http://www.bangkokpost.com/life/improvement/23619/killer-around-the-corner
KILLER AROUND THE CORNER
Recent outbreak of pneumonic plague in China has alarm bells ringing
Writer: By ANJIRA ASSAVANONDA
Published: 10/09/2009 at 12:00 AM
Newspaper section: Mylife
After the outbreak of bird flu and the deadly H1N1 virus, parts of the world have come under the threat of pneumonic plague, a disease that in the past was a dreadful killer.
As of Aug 6, the plague had reportedly killed three people in north-western China, which had 12 confirmed cases, and the authorities had sealed off Ziketan, an infected town of more than 10,000 people. The World Health Organisation (WHO) announced that pneumonic plague is the most virulent and least common form of plague. It is caused by the same bacteria as the bubonic plague, which caused the Black Death during the Middle Ages, killing an estimated 25 million people in Europe.
The report sparked fears over whether the disease will become another pandemic threatening the world community, and whether the micro-organism that causes the plague would develop into a new strain that is hard to control.
Thailand, which has a close trading and tourism relationship with China, should also keep a close watch on the disease, so it can properly handle the situation if an outbreak occurs.
Dr Surachai Rungtanapirom, of Bangkok Hospital, has some important information for the public to better understand and prepare for the plague.
What is pneumonic plague?
The plague is a zoonotic disease caused by the bacteria yersinia pestis that mostly circulates among rodents and their fleas.
Bangkok authority rounded up rats at Klong Toey port for testing after the outbreak of pneumonic plague in China.
When humans are bitten by the infected fleas, the bacteria can cause three forms of plague, depending on the route of infection: Bubonic (through the lymphatic system), Septicaemic (through the bloodstream), and Pneumonic plague (through the lungs).
Bubonic plague is the most common form, accounting for 80% of plague cases. It is contracted from the bite of infected fleas. The bacteria enters the skin and travels through the lymphatic system, causing the lymph nodes to be inflamed.
Septicaemic plague accounts for 15% of plague cases, and occurs when the infection spreads directly through the bloodstream. Pneumonic plague, the one that has recently emerged in China, is the most virulent and least common form of the disease.
While bubonic plague is usually transmitted by flea bites, pneumonic plague is easier to contract, through inhaling droplets from an infected person or animal, and can be transmitted from human to human. It may also occur if a person with bubonic or septicaemic plague is left untreated and the bacteria spreads to the lungs.
How can it be transmitted?
Commonly, the transmission occurs among rodent animals, such as rats, chipmunks, squirrels, and wild rabbits.
These animals have fleas, and when humans are bitten by the infected fleas, they can contract the disease. When the host animals die, the hungry fleas will seek other sources of blood to survive. People and animals that visit places where rodents have recently died from plague risk getting it from flea bites.
Dr Surachai Rungtanapirom
Plague transmission can also occur through direct contact with infected tissue or bodily fluids, such as when handling infected rodents.
Besides rodents, house cats and dogs are also susceptible to the plague, and can bring plague-infected fleas into the home. These infected pets can directly transmit plague to people who handle or care for them. It's also possible to become infected from a bite or scratch from a cat or dog.
The other way of transmission is by inhaling droplets expelled by the coughs of infected people or animals.
Normally, yersinia pestis bacteria is easily destroyed by sunlight and drying. Even so, when expelled in droplets, it can survive for up to one hour, and go as far as 50km.
"You'll see the difference when comparing this to the transmission of the H1N1 flu virus. The swine flu is contracted through eye, nose and mouth tissues. If you touch something with flu viruses on it and then touch your mouth or nose, you'll be infected. But the plague bacteria stays in the droplets when patients cough or sneeze, and you'll be infected once you inhale those droplets. However, note that it's not airborne, meaning the germ is not in the breath of infected persons," Dr Surachai said.
What are the symptoms?
When a person becomes infected, plague bacteria will multiply within the body. In case of pneumonic plague, this occurs in the lungs. From the time of infection, it takes one to three days for symptoms to appear.
The first signs of pneumonic plague include instant fever, severe headache, weakness and quick development of pneumonia with shortness of breath, chest pain, and coughing within 24 hours. Sometimes the phlegm turns into a rusty or bloody colour. As the symptoms worsen, patients can have trouble breathing, cough up blood, experience respiratory failure and shock. If not treated, patients may die in 48 hours.
A pet dog can bring plagueinfected fleas into your home.
High fever, body pain, and loss of appetite could be indications of the plague. Some patients may have traces of flea bites on their bodies. If you have any lymphatic symptoms, that could also be a sign of plague. Go to the doctor as soon as possible.
