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Uganda ex DRC: Cluster of several fatal cases of pneumonic plague

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  • Uganda ex DRC: Cluster of several fatal cases of pneumonic plague

    Published Date: 2019-03-12 13:09:14
    Subject: PRO/AH/EDR> Plague - Uganda: Congo DR border, pneumonic, fatal
    Archive Number: 20190312.6363171
    PLAGUE - UGANDA: DEMOCRATIC REPUBLIC OF CONGO BORDER, PNEUMONIC, FATAL
    ************************************************** ********************
    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: Tue 12 Mar 2019
    Source: AFP [edited]
    https://www.9news.com.au/2019/03/12/...ngo-border-who


    A deadly form of plague has broken out on Uganda's border with the Democratic Republic of Congo, and several people are thought to have died of the disease, WHO has said. The agency praised Ugandan health workers for vigilance and prompt action in spotting a suspected outbreak of pneumonic plague, which WHO says is usually fatal unless detected early and treated with antimicrobials.

    Uganda's Health Ministry reported 2 probable cases of the illness in Zombo district on 5 Mar 2019 after a 35 year old woman died and her 23 year old cousin reported similar symptoms, WHO said in a report on [Mon 11 Mar 2019]. Further investigation revealed the dead woman had lived in Atungulei village in Congo's Ituri province, and her 4 year old child had died days beforehand. Finding her sick at her child's burial, her relatives took her to Uganda for treatment.

    The cousin's symptoms raised suspicions of plague, and a preliminary rapid diagnostic test was positive for the disease. Results on additional specimens sent to Uganda's Plague Laboratory in Arua were pending. The patient was steadily improving, the WHO report said.

    Some 55 people, including 11 health workers and people who took part in the dead woman's funeral, had been identified as high-risk contacts and were being followed up. An additional 3 other people reportedly died of similar symptoms in Congo, WHO said, and Congolese authorities were investigating.

    Pneumonic plague is caused by the _Yersinia pestis_ bacterium, usually found in small mammals and their fleas. Humans can be infected through flea bites, unprotected contact with bodily fluids or contaminated materials, and the inhalation of droplets or small particles from a patient with pneumonic plague.

    --
    communicated by:
    ProMED-mail


    [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, as appears to have happened in this case, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - Mod.LL

  • #2
    Outbreaks and Emergencies Bulletin, Week 10: 04 - 10 March 2019
    ...
    Plague Uganda
    2
    Cases
    1
    Death
    50%
    CFR

    EVENT DESCRIPTION

    On 5 March 2019, the Uganda Ministry of Health reported two probable
    cases of pneumonic plague in Zombo District, located in the West Nile
    sub-region, at the border with the Democratic Republic of the Congo.
    The event was initially reported to the local district health authority on
    1 March 2019 when a 35-year-old woman presented to the local health
    facility (Warr Health Centre III) with fever, cough with bloody sputum
    and difficulty in breathing. and she died shortly after arrival. A clinical
    diagnosis of pneumonia was made, and no specimens were collected.

    On 4 March 2019, a 23-year-old cousin of the deceased index case
    presented to the same health facility with a similar illness. The symptoms
    of fever, cough and difficulty in breathing started on 3 March 2019. Initial
    clinical laboratory investigation was positive for malaria on blood smear
    microscopy. However, because of the clinical presentation raising a
    suspicion of plague, the Uganda Virus Research Institute (UVRI) Plague
    Program based in Arua District (a regional hub for West Nile) was called
    in to review the patient and collect appropriate samples. Preliminary
    tests on a sputum specimen were positive for plague on rapid diagnostic
    test (RDT). Additional specimens were collected and transported to the
    Plague Laboratory in Arua for culture, and the test results are pending.
    Blood specimens collected and shipped to the UVRI in Entebbe tested
    negative for Ebola, Marburg, Crimean-Congo and Rift Valley fever by
    polymerase chain reaction. The patient is being managed on antibiotic
    therapy in Warr Health Centre III and she is steadily improving.

    Fifty-five high risk contacts (family members, those who participated in
    the traditional burial and 11 health workers) have been identified and are
    under follow up. An additional 59 contacts who attended the burial but
    did not come into contact with the deceased and/or the current patient
    have been listed.

    Further epidemiologic investigation established that the index case (for
    the event in Uganda) previously lived in Atungulei village in Mahagi
    District, Ituri Province, Democratic Republic of the Congo. She reportedly
    lost a 4-year-old child in the past days, prompting her relatives from
    Uganda to travel to the Democratic Republic of the Congo for the burial.
    After finding her sick, the relatives (from Uganda) decided to transport
    her to Uganda for treatment. In addition, there is information that three
    other people died of similar illness in the Democratic Republic of the
    Congo. Authorities in the Democratic Republic of the Congo have been
    informed and investigations are ongoing.


    PUBLIC HEALTH ACTIONS

    A national rapid response (RRT) team has been deployed to the
    affected district, working with the district RRT to conduct outbreak
    investigation and implement initial response activities. The two
    teams are developing an outbreak response plan.

    Case definitions for plague have been disseminated to health
    facilities to improve case detection.

    The identified high-risk contacts, including 11 health workers, are
    being followed up daily.

    Health education and community sensitization activities were
    conducted during the burial of the first probable case. Health
    education is also being provided to the contacts being followed up.

    WHO has provided personal protective equipment (gloves, face
    masks and shields, gumboots, aprons, coveralls, etc.), triple
    packaging specimen materials and spray pumps.

    SITUATION INTERPRETATION

    The Ministry of Health in Uganda has reported two probable cases of pneumonic plague in
    Zombo District, likely to be imported. The suspected plague outbreak was quickly detected
    and reported because of the vigilance and prompt actions of the health workers. This is
    an indication of a functional surveillance system, which is commendable. However, more
    efforts are required to ensure that any other cases are promptly detected, isolated and
    investigated to avoid establishment of local transmission.
    ...

    https://apps.who.int/iris/bitstream/...0410032019.pdf

    https://www.afro.who.int/publication...-10-march-2019

    ----------------------------------

    Media reports of plague outbreaks in Ituri in 2014 and 2018:

    DRC - Province Orientale - Ituri: 7 deaths of bubonic plague in Logo
    https://flutrackers.com/forum/forum/...plague-in-logo


    DRC - Ituri: 10 cases of bubonic plague including 1 death in Rethy
    https://flutrackers.com/forum/forum/...death-in-rethy
    ------------------------------

    See also:

    Volume 24, Number 2—February 2018
    Synopsis
    Ecologic Features of Plague Outbreak Areas, Democratic Republic of the Congo, 2004–2014
    ...
    Abstract
    During 2004–2014, the Democratic Republic of the Congo (DRC) declared 54% of plague cases worldwide. Using national data, we characterized the epidemiology of human plague in DRC for this period. All 4,630 suspected human plague cases and 349 deaths recorded in DRC came from Orientale Province. Pneumonic plague cases (8.8% of total) occurred during 2 major outbreaks in mining camps in the equatorial forest, and some limited outbreaks occurred in the Ituri highlands. Epidemics originated in 5 health zones clustered in Ituri, where sporadic bubonic cases were recorded throughout every year. Classification and regression tree characterized this cluster by the dominance of ecosystem 40 (mountain tropical climate). In conclusion, a small, stable, endemic focus of plague in the highlands of the Ituri tropical region persisted, acting as a source of outbreaks in DRC.
    ...
    https://wwwnc.cdc.gov/eid/article/24/2/16-0122_article
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

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