Published Date: 2012-12-24 13:23:32
Subject: PRO/AH/EDR> Plague - Madagascar (02): fatalities
Archive Number: 20121224.1467364
PLAGUE - MADAGASCAR (02): FATALITIES
************************************
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: Mon 17 Dec 2012
Source: RFI (Radio France Internationale) [in French, trans. Mod.JW, edited]
http://www.rfi.fr/afrique/20121217-madagascar-peste-oms-celine-seignon-kandissounon
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]
Subject: PRO/AH/EDR> Plague - Madagascar (02): fatalities
Archive Number: 20121224.1467364
PLAGUE - MADAGASCAR (02): FATALITIES
************************************
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: Mon 17 Dec 2012
Source: RFI (Radio France Internationale) [in French, trans. Mod.JW, edited]
http://www.rfi.fr/afrique/20121217-madagascar-peste-oms-celine-seignon-kandissounon
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]