PLAGUE, PNEUMONIC - CONGO DR (ITURI)
A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org> [1] Date: Fri, 18 Feb 2005 From: Marianne Hopp <[EMAIL PROTECTED]> Source: WHO Outbreak Reports 18 Feb 2005 [edited] <http://www.who.int/csr/don/2005_02_18/en/> Plague in the Democratic Republic of the Congo ---------------------------------------------- As of Tue, 15 Feb 2005, WHO has received reports of 61 deaths from pneumonic plague in the district of Ituri, Oriental province, in the northern part of the country. The total number of cases is still not known. [Note this was posted to the WHO website on 18 Feb 2005. - Mod.JW] Preliminary results from rapid diagnostic tests in the area confirm pneumonic plague, and the cases had clinical features compatible with this disease. 40 samples have been taken and will be tested by culture and serology at the Institut de la Recherche Biomedicale, Kinshasa [Congo Rep.]. No cases of bubonic plague have been reported to date. The cases have occurred in workers in a diamond mine in Zobia where about 7000 people work. The mine was re-opened on 16 Dec 2004 and the 1st case occurred on 20 Dec 2004. A team from Medecins sans Frontieres (Belgium and Switzerland), Medair, WHO and Ministry of Health have been in the area to assess the situation. An additional multi-disciplinary team will be leaving for the Democratic Republic of the Congo on 19 Feb 2005. If humanitarian access is possible given the security concerns in the area, the team will go to the affected area to provide technical support in case management and treatment of cases, intensive surveillance and tracing of possible contacts and further epidemiological investigations. -- ProMED-mail <[EMAIL PROTECTED]> [2]Date: Fri, 18 Feb 2005 From: ProMED-mail <[EMAIL PROTECTED]> Source: Reuters Health 18 Feb2005 <www.reutershealth.com> WHO: Thousands flee as plague kills 61 in Congo ----------------------------------------------- An outbreak of plague in northeastern Democratic Republic of Congo has killed 61 diamond miners and infected hundreds more, the World Health Organization (WHO) said Friday [18 Feb 2005]. Many of the 7000 miners working in Zobia, north of the city of Kisangani, have fled since the outbreak began 2 months ago, and could have spread the highly contagious disease, the United Nations agency said. "The epidemiological data is still incomplete but we are sure there are at least 61 deaths. The main problem is that due to panic, maybe two thirds of the population, ran away from the mine," Eric Bertherat, head of the WHO team, told reporters. "There is a risk that some patients in [the] incubation [period] run away and maybe arrive in Kisangani. So it is very important to inform health care workers to alert them of the risk of admission of highly contagious patients," he said. Kisangani is Congo's 3rd biggest city and a major trading center on the Congo River. Plague, which is spread between rodents by fleas, can also be transmitted to people through infected rodent flea bites. It has a case-fatality rate of 50% to 60% in humans if not treated with antibiotics, WHO says. There are 3 main forms of plague in humans and the one suspected in the former Zaire is pneumonic plague, WHO said. "It is very important to quarantine, isolate these people who are sick with pneumonic plague so that the transmission is brought under control. If we can find the cases and treat them effectively, this can be stopped," said May Chu, a WHO expert. A 10-member WHO emergency team was leaving at the weekend with supplies of antibiotics to try to stem the outbreak and ensure that health workers in the region isolate suspect cases. But the remote mine in mineral-rich Ituri, reportedly controlled by rebels, is difficult to reach and the team will require U.N. security clearances, officials said. Cases are still occurring in the mine, where conditions are crowded and unsanitary, and 20 workers were admitted to health facilities in Zobia with symptoms Wednesday [16 Feb 2005], he added. The diagnosis of plague had been verified through testing, WHO spokesman Dick Thompson said. [By Stephanie Nebehay] -- ProMED-mail <[EMAIL PROTECTED]> [As implied in the posting, the epidemic curve and analysis are needed to discover the potential cause of the outbreak. Cases have apparently been reported over almost 2 months, so it is likely that several generations of primary pulmonary plague have occurred, assuming the diagnosis is correct. 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 pneumonic complications in bubonic plague. It is also the form of disease contracted from infected cats. This is, importantly, the form of the disease that would be most likely if _Yersinia pestis_ were to be used in an aerosol as a biological weapon. Such an aerosol would likely be used in an indoor setting to avoid the outdoor UV radiation inactivation of the organism. 