Madagascar Hospitals On High Alert: ‘No One Is Safe’ From The Black Plague

[Sam2]

Madagascar Hospitals On High Alert:
‘No One Is Safe’ From The Black Plague


Mac Slavo
October 23rd, 2017

http://tinyurl.com/yd6tox9u
SHTFplan.com

Travelers are being warned to keep their distance from areas of Madagascar affected by the bubonic plague. As the outbreak worsens, some doctors are even warning that “no one is safe” from the disease.

The outbreak of the black plague in Madagascar has so far killed 97 people, and doctors are warning that it will be continuing to spread and worsen, meaning no one is safe. Health officials say the disease, which contributed to the deaths of more than 50 million people in Europe during the Middle Ages, has spread from rural areas to the more urban areas not usually affected. Hundreds of cases are reported on the tropical island every year, but experts are warning the epidemic is “much more dangerous” than in previous years.

Officials have reported infections in 17 of the island nation’s 22 regions since the outbreak started in August. And the number of cases is growing by the day, said Elhadj As Sy, the secretary general of the International Federation of Red Cross and Red Crescent Societies (IFRC) as the nation put all hospitals on high alert. The hospitals have also begun implementing preventative measures with attempts to stall the spread of the bacterial infection.

The IFRC said it’s introducing the same “safe and dignified” burial methods used in West Africa during the 2014 Ebola epidemic. This helps cut the chain of transmission by preventing further infections through direct contact with infected corpses.

Last week, less than 60 people had died and around 600 had been infected. Now, there are 911 confirmed cases in addition to the almost 100 deaths. While cases of bubonic plague occur in Madagascar nearly every year, the much more dangerous and deadly pneumonic plague has never been so prevalent. It arrived earlier than expected this year, and has become much more contagious with it being transmitted from person to person through the air. Pneumonic plague is the most life-threatening form of the infection caused by the manifestation of a Yersinia pestis bacterial infection.

Although the black plague can be treated effectively with antibiotics, the incubation time of this bacteria is incredibly short. Death often occurs within 12-24 hours of becoming infected. The bubonic strain of the disease is spread through the bites of infected fleas, whereas the more contagious and deadly pneumonic type is spread through the coughing or sneezing of an infected person.

Elhadj As Sy said that overcoming the epidemic would require long-term help, not “just intervening at the peak and then forgetting about it”. Dr. Manitra Rakotoarivony, Madagascar’s director of health promotion, said: “Normally, people who catch the plague live in poor areas, but people in every place in society are catching the disease.”

Jimmy Whitworth, professor of International Public Health at the London School of Hygiene and Tropical Medicine, told The Sun: “It has been a long time since we have seen the plague in an urban environment.

Although health officials have said that internationally, the threat is still fairly low, they’ve also said no one in Madagascar is safe, including travelers, spiking concerns over a possible global pandemic.

[vestige]

has become much more contagious with it being transmitted from person to person through the air.

Dayuuuuum!

[Be Well]

I read Daniel Defoe's "Journal of the Plague Year" when I was around 12 and it made a huge impression on me. I highly recommend it, it's not very long, and it is online. I read it again about 10 or more years ago when H5N1 news was big.

Second link has different formats.

http://www.gutenberg.org/files/376/376-h/376-h.htm

http://www.gutenberg.org/ebooks/376

[Laurane]

The LDS Church pulled its missionaries from Madagascar this week - too risky.

[vestige]

To my (admittedly weak) understanding.... bubonic plague is transmitted by fleas...

right or wrong?

[Publius]

Obama would try and bring a few hundred of them into the country.

[vestige]

Obama would try and bring a few hundred of them into the country.

For humanitarian reasons....

[Publius]

To my (admittedly weak) understanding.... bubonic plague is transmitted by fleas...

right or wrong?

The primary problem is fleas, but can be transmitted by contact with deal animals and or humans (deal or alive) and fluid's.

