Pest - Der schwarze Tod

[Birgitt]

Die Bakterien, die im 14. Jahrhundert als "Schwarzer Tod" Angst und Schrecken verbreitet haben, waren – wie schon vermutet – tatsächlich Pesterreger. Das bestätigen nun genetische Untersuchungen, die Johannes Krause von der Universität Tübingen und seine Kollegen an DNA-Material von Keimen vorgenommen haben, die aus einem zu Hochzeiten der Pest in London genutzten Massengrab stammen. Die Forscher legen damit einen alten Streit vorerst zu den Akten und liefern neue Erkenntnisse über die Evolution, die Seuchen verursachende Bakterien in den Jahrhunderten durchlaufen haben ...

Schwarzer Tod wohl ausgestorben
30.08.2011 - spektrum

Gruß
Birgitt

[Birgitt]

Ein internationales Forscherteam hat das Erbgut des Erregers des Schwarzen Todes vollständig entziffert. Dieser verheerenden Pestepidemie fiel zwischen 1347 und 1351 nach Christus rund die Hälfte aller Europäer zum Opfer. Es sei ihnen in ihrer Studie erstmals gelungen, das komplette Genom eines historischen Krankheitserregers zu rekonstruieren, schreiben die Forscher in der Fachzeitschrift „Nature“. Dadurch könne man nun die genetischen Veränderungen des Keims und seine Gefährlichkeit in den letzten 660 Jahren zurückverfolgen ...

Genom des "Schwarzen Todes" rekonstruiert
13.10.2011 - scinexx



Gruß
Birgitt

[Birgitt]

PLAGUE, PNEUMONIC - MADAGASCAR (05): (ANTANANARIVO)
***************************************************

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Date: Tue 12 Oct 2011
Source: Afriquinfos [machine transl.] [edited]
http://www.afriquinfos.com/articles/201 ... 188649.asp


A pneumonic plague epidemic has been declared in the district of
Miarinarivo located in the province of Antananarivo, the Malagasy
capital has reported to the local press Tuesday, 11 Oct 2011. One
person has died of this disease and 5 other persons are being treated
at the hospital.

The district of Miarinarivo and its environs are included among the 12
regions known as endemic for the disease on the island, but it was
also noted that the regions of the central highlands are the most
favorable to their development because of a higher altitude to 800
meters and a cooler temperature.

Plague reappeared in December 2010 with 5 cases including 1 death in a
village 15 km [9.3 miles] from the capital as well as 16 deaths in
Ambilobe, in the northern region of Madagascar in February 2011.

--
Communicated by:
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[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 secondary pneumonic
complications in bubonic/septicemic plague.

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 [6 feet] 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.

Madagascar was the location of the isolation of multi-antimicrobial
resistant _Y. pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et
al: Multidrug resistance in _Yersinia pestis_ mediated by a
transferable plasmid. N Engl J Med 1997;337: 677-81). The strain was
resistant to chloramphenicol, streptomycin and tetracycline but
sensitive to fluoroquinolones and trimethoprim as well as other
aminoglycosides. This was an ominous observation, however, it is not
clear if this naturally occurring strain has persisted or spread. -
Mod.LL]

[The interactive HealthMap/ProMED map for Madagascar is available at:
http://healthmap.org/r/1kSe - CopyEd.EJP]

[Birgitt]

PLAGUE, FATAL - UGANDA: (ARUA) REQUEST FOR INFORMATION
******************************************************
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Date: Wed 8 Feb 2012
Source: AllAfrica, The New Monitor (Uganda) report [edited]
http://allafrica.com/stories/201202080058.html


A fresh outbreak of plague is suspected after 2 people died of similar symptoms in Vurra County, Arua district, where health officials here have put the community on alert.

Over the years, plague outbreaks have been emerging from the neighboring DR Congo. When contacted, the district health officer, Dr Patrick Anguzu, said he was still consulting for details of the disease. "I have not yet received a report on the outbreak, but I will try to consult," he said.

But the Vurra MP, Dr Sam Okuonzi, told Daily Monitor in a telephone interview that the 2 died in Opia parish. As a drive to fight the annual disease, in 2009, the Ministry of Health launched a sensitization program for the 2 bordering districts of Nebbi and Arua, where previous outbreaks have occurred.

