H5N1

Ituri / Health: 15 suspected cases of pneumonic plague including 11 deaths recorded in Djugu territory

A May 21 report in Le Voix de l'Ituri in the northeast DR Congo: Ituri / Health: 15 suspected cases of pulmonary plague including 11 deaths recorded in Djugu territory. The Google translation:

A disease similar to pulmonary plague is observed in the area of ​​Fataki in the territory of Djugu in the province of Ituri. 

In a lively press briefing on Friday, May 21 in Bunia, the head of the provincial health division of ituri indicated that everything dates back to April 23, 2021 in the health zone of Fataki. The victims show symptoms of headache, fever, cough and vomiting blood. The report shows 15 cases including 11 deaths so far.  

"The first case was that of a woman who had died in the Fataki area of health, health area Bukachele.Une week later, on April 30, a 30 year old man was dead after showing the same symptoms. On May 8, there was another man who had died. We were alerted when there were already 5 deaths in this health area in the same family. There were after, two people who had left instead of the funeral in Bukachele who, on their return, became ill and died in Bhule. This is what prompted our Fataki intervention team to investigate. On May 19, there were two more deaths in Bukachele and two other deaths in Bhule, including a traditional practitioner who treated the sick,“ said Doctor Louis Tchulo in the remarks collected by lavoixdelituri.net. 

In addition, he indicated that four other suspects with the same symptoms are currently being treated in health facilities including two in Bhule and two others in Bukachele. 

"Our team began to identify all the contacts that were with the other patients who died. We also proceeded to the dignified and secure burial of 4 bodies on May 18 and 19 and it did not constitute a danger for the community. What remains for us is to send a team to collect the samples, mainly the sputum that we will bring to the laboratory for confirmation,” he added. 

Since this disease is transmitted by air, Doctor Louis Tchulo invites the population of Fataki in particular and of Djugu in general, to regularly wear masks, to respect physical distancing, to avoid the handling of corpses and to 'alert on all suspected cases. 

It should be remembered that this disease is in addition to the bubonic plague reported since 2020 in Ituri with 461 cases of which 31 deaths have been reported. Since the start of the current year, 75 cases have already been recorded with 1 death in 8 health zones including Biringi, Rethy, Aru, Aungba, Linga, Logo, Rimba and Kambala.

A May 24 report in provinces26rdc.net says the case count is now up to 90, with 12 deaths.

DR Congo: Return of the plague in Ituri, with more than 500 cases and 31 deaths

Ituri province

Via mediacongo.net: mediacongo.net - News - Return of the plague in Ituri, with more than 500 cases and 31 deaths. Excerpt:

More than 500 cases of plague have been detected in a region of the northeast of the Democratic Republic of the Congo for several months, killing around thirty people, AFP learned this Friday, February 19, 2021 from health authorities and experts. .

Currently, we have "more than 520 cases of plague" including "more than 31 deaths," said Dr Patrick Karamura, provincial minister of health of Ituri, a plague endemic region. 

In this "resurgence" of cases, "there are not only cases of bubonic plague. We also have five cases of pulmonary plague, two other cases of septicaemic plague," he said. 

Cases appeared between November 15 and December 13 in the health zone of Biringi, located in the territory of Aru in Ituri, explained Dr Anne Laudisoit, epidemiologist at Ecohealth Alliance, an NGO based in New York, which stays in the area with a team of researchers. 

The average age of those affected is 13, she adds. However, there are big differences: "the youngest person is 3 months old and the oldest, 73 years old", explained the specialist. 

According to Dr Anne Laudisoit, at the time of the first cases, "there was a massive rat death, which is really indicative of the plague". The rats die, the fleas on them look for another animal to feed on and the closest animal is humans, she explained. 

"An upsurge in plague cases has been observed since June 2020 in the health zone of Rethy, in the province of Ituri," warned the World Health Organization (WHO) on July 20. 

Ituri is the only area in the DRC where the plague is endemic. The disease was confirmed there as early as 1926. 

From Lake Albert to the Aru region bordering southern Sudan, it is "an area where the plague resurfaces frequently and unpredictably", according to Dr Laudisoit.

