1. Location: Mandritsara (Madagascar)
2. Diseases listed: Malaria, Dengue, Plague
3. Details of the outbreak
On 10 December 2013, BBC news/Africa reported a deadly outbreak of the bubonic plague in a village near Mandritsarad in Madagascar. The outbreak that occurred a week earlier, was revealed after the death of 20 people in the village. Tests conducted on the bodies by The Pasteur Institute in Madagascar, certified that the death was related to the bubonic plague. Since unhygienic conditions are the main causes for plague dissemination, a program was implemented to exterminate rats, fleas and cockroaches to avoid the spread and further outbreaks of the illness in areas of the country where living standards have declined.
4. Characteristics of the bubonic plague
Epidemiology and distribution: The bubonic plague also known as the Black Death is an old deadly illness that has re-emerged 3 times in the past. With exception of Australia, the illness currently occurs in mainly tropical and sub-tropical areas of all continents and is more prevalent in developing countries. In 1994 an outbreak killed almost 10 million people in India.
Cause: The microorganism responsible for the bubonic plague is Yersinia pestis, a Gram negative, facultative anaerobic cocobacillus of the family Enterobacteriaceae. It is an obligate intracellular pathogen and was formally known as Pasteurella pestis. The bacterium can infect both humans and animals and possesses 2 virulent factors, Antigens F1 and VW.
Transmission: Transmission of the bubonic plague to humans is commonly operated through the bite of a rodent flea. People can be also be infected directly from a plague-infected rodent or other animals through skin lesions or mucous membranes of the mouth, nose or eyes. Plague is only occasionally transmitted between humans.
Symptoms: The bubonic plague takes its name from the infected, swollen and tender lymph glands called "buboes" that develop very quickly near the area of the flea bite. About 1 to 6 days after the bite, an infected person develops e.g. a high fever, chills, muscle aches, trembling, profuse sweating, headaches and extreme weakness.
Diagnosis: Initial diagnosis includes a physical examination. This is confirmed by analysis of the patient blood or other fluids for evidence of Yersinia pestis infection using biochemical, genotypic and serology tests. Further tests can include X-rays and biopsies.
Treatment: The bubonic plague is a very deadly illness, but if diagnosed quickly and treated with antibiotics, lives can be saved. Streptomycin, chloramphenicol and tetracycline are antibiotics that can used to treat the disease.
Prevention: Prevention measures include e.g. education of the populations on the illness and the application of good hygienic practices, protection against flea bites, control of rodents and fleas in homes, absence of contact with rodents and dead animals. There are currently 2 vaccines available for preventing plague and which are recommended mainly for high risk workers. Antibiotics are also sometimes used to prevent the occurrence the infection.
Yersinia pestis is usually susceptible to antibiotics used to treat the bubonic plague. However, in the mid 1990’s, an occurrence of multi-drug resistant species have been noticed. The first multi-resistant strain was isolated in Madagascar and was found to be resistant to various antibiotics. This constitutes a serious threat to public health and there is a need to implement rapid and effective surveillance measures to control the occurring of the illness.
Galimand, Marc, Carniel Elisabeth, and Courvalin Patrice. Resistance of Yersinia pestis to Antimicrobial Agents. Antimicrobial agents and chemotherapy 50.10 (2006): 3233-3236. Print.
Perry, Robert D, and Fetherston, Jacqueline D. Yersinia pestis-etiologic agent of plague Clinical Microbiology Reviews 10.1 (1997): 35-66. Print.