[byline: Felix Warom Okello, Clement Aluma]

--
communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

[No specific details of the cases are included in the posting. Most cases are due to bubonic plague following the bite of an infected rodent flea, causing a swollen and very tender lymph gland. The swollen gland is called a "bubo". Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being bitten.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. At this stage, person-to-person spread can occur, causing other cases of "primary" plague pneumonia.

The districts of Uganda can be seen on the map at http://www.coetzee-uganda.com/index_fil ... Uganda.htm. The HealthMap/ProMED-mail interactive map of Uganda is available at http://healthmap.org/r/00XI. - Mod.LL]

[Birgitt]

PLAGUE, FATAL - UGANDA (02): BACKGROUND
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Date: Tue 14 Feb 2012
Source: GideonOnline [edited]
http://www.GideonOnline.com


The following background data on plague in Uganda are abstracted from Gideon (http://www.GideonOnline.com) and the Gideon e-book series (1, 2) (primary references available on request):

The earliest record of plague in Africa was a report by missionaries in Uganda in 1877, and reporting statistics for much of the continent have been documented for more than 100 years. A series of plague epidemics were recorded in East Africa during the 1920s and 1930s (see graph 3; http://www.gideononline.com/wp/wp-conte ... Plague.png).

31 305 plague deaths were reported in Uganda during 1910 to 1919; 17 410 during 1920 to 1929; 11 387 during 1930 to 1939.

Presumed local reservoirs include the Nile rat, _Arvicanthus niloticus_. Presumed local flea vectors include _Xenopsylla cheopis_ and _X. brasiliensis_.

Notable outbreaks:
1982 - an outbreak (152 cases, 3 fatal) was reported.
1986 - an outbreak (340 cases, 27 fatal) was reported.
1993 - an outbreak (167 cases, 18 fatal) was reported in Western Region (Nebbi district).
1998 - an outbreak was reported in Arua district.
2001 - an outbreak was reported in Nebbi district.
2004 - an outbreak (4 cases, one confirmed, 3 fatal) of pneumonic plague was reported in Kango subcounty.
2006 - an outbreak (127 cases, 11 fatal) was reported in Arua and Nebbi districts, including 12 cases of pneumonic plague.
2007 - outbreaks (179 cases, total) were reported in Masindi district (19 cases, 9 fatal), and in Arua (121 cases, 10 fatal) and Nebbi (39 cases, 9 fatal).
2008 - an outbreak (68 deaths) was reported in Arua and Nebbi.

References
----------
1. Berger SA. Infectious diseases of Uganda, 2012. 398 pp, 61 graphs, 1711 references. Gideon e-books, http://www.gideononline.com/ebooks/coun ... of-uganda/.
2. Berger SA. Plague: global status, 2012. 98 pp, 102 graphs, 524 references. Gideon e-books, http://www.gideononline.com/ebooks/dise ... al-status/.
3. Gideon graph tool at http://www.gideononline.com/wp/wp-conte ... Graphs.pps.

--
communicated by:
Dr Steve Berger
Geographic Medicine
Tel Aviv Medical Center


[ProMED-mail thanks Dr Berger for his continuing contributions. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1wa6.]

[Birgitt]

PLAGUE - MADAGASCAR: FATALITIES
******************************************
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Date: Thu 15 Nov 2012
Source: L'Express de Madagascar [in French, trans. Mod.MPP, edited]
http://www.lexpressmada.com/epidemie-ma ... peste.html


The arrival of the rain is not always good news, as rats [and their fleas], the plague vectors, take refuge in habitats, wreaking havoc.

It is the beginning of the plague season on the Big Island and it is time to start worrying. 6 patients have died of the disease in a month. The Bongolava region has paid the highest price. "Of the 43 cases identified, 2 people died of bubonic plague on [2 Oct 2012], 2 others died on 5 Nov 2012, and another person died on 9 Nov 2012 person," the statistical management of health monitoring and epidemiological surveillance (DVSSE) within the Ministry of Public Health reported yesterday [14 Nov 2012].

However, this epidemic does not affect this region alone. Another victim of the plague was also registered in the District of Mandoto in Vakinankaratra, on 9 Oct 2012. The same day, 3 other non-fatal cases were found in the district of Ambalavao in the Haute-Matsiatra region.