The four Black Deaths

I had an opportunity to read this long article in The American Historical Review, and found it fascinating: Four Black Deaths. We tend to think of the Black Death as a European disaster, but medical historian Monica H. Green shows its extent was far greater. The abstract: 

The Black Death, often called the largest pandemic in human history, is conventionally defined as the massive plague outbreak of 1346 to 1353 C.E. that struck the Black Sea and Mediterranean, extended into the Middle East, North Africa, and western Europe, and killed as much as half the total population of those regions. Yet genetic approaches to plague’s history have established that Yersinia pestis, the causative organism of plague, suddenly diverged in Central Asia at some point before the Black Death, splitting into four new branches—a divergence geneticists have called the “Big Bang.” 

Drawing on a “biological archive” of genetic evidence, I trace the bacterial descendants of the Big Bang proliferation, comparing that data to historical human activities in and around the area of plague’s emergence. The Mongols, whose empire emerged in 1206, unwittingly moved plague through Central Eurasia in the thirteenth, not the fourteenth, century. Grain shipments that the Mongols brought with them to several sieges, including the siege of Baghdad, were the most likely mechanism of transmission. 

The fourteenth century plague outbreaks represent local spillover events out of the new plague reservoirs seeded by the military campaigns of the thirteenth century.

Mongolia: Two dead of bubonic plague

Via Web24 News, an Infobae report: Mongolia ordered quarantine and closure of part of the border with Russia after reported deaths from bubonic plague. A lightly edited excerpt and then a comment:

Mongolia ordered entry into quarantine from the city of Tsetseg, in the western province of Khov, after two deaths were detected by bubonic plague, as reported by local health authorities. A partial closure of the border with Russia was also ordered, to avoid an outbreak that could spread beyond the country’s limits. 

The victims, whose identity was not disclosed so far, had consumed marmot meat. The disease is also known in the region as “marmot plague” 

“Specialists from the National Center for Disease Control and Prevention (NCDC) and the National Center for Disease Control and Prevention (NCDC) in Khovd and Bayan-Ulgii are working to establish a quarantine in Jargalant and Tsetseg soums," the local government said. 

“In the two confirmed cases, 146 first contact and 504 second contact individuals were identified, and 146 first contact samples were collected and analyzed," health workers said in the statement. 

The affected place is about 500 kilometers south of Siberia. The Russian state news service, Tass, confirmed the immigration closure to prevent the passage of private vehicles and the transport of merchandise.  

It is not the first time that Mongolia has resorted to a similar measure on that edge.. A key border crossing with Russia with closed in May 2019 on suspicion that it may have played a role in an outbreak of the plague, leaving several Russian tourists stranded. A couple had died after eating marmot meat in that incident.

The May 2019 incident was reported here. In November 2019, three more cases were reported, one resulting from eating a plague-infected rabbit.

COVID-19 has the potential to become as severe as the Spanish flu

Via Maclean's: COVID-19 has the potential to become as severe as the Spanish flu.

Timothy Sly is an epidemiologist and professor at the school of Public Health at Ryerson University. In 2003, he was involved in the management of SARS in Toronto.   

We are very likely heading toward the pandemic of the century.   

We have been preparing for it since 2003, when SARS revealed both our non-existent, early-warning systems and the inadequacy of our initial responses to a novel infectious disease. But the battle was fought well and when the dust settled, Canada had recorded 438 probable and suspect SARS cases, of which 44 had not survived, a 10 per cent case-fatality rate (CFR), similar to other SARS-affected countries. And like those other countries, we learned a lot, planned a lot, and in September 2004 the Public Health Agency of Canada was established.     

Pandemic planning was accelerated later that same year, when another communicable disease threat emerged in Southeast Asia: a deadly avian influenza virus. Since 2003, 400 out of the approximate 800 humans who have became infected from poultry have died, a CFR of 50 per cent, similar to untreated bubonic plague, untreated cholera, and Ebola hemorrhagic fever. Yes, you read that correctly; it’s an avian influenza virus with the antigen code H5N1 otherwise known as “bird flu.” Fortunately, it still is not capable of sustained spread person-to-person.