[vestige]

deal animals and or humans

as in picking them up... touching them... or treating them as do physicians?

[ainitfunny]

Quote Originally Posted by vestige View Post
To my (admittedly weak) understanding.... bubonic plague is transmitted by fleas...

right or wrong?

The primary problem is fleas, but can be transmitted by contact with deal animals and or humans (deal or alive) and fluid's.

Actually PNEUMONIC PLAGUE, as I understand it, cuts the fleas out of the picture and takes off as AIRBORNE PERSON TO PERSON disease!

That is WHY they say ANYONE can catch pneumonic plague, no matter how "clean" and removed from any dirty, buggy, environment and how much they avoid touching sick people. All healthy people have to do is BREATHE where a (LIVING, BREATHING,) infected person with pneumonic plague has been!!

The incredibly short "time from exposure to death'' period (12-24 HOURS!) is the ONLY "saving grace", in that it should die out quickly if people wear N95 masks and are preventing from assembling, riding public transportation, and essentially avoid each other for a week or two. Curing it with antibiotics is usually easy, except it is usually too far progressed towards death by the time people realize what hit them!

Getting people to self-isolate as much as possible, suspending everything that CAN be suspended (school, athletics, shopping, meetings whatever) is the biggest obstacle to stopping it. That is even harder to do in an Urban environment!

They also need to get everyone (at least in the cities!) into N95 face masks (WITHOUT EXHALE VALVES!) ASAP, like LAST WEEK!
Rural citizens have it much easier isolating from each other than city dwellers.

Masks must, MUST cover the NOSE or it is as if they are not wearing a mask at all!!

[Be Well]

To my (admittedly weak) understanding.... bubonic plague is transmitted by fleas...

right or wrong?

From article:

While cases of bubonic plague occur in Madagascar nearly every year, the much more dangerous and deadly pneumonic plague has never been so prevalent. It arrived earlier than expected this year, and has become much more contagious with it being transmitted from person to person through the air. Pneumonic plague is the most life-threatening form of the infection caused by the manifestation of a Yersinia pestis bacterial infection.

Very freaking bad news.

[ainitfunny]

From article:



Very freaking bad news.

YES,it surely IS.
God prevent anyone WITH that airborne disease getting on an airplane, especially as pilots or crew!! Everyone would end up with it, and the pilots could become incapacitated before a long transcontinental flight could be completed.

When Bubonic Plague MORPHS into "pneumonic (Airborne) plague" GRANNY BAR THE DOOR!

[WestGardener]

To my (admittedly weak) understanding.... bubonic plague is transmitted by fleas...

right or wrong?

It is but this one has caused pneumonic plague, meaning its in the lungs. It then becomes airborne and this event going on in Madagascar most of the cases are the airborne pneumonic. Three types of plague are Bubonic, pneumonic and septicemic. Septicemic plague infects the blood stream, bubonic plague infects the lymph nodes.

[WestGardener]

Actually PNEUMONIC PLAGUE, as I understand it, cuts the fleas out of the picture and takes off as AIRBORNE PERSON TO PERSON disease!

That is WHY they say ANYONE can catch pneumonic plague, no matter how "clean" and removed from any dirty, buggy, environment and how much they avoid touching sick people. All healthy people have to do is BREATHE where a (LIVING, BREATHING,) infected person with pneumonic plague has been!!

The incredibly short "time from exposure to death'' period (12-24 HOURS!) is the ONLY "saving grace", in that it should die out quickly if people wear N95 masks and are preventing from assembling, riding public transportation, and essentially avoid each other for a week or two. Curing it with antibiotics is usually easy, except it is usually too far progressed towards death by the time people realize what hit them!

Getting people to self-isolate as much as possible, suspending everything that CAN be suspended (school, athletics, shopping, meetings whatever) is the biggest obstacle to stopping it. That is even harder to do in an Urban environment!

