Re: 4 cases of plague in Libya, and fears of moving to Egypt - Denied by WHO
Can we send some of the denials to ProMED?
http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88691
Archive Number 20110531.1669
Published Date 31-MAY-2011
Subject PRO/AH/EDR> Plague, bubonic - Libya: (BN)
PLAGUE, BUBONIC - LIBYA: (AL BUTNAN)
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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: Sun 29 May 2011
Source: Youm7.com [in Arabic, trans. Corr.SB, edited]
<http://www.youm7.com/News.asp?NewsID=423226&SecID=97&IssueID=0>
The emergence of several infectious diseases, including plague, has
been reported in the Libyan city of Tobruk. A medical source at the
city's central hospital, said that at least 4 cases [of plague] have
been isolated at the medical hospital.
He pointed out that there are 17 other cases which are undergoing
medical tests on suspicion of being infected with the disease, said
the medical source, who preferred anonymity. There is a state of panic
and fear, which has hit the city, and it is not the 1st time this has
occurred, as, in mid-June 2009, there was an outbreak of bubonic
plague on the outskirts of Tobruk, which resulted in deaths.
The source added that the Egyptian authorities are taking necessary
action on the Egyptian-Libyan border to prevent the transmission of
the disease into Egypt.
An official quarantine [has been imposed] at the alternate port of
Salloum. The fear of the spread of the disease in Egypt will be the
biggest focus with the re-emergence of the disease plague, and this
has contributed to the lawlessness taking place on the Libyan-Egyptian
border at the moment.
The border city of Tobruk is experiencing many difficulties in the
field of health services because it has lost contact with the capital,
Tripoli, since the outbreak of the revolution on 17 Feb 2011.
[Byline: Mahmoud Nasr]
--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>
[The manifestations of plague in these cases are not stated but are
likely to be bubonic in nature causing exquisitely painful
lymphadenopathy (the bubo). In the absence of pneumonia spread from
the local node, person-to-person transmission in bubonic plague does
not occur.
Tobruk or Tubruq is a town, seaport, and peninsula in northeastern
Libya, near the border with Egypt, in North Africa. It is the capital
of Al Butnan District (formerly Tobruk District). Its location can be
found on a map at: <http://en.wikipedia.org/wiki/Tobruk>. The last
cluster of _Yersinia pestis_ infection occurred in 2009 in the same
area of northeastern Libya. The following contains a description of
previous outbreaks in the Saharan Africa area.
Consumption of the meat of an infected camel has been reported to
cause plague in Libya in 1976 (1). The abstract of the paper is: "In
1976, in a small, remote Libyan village, an apparently sick camel was
slaughtered and skinned, and the camel meat was distributed for human
consumption. A few days later, 15 villagers suffered a severe febrile
illness. Of the 5 individuals who had participated in the killing and
dispensation of the camel, all were dead within 4 days. When samples
of serum from 9 of the remaining patients were examined, 7 were found
to be positive for plague as determined by the passive
hemagglutination test. Another 6 persons became ill after killing 2
goats, and the serum of one goat contained antibodies to _Yersinia
pestis_. Because all of the remaining patients except one were treated
early enough, they recovered. These incidents confirm previous reports
that the camel and the goat are susceptible to naturally occurring
plague infection and have a significant role in the dissemination of
human plague."
Two more recent outbreaks in the Arab world have been reported in
2005. In Saudi Arabia (2), a cluster of 5 plague cases were reported
including 4 with severe pharyngitis and submandibular lymphadenitis.
These 4 case-patients had eaten raw camel liver. _Yersinia pestis_ was
isolated from bone marrow of the camel and from jirds [rodents]
(_Meriones libycus_) and fleas (_Xenopsylla cheopis_) captured at the
camel corral. In Jordon (3), a 1997 outbreak of plague was reported
associated with cervical lymphadenopathy and fever that occurred in
the Jordanian village of Azraq ad-Druze, 50 km [31 miles] west of the
border with Saudi Arabia. The 12 cases who presented at hospital were
initially assumed to have tularaemia, and all were successfully
treated with gentamicin. But all 12 were found to have anti-_Y.
pestis_ IgM. 11 of the 12 patients reported that, 2-4 days before
their symptoms appeared, they had eaten the meat cut from the carcass
of the same camel, either raw (10 cases) or cooked (one case). All 12
patients were diagnosed as cases of pharyngeal plague (the 1st cases
of plague reported in Jordan for more than 80 years) caused by _Y.
pestis_ that most had acquired when they ate raw meat from a camel
that was infected with the pathogen.
The source of the cases of bubonic plague in northeastern Libya is
not reported in this posting but may be related to camels and camel
fleas. ProMED awaits further documentation of this outbreak.
Plague outbreaks in North Africa may bring to mind the novel written
by Nobel Prize-winning novelist Albert Camus, "The Plague," which
chronicled a 1940s plague outbreak in Oran, Algeria, which began with
a rat die-off in and around the apartment building of the protagonist
Dr. Bernard Rieux.
1. Christie AB, Chen TH, Elberg SS. Plague in camels and goats: their
role in human epidemics. J Infect Dis 1980;141: 724-726.
2. Bin Saeed AA, Al-Hamdan NA, Fontaine RE: Plague from eating raw
camel liver. Emerg Infect Dis. 2005;11: 1456-1457.
3. Arbaji A, Kharabsheh S, Al-Azab S, et al: A 12-case outbreak of
pharyngeal plague following the consumption of camel meat, in
north-eastern Jordan. Ann Trop Med Parasitol. 2005;99: 789-793. -
Mod.LL]
[The interactive ProMED/HealthMap map showing Tobruk (Tubruq) is at
<http://healthmap.org/r/0VFe>
Zoom in step by step to see city names. - Mod.JW]