But the pandemic disease which killed more people in little over a year than any other in history, was the 1918 H1N1 avian influenza, sometimes erroneously called the “Spanish flu.” With a global case fatality of two to 2.5 per cent, it is estimated to have harvested at least 50 million people, with possibly many more in areas that were not keeping records. 

In case you are reaching for the keyboard to point out that the “Black Death,” or bubonic plague, killed many more than that, it’s not true. The plague killed a greater proportion of the world’s population at that time, but it took nearly a century to kill the same number as the 1918 flu did in about 15 months. Although the 1918 flu case-fatality rate was less than SARS, its transmission was much more effective, enabling it to reach the entire globe.    

We must now face the reality that COVID-19 may have the potential to become as severe as the 1918 influenza. The CFR of around 2 per cent has appeared to increase over the last couple of weeks to about 3.5 per cent, due in all likelihood to the logistic impossibility of recording the actual case numbers on a daily basis from a population of more than a billion with anything even remotely resembling accuracy and validity. 

By comparison, the cases occurring outside of China, which we can assume to have been made under greater scrutiny, were around 0.3 per cent fatal (up until Feb. 19 that is, when Iran first announced some clearly dubious and understated claims). 

COVID-19’s rate of spread globally shows no sign of slowing and of course it’s moving far faster than the Spanish flu in 1918, when it took an ocean liner about six days to travel from Southampton, England to New York, longer than the one-to-three-day incubation period of influenza. Today, viruses travel in comfort at 600 kilometres per hour and at 39,000 feet; they can be anywhere on the planet in 24 hours. The incubation period of COVID-19 can be two to 11 days, but usually six to seven days, and certainly long enough to be at the destination for several days before the first signs of illness are noticed.   

We can certainly pay tribute to the pandemic planning of the early 2000s, without which we might not have been able to contain the few dozen cases of COVID-19 that have arrived in Canada thus far, or prevent onward transmission through the community. But the odds are stacked against this scenario remaining unblemished.  

During the earliest stages of controlling the spread of any infectious pathogen, containment is key, involving finding and isolating sick individuals who meet the case definition, and quarantining their contacts. Theoretically, if this is immediate and flawless, it can be 100 per cent effective. But inevitably, we must expect “leakage” due to time delays, “hidden” cases such as asymptomatic and pre-symptomatic cases, defective case-definitions, and errors in logistics and reporting. 

Sooner rather than later, we will find cases with no known connection to foreign sources or indeed to any other known case. That will imply the existence of unknown infectious cases—stepping stones, if you like—who will already have infected others. When that happens, the scenario will inevitably change from simple “containment” to “mitigation.”    

We will still try to contain and isolate all cases while searching for asymptomatic or missing infectious individuals, but an uncontained spread will be a very real possibility at that stage. Mitigation at the individual, family or group level becomes top priority. 

Essentially, it’s a reversal of the containment principle and involves drawing a “healthy containment” circle around yourself, in a sea of possible infection, and hoping to stop the virus entering by using hygiene and distancing.

China: More on the plague cases

Via South China Morning Post: Chinese man, 55, contracts bubonic plague after eating wild rabbit. Excerpt:

A man from Inner Mongolia has been diagnosed with bubonic plague after eating a wild rabbit, the local health authority said on Sunday, less than a week after two other people from the region were reported to have contracted the pneumonic form of the disease. 

The latest casualty is a 55-year-old from Xilingol league in the north China region, who is being treated at a hospital in Huade county, the health commission said. 

The man, who was not named, caught and ate the rabbit on November 5 and appeared unaffected for more than a week. However, on Saturday he fell ill with a fever and went to the hospital for help, the statement said. 

After being diagnosed with the infectious disease, 28 people with whom he had been in close contact were put into quarantine, it said. 

However, the statement said the case was not linked to the two people from remote villages in Inner Mongolia who were diagnosed with pneumonic plague earlier in the month and are being treated in Beijing. 

The Beijing Health Commission said on Saturday that one of the patients was now in a stable condition, while the second was in a more serious state despite having earlier shown signs of recovery.