They also need to get everyone (at least in the cities!) into N95 face masks (WITHOUT EXHALE VALVES!) ASAP, like LAST WEEK!
Rural citizens have it much easier isolating from each other than city dwellers.

Masks must, MUST cover the NOSE or it is as if they are not wearing a mask at all!!

You are correct.

[ainitfunny]

Just LAST MONDAY, THE NY TIMES PUBLISHED THIS ARTICLE giving their urban readers and those wise enough to be cued by the looming need they may/will have for this information!
http://www.nytimes.com/health/guides.../overview.html

Thanks for using our Health Guides. We'll be taking them down at the end of October.

For the latest Health news, visit our Health section. Questions? Visit our directory for a comprehensive list of contact options.
New York Times
Monday, October 23, 2017

Plague is a severe and potentially deadly bacterial infection.
Reference from A.D.A.M.
Back to Top
Alternative Names

Bubonic plague; Pneumonic plague; Septicemic plague
Back to Top
Causes

Plague is caused by the bacteria Yersinia pestis. Rodents, such as rats, carry the disease. It is spread by their fleas.

People can get the plague when they are bitten by a flea that carries the plague bacteria from an infected rodent. In rare cases, you may get the disease when handling an infected animal.

A plague lung infection called pneumonic plague can spread from human to human. When someone with pneumonic plague coughs, tiny droplets carrying the bacteria move through the air. Anyone who breathes in these particles may catch the disease. An epidemic may be started this way.

In the Middle Ages in Europe, massive plague epidemics killed millions of people. Plague can still be found in Africa, Asia, and South America.

Today, plague is rare in the United States, but it has been known to occur in parts of California, Arizona, Colorado, and New Mexico.

There three most common forms of plague are:

Bubonic plague -- an infection of the lymph nodes
Pneumonic plague -- an infection of the lungs
Septicemic plague -- an infection of the blood

The time between being infected and developing symptoms is typically 2 to 7 days, but may be as short as 1 day for pneumonic plague.

Risk factors for plague include a recent flea bite and exposure to rodents, especially rabbits, squirrels, or prairie dogs, or scratches or bites from infected domestic cats.
Back to Top
Symptoms

Bubonic plague symptoms appear suddenly, usually after 2 - 5 days of exposure to the bacteria. Symptoms include:

Chills
Fever
General ill feeling (malaise)
Headache
Muscle pain
Seizures
Smooth, painful lymph gland swelling called a bubo
Commonly found in the groin, but may occur in the armpits or neck, most often at the site of the infection (bite or scratch)
Pain may occur in the area before the swelling appears

Pneumonic plague symptoms appear suddenly, typically 2 - 3 days after exposure. They include:


Cough
Difficulty breathing
Fever
Frothy, bloody sputum
Pain in the chest when you breathe deeply
Severe cough

Septicemic plague may cause death even before its symptoms occur. Symptoms can include:

Abdominal pain
Bleeding due to blood clotting problems
Diarrhea
Fever
Nausea
Vomiting


Exams and Tests

Tests that may be done include:

Blood culture
Culture of lymph node aspirate (fluid taken from an affected lymph node or bubo)
Sputum culture


Treatment

People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death may occur.

Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, and respiratory support usually are also needed.

Patients with pneumonic plague should be strictly isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

Outlook (Prognosis)

Without treatment, about 50% of people with bubonic plague die. Almost all people with pneumonic plague die if not treated. Treatment reduces the death rate to 50%.

When to Contact a Medical Professional

Call your health care provider if you develop plague symptoms after exposure to fleas or rodents, especially if you live in or have visited an area where plague occurs.

[Profit of Doom]

Doxycycline is first or second choice for nearly every bacterial bioweapon.
Be sure your fish and birds are well protected!

[Hognutz]

Doxycycline is first or second choice for nearly every bacterial bioweapon.
Be sure your fish and birds are well protected!

I wonder if you can take it preventively. Such as if a family member comes down with it...