The treatment
When a plague infection is suspected, the person is often hospitalised and placed in isolation for at least a week.
Early treatment is crucial to reduce the chances of death. The treatment typically involves antibiotics, such as streptomycin, gentamicin, tetracyclines and chloramphenicol, which should be administered within 24-48 hours of the onset of symptoms, otherwise, the chance of fatality will be high.
It is also important to identify and examine people who have been in close contact with an infected person.
"Pneumonic plague has a high fatality rate. If left untreated, the patients can die within 24 hours, but it is also curable if diagnosed in time," Dr Surachai said. He added that with timely and proper treatment, patients can recover within a week.
HISTORY OF THE PLAGUE
According to Dr Surachai, there were three major outbreaks in the past. The first outbreak occurred in the 6th century.Known as the Plague of Justinian, the pandemicstarted in Egypt and spread to Europe, including Constantinople, killing 10,000 people a day. The outbreak continued for about50years, with millions of people dead.
The second pandemic, knownas the Black Death, occurred in the 14th century. It started in southern India and China, spreading to Europe via Egypt.
In 1346. an outbreak wasreported in Italy, called the Great Mortality. It continued throughout the 15th, 16th and 17th centuries. In 1665, a major outbreak in London killed 60,000 people. Itwas knownas the Great Plague of London.
The third outbreakwasthe world pandemic in 1896. The plague spread to Singapore, Thailand, Philippines, Hawaii, Arabia, Persia, Turkey, Egypt, west Africa and Russia, and in Europe to North America and Mexico. In 1900-1901, therewas a report that 60,000 people died of the disease in China, and in 1910-1911, 10,000 people died in Manchuria, which wasfollowed by outbreaks in California and Russia.
THE HISTORY OF THE PLAGUE IN THAILAND
The first report of the plague in Thailandwas in December 1904 at the warehouses in Thonburi, which wasa living area for Indian merchants.Thenthe disease spread toBangkok and other provinces. The disease wasspread by land, water transport and train. Therewas no clear record of fatalities, but in 1913, about 300people were reported dead in Nakhon Pathom. The last outbreak wasin 1952, with one person killed and two people infected in Taklee Market in Nakhon Sawan. Mostly, the plague bacteriacamefrom rats hiding amongst imports from neighbouring countries.
KILLER AROUND THE CORNER
Recent outbreak of pneumonic plague in China has alarm bells ringing
Writer: By ANJIRA ASSAVANONDA
Published: 10/09/2009 at 12:00 AM
Newspaper section: Mylife
After the outbreak of bird flu and the deadly H1N1 virus, parts of the world have come under the threat of pneumonic plague, a disease that in the past was a dreadful killer.
As of Aug 6, the plague had reportedly killed three people in north-western China, which had 12 confirmed cases, and the authorities had sealed off Ziketan, an infected town of more than 10,000 people. The World Health Organisation (WHO) announced that pneumonic plague is the most virulent and least common form of plague. It is caused by the same bacteria as the bubonic plague, which caused the Black Death during the Middle Ages, killing an estimated 25 million people in Europe.
The report sparked fears over whether the disease will become another pandemic threatening the world community, and whether the micro-organism that causes the plague would develop into a new strain that is hard to control.
Thailand, which has a close trading and tourism relationship with China, should also keep a close watch on the disease, so it can properly handle the situation if an outbreak occurs.
Dr Surachai Rungtanapirom, of Bangkok Hospital, has some important information for the public to better understand and prepare for the plague.
What is pneumonic plague?
The plague is a zoonotic disease caused by the bacteria yersinia pestis that mostly circulates among rodents and their fleas.
Bangkok authority rounded up rats at Klong Toey port for testing after the outbreak of pneumonic plague in China.
When humans are bitten by the infected fleas, the bacteria can cause three forms of plague, depending on the route of infection: Bubonic (through the lymphatic system), Septicaemic (through the bloodstream), and Pneumonic plague (through the lungs).
Bubonic plague is the most common form, accounting for 80% of plague cases. It is contracted from the bite of infected fleas. The bacteria enters the skin and travels through the lymphatic system, causing the lymph nodes to be inflamed.
Septicaemic plague accounts for 15% of plague cases, and occurs when the infection spreads directly through the bloodstream. Pneumonic plague, the one that has recently emerged in China, is the most virulent and least common form of the disease.
While bubonic plague is usually transmitted by flea bites, pneumonic plague is easier to contract, through inhaling droplets from an infected person or animal, and can be transmitted from human to human. It may also occur if a person with bubonic or septicaemic plague is left untreated and the bacteria spreads to the lungs.