Several of the people with whom they had been in close contact and had been quarantined had since been released from hospital after showing no signs of the disease, the authority said. 

Although plague has been mostly eradicated in China, cases are occasionally reported in northern parts of the country. According to official yearbooks there have been six fatalities from the disease in the past five years.

China's Inner Mongolia reports fresh bubonic plague case

Via Reuters: China's Inner Mongolia reports fresh bubonic plague case. Excerpt:

BEIJING (Reuters) - China’s Inner Mongolia reported a fresh, confirmed case of bubonic plague on Sunday, despite an earlier declaration by the country’s health officials that the risk of an outbreak was minimal.  

The health commission of the autonomous region said a 55-year-old man was diagnosed with the disease after he ate wild rabbit meat on Nov. 5.  

Bubonic plague is the most common form of plague globally and can advance and spread to the lungs, which is more severe type called pneumonic plague, according to the World Health Organization. 

The Inner Mongolia case follows two that were confirmed earlier this month in Beijing. In both cases, the two patients from Inner Mongolia were quarantined at a facility in the capital after being diagnosed with pneumonic plague, health authorities said at the time. 

The Inner Mongolia health commission said it found no evidence so far to link the most recent case to the earlier two cases in Beijing. 

The patient in Inner Mongolia is now isolated and treated at a hospital in Ulanqab, the health commission said.  

A total of 28 people who had close contact with the patient are now isolated and under observation, and the commission said there are no abnormal symptoms found in them.

Pneumonic plague is diagnosed in China

The New York Times takes note: Pneumonic Plague Is Diagnosed in China. Excerpt and then a comment:

BEIJING — Two people in China were diagnosed with plague, setting off a panic on Tuesday about the potential spread of the highly infectious and fatal disease and prompting China’s government to warn citizens to take precautions to protect themselves.  

Beijing officials said the two infected people came from Inner Mongolia, a sparsely populated region of northern China. They sought treatment on Tuesday in a hospital in Beijing’s Chaoyang District, where they were diagnosed with pneumonic plague, according to the government office of the district.  

The Chinese Center for Disease Control and Prevention said on Weibo, the microblogging site, that there was no need for Beijing residents to panic and that the risks of further transmission are “extremely low.” The authorities quickly isolated the patients, conducted epidemiological investigations on the people who could have been exposed and disinfected all the relevant sites, the CDC said. They have also strengthened monitoring of patients with fever, it added. 

Pneumonic plague is one of three types of infectious disease known as plague caused by the same bacterium, Yersinia pestis. Patients diagnosed with pneumonic plague, which causes high fevers and shortness of breath, sometimes first contract the closely related and more well-known disease, bubonic plague.

Fears are mounting in China over a possible outbreak of the disease, once known as the Black Death, which killed tens of millions of people in medieval Europe, and spread through Asia and Africa. 

Last month, the authorities in China said they would strengthen quarantine measures to prevent plague from entering the country after Madagascar was struck by a fast-spreading outbreak of the disease. It is unclear when the cases were first detected in China but residents are asking why the authorities took so long to diagnose and disclose the problem. 

Li Jifeng, a doctor at Beijing Chaoyang Hospital where the two people sought treatment, wrote on WeChat, a social media platform, that the patients sought treatment on Nov. 3. That post, which has since been deleted, was published by CN-Healthcare, a website that covers health care news in China. Dr. Li could not be reached for comment and Beijing Chaoyang Hospital declined to comment.  

Dr. Li wrote that the patient she saw was a middle-aged man, who had a fever and complained of breathing difficulties for 10 days. He sought treatment at a hospital in Inner Mongolia but his condition did not improve. His wife also developed a fever and respiratory problems.  

“After so many years of specialist training, I’m familiar with the diagnosis and treatment of most respiratory diseases,” wrote Dr. Li. “But this time, I looked and looked at it. I couldn’t guess what pathogen caused this pneumonia. I only knew it was rare.”

On why the authorities took so long to make the announcement, Dr. Li wrote that signs of any infectious disease need to be repeatedly verified and investigated, and such announcements cannot be “transmitted casually.”  