The cause of this deadly epidemic seems always the same. "The plague victims sometimes live in remote areas and they self-medicate before going to a health center when the disease worsens. However, all health centers are equipped with rapid diagnostic test and medications to treat this disease immediately," said Alain Marcel Rahetilahy, head of epidemic and neglected diseases within the Ministry of Health. In contrast, the Regional Director of Public Health for Tsiroanomandidy refused to disclose the circumstances of this deadly epidemic in its domain, without the written permission of the Secretary General of the Ministry of Health.

However, Alain Marcel Rahetilahy does not want to dramatize the situation. "These cases have yet to be confirmed by the Pasteur Institute of Madagascar. And every year, only 30-40 percent of reported cases are confirmed, even if the initial result is positive by a rapid diagnosis test. So the situation is it not very disturbing," he reassured.

Yet other doctors remain cautious. "The heat, the rain, and the bushfires that devastated several regions in recent months, forced the rats, propagation vectors of the plague, to flee to the villages. This is why people must remain vigilant," warned a doctor who does not wish to reveal his name. And according to the Secretary General of the Ministry of Health, Philemon Tafangy, the number of suspected cases of plague is between 300 and 500 annually.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Plague is caused by the _Yersinia pestis_ bacillus, carried by rat fleas. At the start of the rainy season, currently, rats flee the sewers of Madagascar in massive numbers and take refuge in people's cottages. [The following paragraph of this posting is from 1998 (Chanteau S, Ratsifasoamanana L, Rasoamanana B, et al: Plague, a Reemerging Disease in Madagascar. Emerg Infect Dis 1998; 4(1): 101-4: "Between 1930 and 1990, bubonic plague had "virtually disappeared" on the island due to efficient pest-control and good health-management. However since 1990, an annual 200 cases are being reported and bubonic plague takes on epidemic form especially in the port of Mahajanga each year. In the capital city of Antananarivo more cases are also being notified each year since 1990. Madagascar (pop. 13 million) has accounted for 45 percent of all the cases of plague in Africa."

Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node which drains the area where the flea bite occurred) to the bloodstream. The bacteremia can cause a coagulopathy producing the purpura seen in the "Black Plague" and also spread to the lung causing a hemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.

Madagascar was the location of the isolation of multi-antimicrobial resistant _Y. pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al: Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med 1997; 337(10): 677-80). The strain was resistant to chloramphenicol, streptomycin and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear if this naturally occurring strain has persisted or spread. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1kSe.]

[Birgitt]

PLAGUE - MADAGASCAR (02): FATALITIES
************************************
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http://www.isid.org


Date: Mon 17 Dec 2012
Source: RFI (Radio France Internationale) [in French, trans. Mod.JW, edited]
http://www.rfi.fr/afrique/20121217-mada ... ndissounon


This is the peak season for the plague in Madagascar. The Big Island remains one of the countries most affected by this disease in the world, the 2nd after the Congo Democratic Republic. With the current heat and rain, cases are increasing in this period. Several foci are being discovered around the capital, Antananarivo.

10 patients have just been newly identified some 80 km from the capital. Other cases have been reported even closer. In total, since the beginning of 2012, the plague has already affected 250 people, 90 since early October 2012, with nearly one out of 5 patients dying. Dr. Celine Seignon-Kandissounon, representative of the WHO in Madagascar, reports an increase in the number of deaths: "Compared to 2011, there are fewer cases, but these cases were more serious. It was noted that there are more deaths in 2012."

The problem with the plague is that too often patients have consulted late, and since the beginning of the crisis 4 years ago, it has worsened. "The vulnerability of the population has increased," says Dr. Seignon, "with the [worsening of the] socio-economic situation. Sometimes, accessibility to the health care centers is difficult, so delay in treatment can explain the increase in the number of deaths."

Information campaigns and treatment are underway. The villages affected by the disease are quarantined to contain the outbreak, but it is certain that in Madagascar, plague will never be eradicated.