[Old Gray Mare]

If it is airborne and enters the body via mucus membranes, then wouldn't it be a good idea to protect the eyes as well? Goggles of some sort?

If airborne is it capable of entering via the skin pores? Is protective clothing required? How dangerous is it?

[Foothiller]

The democrats will start telling us its Trump's fault due to racism and we should immediately open a new immigration wave from Madagascar so we cna help them here, instead of helping them there.

Worked for the beaners and the mohameddans. Why not the Africans too?

America won't be great till it's brown... signed the Democrats.

[Melodi]

To my (admittedly weak) understanding.... bubonic plague is transmitted by fleas...

right or wrong?

Among other things, it has three forms (without going into great detail you can find all that with a google search) but once it infects people and animals it can morph into an airborne version which is believed to be what killed a huge portion of the people who died in the 14th century (http://www.history.com/news/medieval...scientists-say).

In that form, the disease can spread rapidly from person to person and people can go to bed feeling fine and be found dead in the morning; I suspect that is what is going on here from the description.

And while today this infection can be treated nearly 100 percent of the time with antibiotics (as long as they keep working) in the third world and/or with the airborne versions of the disease; the cure may not come in time to save the person and/or prevent them from infecting others.

So while fleas and ticks are one of the primary carriers of the disease, once it breaks into the human population it has to either be stopped by treatment and quarantine or it turns into another pandemic; which almost happened 23 years ago when we had just gotten married (that outbreak started in India and flights to the UK were carefully screened before people were allowed off the plane).

Since the second great outbreak in the 14th century ( the previous one was in the 6th century) this disease used to sweep the world at least once every hundred years or so (once worldwide travel was established in the 1500's anyway) the last two outbreaks have been contained to their gestational area for the most part, but doctors know this is a ticking timebomb (pun intended) that could get out of hand any day; and once the antibiotics stop working could wipe out 1/3 to 1/2 of the population again (as it did in Europe, the Middle East and probably Asia in the 14th century) some places had a 90 percent die off...

your doom for today...

[Old Gray Mare]

The plague is endemic to rodents in the SW United States so there are medical practitioners here who have had to deal with the problem. - OGM

Fair use.
Information from The CDC web site.

What is plague?
Plague is an infectious disease that affects rodents, certain other animals, and humans. It is caused by the Yersinia pestis bacteria. These bacteria are found in many areas of the world, including the United States.

How do people become infected with plague?
People most commonly acquire plague when they are bitten by a flea that is infected with the plague bacteria. People can also become infected from direct contact with infected tissues or fluids while handling an animal that is sick with or that has died from plague. Finally, people can become infected from inhaling respiratory droplets after close contact with cats and humans with pneumonic plague.

What are the different forms of plague?

There are three forms of plague:

Bubonic plague: Patients develop sudden onset of fever, headache, chills, and weakness and one or more swollen, tender and painful lymph nodes (called buboes). This form is usually the result of an infected flea bite. The bacteria multiply in the lymph node closest to where the bacteria entered the human body. If the patient is not treated with appropriate antibiotics, the bacteria can spread to other parts of the body.

Septicemic plague: Patients develop fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic plague can occur as the first symptoms of plague, or may develop from untreated bubonic plague. This form results from bites of infected fleas or from handling an infected animal.

Pneumonic plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous. Pneumonic plague may develop from inhaling infectious droplets or from untreated bubonic or septicemic plague that spreads to the lungs. The pneumonia may cause respiratory failure and shock. Pneumonic plague is the most serious form of the disease and is the only form of plague that can be spread from person to person (by infectious droplets)

What is the incubation period for plague?
A person usually becomes ill with bubonic plague 2 to 6 days after being infected. Someone exposed to Yersinia pestis through the air would become ill within 1 to 3 days.