The police quarantined the emergency room in the Chaoyang Hospital on Monday night, the news outlet Caixin reported, citing residents.  

On Tuesday, Chinese censors instructed online news aggregators in China to “block and control” online discussion related to news about the plague, according to a directive seen by The New York Times. 

Skeptical Chinese internet users have charged the government with being slow to disclose news about the disease, which is transmitted between humans and kills even faster than the more-common bubonic form. China has a history of covering up and being slow to announce infectious outbreaks, prompting many people to call for transparency this time. 

“The plague is not the most terrifying part,” one user wrote on Weibo. “What’s even scarier is the information not being made public.”

China took a deserved kicking for its suppression of SARS news, and when H7N9 avian flu suddenly appeared in Shanghai and spread across the country, the authorities almost drowned us with information—not only news reports, but research articles that made Saudi MERS studies look as pathetic as they were.

Somehow those reports dried up not long after the accession of Xi Jinping, and health problems in a nation of over 1 billion mysteriously solve themselves these days.

 

Pneumonic plague, serious as it is for the unlucky person who contracts it, is a very small problem in a large and prosperous country. (It's been endemic in US Southwest since the San Francisco plague outbreak of 1900. And antibiotics routinely beat it.) Plague in China deserves coverage as a one-off, and the Chinese authorities would look a lot better if they'd reported these cases as an interesting oddity: "in other news..."

Two pneumonic plague cases confirmed in Chinese villagers

Via the South China Morning Post: Two pneumonic plague cases confirmed in Chinese villagers. Excerpt:

The Chinese health authorities have confirmed two cases of pneumonic plague among Inner Mongolian villagers. The patients from the remote area of Sunite Left Banner, close to the Mongolian border, were diagnosed in Beijing. 

They were being treated at unnamed hospitals in the capital’s Chaoyang district and disease control measures had been taken, according to a notice published on the Chaoyang health commission’s website on Tuesday. 

Doctors at Chaoyang Hospital confirmed that the patients had been treated there but had since been transferred elsewhere, local media reported. 

On Wednesday, China’s Centre for Disease Control and Prevention (CDC) said that the risk of the disease spreading was “extremely low” and that “citizens can carry on with their daily lives and visit medical institutions without worrying about the risk of infection”.  

It added that Beijing residents need not worry about catching the disease through coming into contact with rats, since the outbreak had originated outside the capital.

In China two people got the plague. Why is it still a thing?

Via CNN: In China two people got the plague. Why is it still a thing? Excerpt:

Two people in China are being treated for plague, authorities said Tuesday. It's the second time the disease, the same one that caused the Black Death, one of the deadliest pandemics in human history, has been detected in the region -- in May, a Mongolian couple died from bubonic plague after eating the raw kidney of a marmot, a local folk health remedy. 

The two recent patients, from the Chinese province of Inner Mongolia, were diagnosed with pneumonic plague by doctors in the Chinese capital Beijing, according to state media Xinhua. They are now receiving treatment in Beijing's Chaoyang District, and authorities have implemented preventative control measures.

Plague, caused by bacteria and transmitted through flea bites and infected animals, can develop in three different forms. Bubonic plague causes swollen lymph nodes, while septicemic plague infects the blood and pneumonic plague infects the lungs. 

Pneumonic -- the kind the Chinese patients have -- is more virulent and damaging. Left untreated, it is always fatal, according to the World Health Organization (WHO). 

During the Middle Ages, plague outbreaks devastated Europe, killing around 50 million people. Since then, we've invented antibiotics, which can treat most infections if they are caught early enough -- but the plague isn't gone. In fact, it's made a recent comeback. 

From 2010 to 2015, more than 3,248 cases were reported worldwide, including 584 deaths, according to the WHO. The three most endemic countries are the Democratic Republic of the Congo, Madagascar, and Peru. 

In the United States, there have been anywhere from a few to a few dozen cases of plague every year, according to the Centers for Disease Control and Prevention. In 2015, two people in Colorado died from the plague, and the year before there were eight reported cases in the state. 

Having caused close to 50,000 human cases during the past 20 years, the plague is now categorized by WHO as a re-emerging disease.