been treated can also spread the disease."
Time - Like no other disease, plague evokes terror. One of the most lethal illnesses in human history, it killed probably a third of Europe's population in the 14th century. It may also have been one of the first agents of biological warfare: It's said that in the 1340s, invading Mongols catapulted their plague dead over the city wall into Kaffa in the Crimea.
Yet the plague is not just a disease of the distant past. While cases tapered off in the mid-20th century, the World Health Organization (WHO) now classifies plague as "re-emerging."
No one is predicting another pandemic like the Black Death that devastated Europe. The WHO now records at most only a few thousand cases worldwide per year; and, if detected early, the disease can be treated effectively with antibiotics.
But since the early 1990s, plague has returned to places — including India, Zambia, Mozambique, Algeria and parts of China — that had not seen it in many years or even decades. Its global footprint has also shifted, according to a paper published last month in the journal PLoS Medicine. In the 1970s, most plague cases were in Asia; today, more than 90% are in Africa.
The conundrum for epidemiologists: Why is human plague reappearing now, even though nearby animal populations have likely harbored the culprit Yersinia pestis bacteria all along?
Plague lives in many rodent species, and is most often transferred to humans by the animals' fleas. Scientists know which regions of the world harbor infected animals, but they are only just beginning to understand the dynamics of plague infection. Its spread depends not just on Yersinia pestis but also on interactions among rodents and, crucially, on contact between humans and wildlife.
Madagascar is a good example. For decades, plague was restricted to the highlands, according to a 2004 paper by researchers in Madagascar, Senegal and France. But it showed up on the coast in 1991, when the Asian shrew somehow picked up infected fleas. The plague's earlier comeback in the inland capital, Antananarivo, arose as city sprawl and shoddy housing put residents in closer contact with black rats. In 1998, inland villages reported cases, too, perhaps caused by rats displaced through deforestation.
Even in the antibiotic age, then, containing plague requires monitoring more than human cases, says Nils Christian Stenseth, head of the Center for Ecological and Evolutionary Synthesis in Oslo, and lead author of the PLoS Medicine paper. Working with nearly 50 years of animal, human and bacteriological statistics from the former Soviet Union, his team found that human plague in Kazakhstan occurs only when the local gerbil population reaches a certain threshold in winter. Warmer winters mean more gerbils. That, says Stenseth, suggests plague's "re-emergence might have a climate component."
If so, global warming may exacerbate the threat — an unsettling thought, given the viciousness of the disease.
"The plague bacillus is probably the most pathogenic infectious agent on the planet right now, and we still don't know why it's so virulent," says Elisabeth Carniel, a plague expert at the Institut Pasteur in Paris.It may no longer make history, but plague hasn't lost its terrifying power.
Health Freedom Alliance - Two people have died, a town of 10,000 is under quarantine, and the area within a 17-mile radius around it has been sealed to contain a pneumonic plague outbreak:
Chinese authorities have put a whole town in quarantine after an outbreak of horrifying pneumonic plague.
Two people have died from the highly contagious disease, an even more powerful brother of The Black Death – the bubonic plague believed to have wiped out a quarter of the population of Europe in the 14th Century.
Pneumonic plague is one of the most virulent and deadly diseases on earth, usually fatal within 24 hours.
It attacks the lungs and kills nearly everyone who catches it unless they get rapid treatment with antibiotics.
A dozen people in the stricken town of Ziketan have so far been infected. The disease spreads fast and is passed from person to person by coughing.
Authorities in northwest China have sealed off the remote town of 10,000 people and begun a treatment and quarantine programme.
Residents are terrified, shops have been shuttered, homes disinfected, face masks distributed, there has been panic buying and streets are deserted, witnesses reported.
The World Health Organisation said it was in close contact with Chinese health authorities and that measures taken so far were appropriate.
It looks serious, but the Chinese regime being what it is, they aren’t limited by anything in t