--
Communicated by:
ProMED-FRA
<promed-fra@promedmail.org>

[There have been few cases but more deaths this year (2012) compared to last year. Delayed treatment may explain this fact, but we must also consider other factors such as the virulence of the infecting strains, resistance to the antibiotics used, counterfeit drugs, and, therefore, under-dosage of those used in the treatment of the disease. In any case, this article is quite pessimistic. If efforts are made to raise the awareness of the people and improve levels of hygiene and sanitation, with a fierce struggle against rats and their [fleas], plague could one day be only a sad memory on the Big Island.

An interactive ProMED-mail HealthMap of Madagascar is available at: http://healthmap.org/r/018m. - Mod.BM]

[For background see: Chanteau S, Ratsifasoamanana L, Rasoamanana, et al: Plague, a reemerging disease in Madagascar. Emerg Infect Dis 1998;4: 101-104. Available from http://wwwnc.cdc.gov/eid/article/4/1/98-0114.htm.

Abstract
------
Human cases of plague, which had virtually disappeared in Madagascar after the 1930s, reappeared in 1990 with more than 200 confirmed or presumptive cases reported each year since. In the port of Mahajanga, plague has been reintroduced, and epidemics occur every year. In Antananarivo, the capital, the number of new cases has increased, and many rodents are infected with _Yersinia pestis_. Despite surveillance for the sensitivity of _Y. pestis_ and fleas to drugs and insecticides and control measures to prevent the spread of sporadic cases, the elimination of plague has been difficult because the host and reservoir of the bacillus, _Rattus rattus_, is both a domestic and a sylvatic rat.

In the last 15 years [through 1998], Madagascar (population 13 million) has accounted for 45 percent of the cases of plague in Africa. - Mod.JW]

[Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node which drains the area where the flea bite occurred) to the bloodstream. The bacteremia can cause a coagulopathy producing the purpura seen in the "black plague" and also spread to the lung causing a hemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.

Madagascar was the location of the isolation of multi-antimicrobial resistant _Y. pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al: Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med 1997; 337(10): 677-80). The strain was resistant to chloramphenicol, streptomycin, and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear whether this naturally occurring strain has persisted or spread. - Mod.LL]

[Birgitt]

PLAGUE - MADAGASCAR: PRISON, URBAN RISK, ALERT
***********************************************
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Date: Thu 10 Oct 2013
Source: BBC [edited]
http://www.bbc.co.uk/news/world-africa-24461474


Madagascar faces a bubonic plague epidemic unless it slows the spread of the disease, experts have warned. The Red Cross and Pasteur Institute say inmates in the island's rat-infested jails are particularly at risk.

The number of cases rises each October as hot humid weather attracts [promotes breeding of] fleas, which transmit the disease from rats and other animals to humans. Madagascar had 256 plague cases and 60 deaths in 2012, the world's highest recorded number.

Bubonic plague, known as the Black Death when it killed an estimated 25 million people in Europe during the Middle Ages, is now rare. Bubonic plague swept through Europe in the 14th Century, killing between one third and one half of the entire population. But the Black Death, as it was called, seemed to disappear some time in the 17th Century, and many people today assume it has died out completely. In fact bubonic plague remains a serious public health problem in many parts of the world. In Madagascar [and Mongolia and the western USA], plague is endemic in the animal population, and cannot be eradicated.

The prevalence of rats in Madagascar's prisons means the plague can spread easily. Fleas from plague-carrying rats infect prisoners, prison guards and visitors. And rats, unlike the prisoners, can go in and out of jail anytime. The threat to the general population is clear.

October is regarded as the start of the plague season in Madagascar. The hot, humid weather means more fleas, and more risk of disease.

The International Committee of the Red Cross (ICRC) in Geneva and the Pasteur Institute have worked with local health groups in Madagascar since February 2012 on a campaign to improve prison hygiene. "If the plague gets into prisons there could be a sort of atomic explosion of plague within the town. The prison walls will never prevent the plague from getting out and invading the rest of the town," said the institute's Christophe Rogier.

The ICRC said the 3000 inmates of Antanimora, the main prison in the heart of the capital Antananarivo, live with a huge rat population which spreads infected fleas through food supplies, bedding, and clothing.