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 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. - Mod.LL] [see also: 2004 ---- Plague - Congo DR (Ituri): susp. 20040730.2083 Plague - Uganda (Arua, Nebbi) 20040112.0128 2003 ---- Plague - Uganda (Arua, Nebbi) (02): background 20031013.2584 Plague - Uganda (Arua, Nebbi) 20031012.2566 Plague - Algeria (Oran) (04) 20030704.1643 Plague, bubonic - Algeria (Oran) 20030622.1537 Plague - Uganda (Arua) 20030331.0794 2002 ---- Plague - Uganda (Nebbi District): RFI 20021218.6090 Plague - Uganda (Arua, Nebbi) 20021130.5938 Plague, bubonic - Malawi (Nsanje) 20020601.4378 Plague, bubonic - Malawi, Mozambique 20020510.4160 2001 ---- Plague - Uganda (Arua, Nebbi) 20011031.2689 Plague - Uganda (Okoro County) (02) 20011016.2543 Plague, suspected - Congo DR 20011011.2484 Plague - Uganda (Okoro County) 20011009.2459] .................................ll/pg/dk/jw ########################################################## ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the information, and of any statements or opinions based thereon, are not guaranteed. 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Send commands to subscribe/unsubscribe, get archives, help, etc. to: [EMAIL PROTECTED] For assistance from a human being send mail to: [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Friday, February 18, 2005 6:53 PM To: [EMAIL PROTECTED] Subject: [DailyBrief] Plague Kills Scores in Congo Outbreak Plague Kills Scores in Congo Outbreak By BRYAN MEALER, AP KINSHASA, Congo (Feb. 18) - A rare form of plague has killed at least 61 people at a diamond mine in the remote wilds of northeast Congo, and authorities fear hundreds more who fled into the forests to escape the contagion are infected and dying, the World Health Organization said Friday. Eric Bertherat, a doctor for the U.N. health agency, said the outbreak has been building since December around a mine near Zobia, 170 miles north of Kisangani, the capital of the vast Oriental province. Nearly all the 7,000 miners have abandoned the infected area and sought refuge in the world's second-largest tropical rain forest, all but cut off from the outside world. Security fears - mainly from bandits and militia left over from Congo's five-year war - also have slowed international response, Bertherat said. Plague is spread mainly by fleas and causes an infection in the lungs that slowly suffocates its victims. If caught in time, it can be treated with antibiotics. Bubonic plague is the most common form of plague and is transmitted to people through the bite of an infected flea. It usually is spread by rodents. It does not spread person to person. Pneumonic plague - the kind in the current outbreak - is rarer but also more easily transmitted from person to person through coughing or close contact. Bertherat, speaking to reporters by telephone from Geneva, said plague commonly is found in this region of northern Congo, but an outbreak this large was unusual. Unlike the deadly Ebola virus, which also is found in the dark forests of Congo, Bertherat said this outbreak of plague was unlikely to spread too quickly, given the remote and isolated terrain. "It's still a large concern," Bertherat said, "because these are cases moving elsewhere." Bertherat and a 10-member team of WHO doctors will arrive in Kisangani on Monday to prepare for a journey into the forests. He said doctors from the aid organization Medecins Sans Frontieres, or Doctors Without Borders, already were there, treating miners they could locate. The forests have long been both a refuge and a death trap for Congolese running from war, disaster and disease. More than 1 million people still live rough in the forests after fleeing Congo's devastating 1998-2002 war. Aid groups say nearly 1,000 people still die every day from war-induced starvation and disease. According to the WHO, the incubation time for plague is two to six days. Victims develop a fever and cough. Breathing becomes difficult as lungs fill with fluid. Unless antibiotics are given within the first 24 hours, death can come as quickly as within 48 hours.Source: _http://aolsvc.news.aol.com/news/article.adp?id=20050218143509990010_ (http://aolsvc.news.aol.com/news/article.adp?id=20050218143509990010) This information is provided by Nena Wiley, Traumatic Stress and Emergency Resource Specialist, Litchfield Park, AZ., as a service to members of the Emergency Services and Management Community with the purpose of offering relevant and timely information on emergency, terrorism and critical incidence stress management (CISM) issues. Posts may be forwarded to other individuals, organizations and lists for non-commercial purposes. To join the list, please go to: _www.purepursuitintelnetwork.com_ (http://www.purepursuitintelnetwork.com/) "When terrorism threatens our future, we cannot afford to live in the past." 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