When bubonic plague is left untreated, plague bacteria can invade the bloodstream. When plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition called septicemic plague. Untreated bubonic plague can also progress into an infection of the lungs, causing pneumonic plague. If plague patients are not given specific antibiotic therapy, all forms of plague can progress rapidly to death.

How is plague diagnosed?
The first step in plague diagnosis is evaluation by a health worker. If the health worker suspects plague, samples of the patient’s blood, sputum, or lymph node aspirate are sent to a laboratory for testing. Once the laboratory receives the sample, preliminary results can be ready in less than two hours. Laboratory confirmation will take longer, usually 24 to 48 hours. Often, presumptive treatment with antibiotics will start as soon as samples are taken, if plague is suspected.

How many cases of plague occur in the United States? Globally?
Plague was first introduced into the United States in 1900. Between 1900 and 2012, 1006 confirmed or probable human plague cases occurred in the United States. Over 80% of United States plague cases have been the bubonic form. In recent decades, an average of 7 human plague cases are reported each year (range: 1-17 cases per year). Plague has occurred in people of all ages (infants up to age 96), though 50% of cases occur in people ages 12–45. Worldwide, between 1,000 and 2,000 cases each year are reported to the World Health Organization (WHO), though the true number is likely much higher.

What is the death rate of plague?
In the pre-antibiotic era (1900 through 1941), mortality among those infected with plague in the United States was 66%. Antibiotics greatly reduced mortality, and by 1990-2010 overall mortality had decreased to 11%. Plague can still be fatal despite effective antibiotics, though it is lower for bubonic plague cases than for septicemic or pneumonic plague cases. It is hard to assess the mortality rate of plague in developing countries, as relatively few cases are reliably diagnosed and reported to health authorities. WHO cites mortality rates of 8–10%, however some studies (WHO, 2004) suggest that mortality may be much higher in some plague endemic areas.

How is plague treated?
Plague can be successfully treated with antibiotics. Once a patient is diagnosed with suspected plague they should be hospitalized and, in the case of pneumonic plague, medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph node, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. To prevent a high risk of death in patients with pneumonic plague, antibiotics should be given as soon as possible, preferably within 24 hours of the first symptoms.

Link to source:
https://www.cdc.gov/plague/faq/index.html

[Old Gray Mare]

The link below it to the CDC pages on plague with information on diagnostic testing and drug treatment. I don't know how to post tables or would have posted it. - OGM

Fair use:
CDC - Resources for Clinicians
https://www.cdc.gov/plague/healthcare/clinicians.html

Fair use;
Another CDC post states:
Vaccination and Postexposure Prophylaxis

Vaccines are available that convey protection against certain diseases considered to be potentially terrorism-associated, including anthrax, plague, and tularemia (76). However, these vaccines are not recommended for unexposed autopsy workers at low risk. Consistent application of standard safety practices should obviate the need for vaccination for B. anthracis and Y. pestis. In 2003, the U.S. Department of Health and Human Services (DHHS) initiated a program to administer vaccinia (smallpox) vaccine to first responders and medical personnel. In this context, persons who might be called on to assess remains or specimens from patients with smallpox should be included among this group (91) (Box 2).

The administration of prophylactic antibiotics to autopsy workers exposed to potentially lethal bacterial pathogens is sometimes appropriate. For example, autopsy personnel exposed to Y. pestis aerosols should consider receiving such treatment regardless of vaccination status (92). Similarly, because tularemia can result from infection with a limited number of organisms, an exposure to F. tularensis should also prompt consideration of antimicrobial prophylaxis. However, decisions to use antimicrobial postexposure prophylaxis should be made in consultation with infectious disease and occupational health specialists, with consideration made of vaccination status, nature of exposure, and safety and efficacy of prophylaxis.

Link to Source:
https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5308a1.htm

[naturallysweet]

We really should bar people from flying from that region. Imagine someone hopping on a plane and going to a major city, during flu season.

[Melodi]

We really should bar people from flying from that region. Imagine someone hopping on a plane and going to a major city, during flu season.