The ICRC's Evaristo Oliviera said this could affect not only inmates and staff, but others they come into contact with. "A prison is not a sealed place, first of all the staff themselves who work in the prison are at risk, and they go home at the end of the day, already perhaps being a vector of the disease," he told the BBC. "Also the rats themselves, they can go in and out of the jail and also propagate the disease. And the prisoners do have visitors who can be also infected, and the prisoners eventually go out as well so we have many, many ins and outs for the disease to spread."

The BBC's Imogen Foulkes in Geneva says the eradication project undertaken by the ICRC is tricky because simply killing the rats is not enough. To prevent their infected fleas transferring to another host, possibly a human, the insects must be destroyed as well as the rodents, she says.

Experts say that Africa -- especially Madagascar and the Democratic Republic of Congo -- accounts for more than 90 percent of cases worldwide. During the last 20 years, at least 3 countries experienced outbreaks of human plague after dormant periods of about 30-50 years, experts say. These areas were India in 1994 and 2002, Indonesia in 1997 and Algeria in 2003. According to the WHO, the last significant outbreak of bubonic plague was in Peru in 2010 when 12 people were found to have been infected.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[As yet, in 2013, there have been no reported cases of plague infection on the island nation of Madagascar [for 2012, see ProMED archives below].

Plague is caused by the _Yersinia pestis_ bacillus, carried by rat fleas. At the start of the rainy season, currently, rats flee the sewers of Madagascar in massive numbers and take refuge in people's cottages. [The following paragraph of this posting is from 1998 (Chanteau S, Ratsifasoamanana L, Rasoamanana B, et al: Plague, a Reemerging Disease in Madagascar. Emerg Infect Dis 1998; 4(1): 101-4:; http://wwwnc.cdc.gov/eid/article/4/1/98 ... rticle.htm

"Between 1930 and 1990, bubonic plague had "virtually disappeared" on the island due to efficient pest-control and good health management. However since 1990, an annual 200 cases are being reported and bubonic plague takes on epidemic form especially in the port of Mahajanga each year. In the capital city of Antananarivo more cases are also being notified each year since 1990. Madagascar (pop. 13 million) has accounted for 45 percent of all the cases of plague in Africa."

Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node which drains the area where the flea bite occurred) to the bloodstream. The bacteremia can cause a coagulopathy producing the purpura seen in the "Black Plague" and also spread to the lungs causing a hemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.

Madagascar was the location of the isolation of multi-antimicrobial resistant _Y. pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al: Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med 1997; 337(10): 677-80; http://www.nejm.org/doi/full/10.1056/NE ... 9043371004). The strain was resistant to chloramphenicol, streptomycin, and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear if this naturally occurring strain has persisted or spread. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1kSe.]

[Birgitt]

A village in Madagascar has been hit by a deadly outbreak of the bubonic plague, medical experts on the island have confirmed. Test were carried out after at least 20 people in the village, near the north-western town of Mandritsara, were reported to have died last week. The International Committee of the Red Cross warned in October that Madagascar was at risk of a plague epidemic [...] Last year, Madagascar had 60 deaths from the plague, the world's highest recorded number.

Madagascar village 'hit by bubonic plague'
10.12.2013 - BBC

Two cases of pneumonic plague - more deadly than bubonic plague - have been reported in Madagascar, a health official has told the BBC. It comes after it was confirmed that there was a deadly outbreak of the bubonic plague in a village in the north-west of the island. Pneumonic plague can be inhaled and transmitted between humans without involvement of animals or fleas. It is the most virulent and least common form of plague. It can kill within 24 hours.

Madagascar hit by 'pneumonic and bubonic plague'
11.12.2013 - BBC

Bei einer Pestepidemie im abgelegenen Norden der Tropeninsel Madagaskar sind in den vergangenen Tagen über 20 Menschen gestorben. Seit September seien insgesamt 36 Menschen in vier verschiedenen Bezirken an der Infektionskrankheit gestorben, hieß es vom Gesundheitsministeriums. Wegen unangemessener Behandlung und später Erkennung der Krankheit habe sich die zunächst in der Region vorherrschende Beulenpest in die tückischere Lungenpest gewandelt, hieß es weiter. Der Erreger, das Bakterium Yersinia pestis, kann bei einer Beulenpest über die Blutbahn in die Lunge geraten.