How can it be transmitted?
Commonly, the transmission occurs among rodent animals, such as rats, chipmunks, squirrels, and wild rabbits.
These animals have fleas, and when humans are bitten by the infected fleas, they can contract the disease. When the host animals die, the hungry fleas will seek other sources of blood to survive. People and animals that visit places where rodents have recently died from plague risk getting it from flea bites.
Dr Surachai Rungtanapirom
Plague transmission can also occur through direct contact with infected tissue or bodily fluids, such as when handling infected rodents.
Besides rodents, house cats and dogs are also susceptible to the plague, and can bring plague-infected fleas into the home. These infected pets can directly transmit plague to people who handle or care for them. It's also possible to become infected from a bite or scratch from a cat or dog.
The other way of transmission is by inhaling droplets expelled by the coughs of infected people or animals.
Normally, yersinia pestis bacteria is easily destroyed by sunlight and drying. Even so, when expelled in droplets, it can survive for up to one hour, and go as far as 50km.
"You'll see the difference when comparing this to the transmission of the H1N1 flu virus. The swine flu is contracted through eye, nose and mouth tissues. If you touch something with flu viruses on it and then touch your mouth or nose, you'll be infected. But the plague bacteria stays in the droplets when patients cough or sneeze, and you'll be infected once you inhale those droplets. However, note that it's not airborne, meaning the germ is not in the breath of infected persons," Dr Surachai said.
What are the symptoms?
When a person becomes infected, plague bacteria will multiply within the body. In case of pneumonic plague, this occurs in the lungs. From the time of infection, it takes one to three days for symptoms to appear.
The first signs of pneumonic plague include instant fever, severe headache, weakness and quick development of pneumonia with shortness of breath, chest pain, and coughing within 24 hours. Sometimes the phlegm turns into a rusty or bloody colour. As the symptoms worsen, patients can have trouble breathing, cough up blood, experience respiratory failure and shock. If not treated, patients may die in 48 hours.
A pet dog can bring plagueinfected fleas into your home.
High fever, body pain, and loss of appetite could be indications of the plague. Some patients may have traces of flea bites on their bodies. If you have any lymphatic symptoms, that could also be a sign of plague. Go to the doctor as soon as possible.
The treatment
When a plague infection is suspected, the person is often hospitalised and placed in isolation for at least a week.
Early treatment is crucial to reduce the chances of death. The treatment typically involves antibiotics, such as streptomycin, gentamicin, tetracyclines and chloramphenicol, which should be administered within 24-48 hours of the onset of symptoms, otherwise, the chance of fatality will be high.
It is also important to identify and examine people who have been in close contact with an infected person.
"Pneumonic plague has a high fatality rate. If left untreated, the patients can die within 24 hours, but it is also curable if diagnosed in time," Dr Surachai said. He added that with timely and proper treatment, patients can recover within a week.
HISTORY OF THE PLAGUE
According to Dr Surachai, there were three major outbreaks in the past. The first outbreak occurred in the 6th century.Known as the Plague of Justinian, the pandemicstarted in Egypt and spread to Europe, including Constantinople, killing 10,000 people a day. The outbreak continued for about50years, with millions of people dead.
The second pandemic, knownas the Black Death, occurred in the 14th century. It started in southern India and China, spreading to Europe via Egypt.
In 1346. an outbreak wasreported in Italy, called the Great Mortality. It continued throughout the 15th, 16th and 17th centuries. In 1665, a major outbreak in London killed 60,000 people. Itwas knownas the Great Plague of London.
The third outbreakwasthe world pandemic in 1896. The plague spread to Singapore, Thailand, Philippines, Hawaii, Arabia, Persia, Turkey, Egypt, west Africa and Russia, and in Europe to North America and Mexico. In 1900-1901, therewas a report that 60,000 people died of the disease in China, and in 1910-1911, 10,000 people died in Manchuria, which wasfollowed by outbreaks in California and Russia.
THE HISTORY OF THE PLAGUE IN THAILAND
The first report of the plague in Thailandwas in December 1904 at the warehouses in Thonburi, which wasa living area for Indian merchants.Thenthe disease spread toBangkok and other provinces. The disease wasspread by land, water transport and train. Therewas no clear record of fatalities, but in 1913, about 300people were reported dead in Nakhon Pathom. The last outbreak wasin 1952, with one person killed and two people infected in Taklee Market in Nakhon Sawan. Mostly, the plague bacteriacamefrom rats hiding amongst imports from neighbouring countries.