What the UK did during the Outbreak in India was test the passengers coming off EVERY plane from the affected area and anyone with a fever or other symptoms was quarantined for testing to make sure their "flu" or "cold" wasn't something else. This included returning Westerners who were not always happy about this, but the result was the potential epidemic did not spread into Europe.

Of course, tons of money and resources were also poured into rural India to try and stop it in its tracks; you need BOTH actions otherwise this could break out anyway. The difference between this disease and say Ebola is that despite its terrifying history it CAN be treated and contained (at least for now) but if it is ignored it might pick up steam to the point where millions could die anyway because the drugs either can't be used soon enough or the disease starts to become resistant (this last one has terrified medical researchers for the last 40 years or so).

[brokenwings]

I agree with Naturallysweet. They need to take this seriously, stop all air traffic and isolate the islands until the disease is eradicated. The only way to stop it from spreading to the rest of the world. Sadly they will never do this.

We really should bar people from flying from that region. Imagine someone hopping on a plane and going to a major city, during flu season.

[mecoastie]

Here is the PDF for the WHO Plague Manual. It includes treatment.

http://www.bvsde.paho.org/texcom/cd0...aguemanual.pdf

[Faroe]

I agree about no flights.
You can't afford even one mistake in screening.

Not that I expect any Western nation to isolate themselves from this...based on the way Ebola was handled, it looked to me like the authorities were trying to spread it.

[Optimus Prime]

You can go to All Day Chemist, online pharmacy in India. We've used it exclusively for our MAG. I pull meds out of our ER pyxis all the time made by Cipla.

Order 14 (one per day for 14 days) Levaquin 500mg pills, 0.26 each for a total of $3.64,,,,,or

28 (2 per day for 14 days) Cipro 500mg pills, 0.41 each for a total of $11.48

One or the other for each member of your group

This news must be putting pressure on suppliers, all Doxy is sold out. Of course YMMV depending on allergies, etc...

[Laurane]

Another country to add to Pres Trump Immigration Ban.....are they Muslims there too?? LOL

(Actually 42% Christian, 52% native religions)

[Jubilee on Earth]

For anyone who isn't already frightened by this news, I recommend reading the Pandemic series, by Bobby Akart. It's a 4-part doomer fiction series about the pneumonic plague, genetically modified by ISIS to be antibiotic resistant, and dispersed around the world as bioterrorism. I was just recommending this series a month or two ago. Here's hoping some nefarious group didn't use the novels as a blueprint. Seriously scary stuff.

[2Trish]

At least they are trying to get across the difference between bubonic & pneumonic plague.

https://beta.theglobeandmail.com/new...beandmail.com&


Pneumonic plague in Madagascar could 'explode' without intervention: Red Cross

The unprecedented outbreak of a highly contagious form of plague in Madagascar's capital of Tananarive could "explode" if local and international efforts to contain the epidemic fall short, a Canadian assessment team deployed by the Red Cross says.

The epidemic has made its way into the congested metropolis of just over two million people.

While the World Health Organization (WHO) believes the risk of global spread is low, there is a moderate risk the disease could spread to neighbouring countries in east and southern Africa and a very high risk of spread locally.

Since the first case was reported on Aug. 31 in Ankazobe district, more than 1,300 cases of suspected, probable and confirmed plague have been identified, and 102 people have died in 18 of Madagascar's 22 regions. In 2014, considered a bad year for plague in Madagascar, only 40 people died. The United Nations says the rapid increase in cases is cause for concern and that "the situation will continue to deteriorate."

"This year, we are seeing urban spread of the pneumonic type" said Tonje Tingberg, the Red Cross field team leader in the country. Two-thirds of cases this year are the highly contagious pneumonic plague, which infects the lungs and is transmitted in the air, unlike the bubonic form of plague that is endemic in rural Madagascar, and which is only transmitted by fleas living on rats. Unlike most years, the plague has hit cities where person-to-person transmission is easier due to urban density and poor sanitation. Schools across the country have been closed and the government has banned public gatherings to reduce the risk of transmission.