Pestausbruch auf Madagaskar mit über 20 Toten
11.12.2013 - ORF

Gruß
Birgitt

[Birgitt]

PLAGUE - MADAGASCAR (03): PNEUMONIC, MORE CASES AND FATALITIES
**************************************************************
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Date: Fri 13 Dec 2013
Source: New Straits Times, Agence France-Presse (AFP) report [edited]
http://www.nst.com.my/latest/39-dead-fr ... t-1.430852


A plague spread by rats [via their fleas] has killed 39 people in recent weeks in Madagascar, the health ministry said Thursday, 12 Dec 2013. "There is an epidemic in Madagascar which is currently affecting 5 districts (out of 112). 86 people have been afflicted by the illness, of which 39 have died," said the ministry in a statement read to AFP.

A doctor in the ministry in Antananarivo said 90 percent of the cases were diagnosed as pneumonic plague, a lethal form, which can kill within 3 days, leaving little time for antimicrobials to work.

The 1st person died before November 2013 but government only officially declared the existence of a plague on 23 Nov 2013. According to the doctor, who cannot be named because he does not have clearance to speak to the media, the 1st case was registered in a village in the remote [district] of Mandritsara [Sofia region].

Affected districts are in the north, northeast, southeast and the center of the island nation.

--
Communicated by:
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[Most cases of plague are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being bitten.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may produce bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. At this stage, as appears to have happened in this outbreak, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1kSe.]

[Birgitt]

PLAGUE - MADAGASCAR (04)
************************
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ProMED-mail is a program of the
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http://www.isid.org

Date: Fri 20 Dec 2013
Source: UN Integrated Regional Information Networks (IRIN) News [edited]
http://www.irinnews.org/report/99370/pl ... madagascar


The bubonic plague season arrived in Madagascar earlier than usual in 2013, and with it an apparently greater prevalence of a more deadly manifestation of the disease.

Between September and December 2013, the health ministry reported 42 known deaths and 84 cases from the illness in 4 of the country's 112 districts. The cases have been recorded at various geographical locations: Mandritsara in the north, Soanierana Ivongo in the [northeast], Ikongo in the southwest, and Tsiroanomandidy in the central highlands.

Dr Voahangy Ravaoalimalala, vice-director of the Malagasy Institut Pasteur, which performs pathogen tests for the health ministry in Antananarivo, told IRIN: "Bubonic plague can be treated easily with antibiotics, but this time some cases of pneumonic plague have also been identified. This form of plague is harder to treat, as it can kill people within 3 days."

Most cases of the 3 common plague forms are bubonic. Between 2 and 8 days after exposure, the patient develops fever and chills, as well as the [painful] swelling of lymph nodes -- the buboes -- to which the bacteria move and where they multiply. The 2nd is septicemic plague, with a fatality rate of 50 percent -- higher than bubonic --, and the 3rd is pneumonic plague, which is fatal in all cases unless the patient is given antibiotics as soon as the symptoms appear.

The health ministry notes that between 300 and 600 cases of bubonic plague occur annually in Madagascar, usually between October and March. Despite some anxiety in the capital, Antananarivo, and local media reports that there was a suspected case of plague in Manjakandriana, 20 km [12.4 mi] from the densely populated city, the cases and fatalities have occurred in fairly isolated areas. 2 weeks ago, officials announced Antananarivo's coffers were empty and there was no money to spare for rubbish collection. Refuse has been piling up in the city, encouraging the spread of rats and mice. The UN Development Programme (UNDP) and the European Union (EU) have donated money and equipment, and have mobilized volunteers to assist in clearing the city of garbage.

According to the WHO, 21 725 persons were infected with plague worldwide in the 1st decade of the 21st century, accounting for 1612 deaths and a case fatality rate of 7.4 percent.

In many countries the disease has retreated as a result of access to medication, rodent-proof housing and better urban hygiene, but living conditions in Madagascar's highland villages -- where people often store their rice crops in their homes -- attract rats and make the country more prone to plague outbreaks. According to WHO, bubonic plague is endemic in many parts of Africa, and "the most heavily affected African countries are the Democratic Republic of the Congo, Madagascar, Mozambique, Uganda and Tanzania."

Plague is thought to have arrived in Madagascar in 1898, carried by infected rats on ships from India. As a result of vaccination campaigns, improved housing and public hygiene, and the discovery of streptomycin and the use of insecticides, plague was brought under control in the 1950s.

During the next 30 years, only 20 to 50 cases per year were reported in Madagascar, but since 1989 the number of suspected cases has increased steadily.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The numbers in this UN IRIN report differ slightly from previous reports of the current _Yersinia pestis_ infection situation on the island nation of Madagascar. The report does contribute some background information about plague there. - Mod.LL

Maps of Madagascar can be seen at http://www.geoatlas.com/medias/maps/cou ... ar_pol.jpg and http://healthmap.org/r/1kSe. - Sr.Tech.Ed.MJ]

[Birgitt]

PLAGUE - MADAGASCAR
*******************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Thu 20 Feb 2014
Source: L'Express de Madagascar [in French, transl, edited]
http://www.lexpressmada.com/blog/actual ... maine-5286


Is the plague outbreak on hold in Madagascar? Christophe Rogier, director of the Pasteur Institute in Madagascar, revealed information that was not reassuring in his progress report for the fight against the plague in prisons launched by the Ministry of Public Health, by the International Committee of the Red Cross (ICRC) and by the prison administration.

"The plague remains sporadic but is much more deadly than malaria. The disease can emerge in a locality where the epidemic has not yet hit, as was the case in Ambilobe in 2011. This sporadic case that was not contained can thus turn into an epidemic. We must be very careful because we get a case of plague each week all over the island," said Christophe Rogier.

The main cause of the resurgence of the disease is not very clear. Some doctors argue that the bush fires are pushing the rats to seek refuge in the homes. They carry fleas infected by the plague, then transmit the disease to humans. This theory is in part true, says Christophe Rogier, but the people infected by the plague in Ambilobe lived in the forest in a mining site far from bush fires.

On the other hand, prisons which usually get a lot of cases of plague have not reported any cases yet. In 2012, thanks to the pest control campaign carried out by the ICRC in the prison of Antanimora, 1600 rats were caught. The short film, made by the ICRC to alert people to the fight against this disease, was a moving testimony for a different reason. The prisoners did not get infected by the plague, but the son of the district chief of Miari­narivo, Justin Tata.

"Plague can infect the whole world. The change in behavior must be priority number one," emphasized Christoph Vogt, regional head of delegation of the ICRC in the Indian Ocean.

Faced with this situation, Philemon Tafangy, general secretary of the ministry of public health, accused other entities. "Let's not only accuse the ministry of public health, but let's ask the right questions: Who should collect the trash so as not to attract the rats? Who is responsible for the lack of drugs in the health centers? Who is in charge of prohibiting bush fires in order not to disturb the natural habitat of rodents? Who should encourage people to go to health centers when they are sick?" he asked.

[Byline: Vonjy Radasimalala]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Plague continues to occur on the island of Madagascar at a slow rate. - Mod.LL

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1kSe.]

[Birgitt]

In Tamatave, Madagaskar, gibt es einen aktuellen Ausbruch der Pest ...

Nineteen people have died of plague in Madagascar over the past two months, AFP reports quoting the Health Ministry. A total of 104 suspected cases have been registered. The disease, which is endemic in Madagascar, is normally seen in parts of the country between October and March. The ministry says the latest outbreak has caused panic in Tamatave, a town on the east coast, which has not seen the disease for 100 years.

Nineteen dead in Madagascar plague outbreak
28.09.2017 - BBC

Gruß
Birgitt

[Alexander]

Die derzeit in Madagaskar auftretende Pest könnte sich nach Angaben der Weltgesundheitsorganisation (WHO) auch auf andere Länder in der Region ausbreiten. Wegen der zahlreichen Flugverbindungen bestehe durchaus Gefahr, dass die hoch ansteckende Seuche auch die Nachbarinseln im Indischen Ozean erreicht, sagte WHO-Sprecher Christian Lindmeier ...

Welt: Seltenere Pest-Form breitet sich auf Madagaskar aus

Grüsse
Alexander

[ferdi]

Oh Pest (und Cholera),

gibt es auch in der Mongolei (war ich letztens), übertragen durch Murmeltiere, deshalb überall Schilder:"Keine Murmeltiere jagen und schon gar nicht verspeisen" -Gute Idee und gute Reise.

Ferdi