Stephane Michaud, director of emergencies at the Canadian Red Cross, told The Globe and Mail that local health officials are operating plague-treatment centres that are currently meeting the demand. "For now, they are able to handle the clinical caseload of plague, and the main effort is at the community level to prevent further spread of the disease," he said. That effort is being led by 2,600 volunteers from the local Red Cross, with "surge support" from an international group of humanitarian aid workers, including Canadians.
Doctors and nurses from the Ministry of Health and officers of the Malagasy Red Cross staff a health-care checkpoint in Ampasapito district on Oct. 5, 2017, with the mission of informing passengers leaving Tananarive, and to potentially detect cases suspected of plague.

Doctors and nurses from the Ministry of Health and officers of the Malagasy Red Cross staff a health-care checkpoint in Ampasapito district on Oct. 5, 2017, with the mission of informing passengers leaving Tananarive, and to potentially detect cases suspected of plague.

RIJASOLO/AFP/GETTY IMAGES
A young woman, left, gestures as she is examined by doctors at the health-care checkpoint.

A young woman, left, gestures as she is examined by doctors at the health-care checkpoint. Two-thirds of Madagascar’s plague cases this year are the highly contagious and airborne pneumonic type.

Pneumonic plague in Madagascar could 'explode' without intervention: Red Cross

An island nation is grappling with an outbreak that has killed more than 100 people, and experts say it could spread across east and southern Africa if left unchecked, Blair Bigham reports

More below • What is pneumonic plague and how bad is it? A primer
Oct. 10, 2017: People stand back as a council worker sprays disinfectant to clean up a market in Tananarive, capital of Madagascar. The World Health Organization has warned that a deadly outbreak of the plague, which began in late August, is swiftly spreading in cities across the country.

Oct. 10, 2017: People stand back as a council worker sprays disinfectant to clean up a market in Tananarive, capital of Madagascar. The World Health Organization has warned that a deadly outbreak of the plague, which began in late August, is swiftly spreading in cities across the country.

RIJASOLO/AFP/GETTY IMAGES
BLAIR BIGHAM
Special to The Globe and Mail
Includes correction
22 hours ago
October 23, 2017

The unprecedented outbreak of a highly contagious form of plague in Madagascar's capital of Tananarive could "explode" if local and international efforts to contain the epidemic fall short, a Canadian assessment team deployed by the Red Cross says.

The epidemic has made its way into the congested metropolis of just over two million people.

While the World Health Organization (WHO) believes the risk of global spread is low, there is a moderate risk the disease could spread to neighbouring countries in east and southern Africa and a very high risk of spread locally.

Since the first case was reported on Aug. 31 in Ankazobe district, more than 1,300 cases of suspected, probable and confirmed plague have been identified, and 102 people have died in 18 of Madagascar's 22 regions. In 2014, considered a bad year for plague in Madagascar, only 40 people died. The United Nations says the rapid increase in cases is cause for concern and that "the situation will continue to deteriorate."

"This year, we are seeing urban spread of the pneumonic type" said Tonje Tingberg, the Red Cross field team leader in the country. Two-thirds of cases this year are the highly contagious pneumonic plague, which infects the lungs and is transmitted in the air, unlike the bubonic form of plague that is endemic in rural Madagascar, and which is only transmitted by fleas living on rats. Unlike most years, the plague has hit cities where person-to-person transmission is easier due to urban density and poor sanitation. Schools across the country have been closed and the government has banned public gatherings to reduce the risk of transmission.

Stephane Michaud, director of emergencies at the Canadian Red Cross, told The Globe and Mail that local health officials are operating plague-treatment centres that are currently meeting the demand. "For now, they are able to handle the clinical caseload of plague, and the main effort is at the community level to prevent further spread of the disease," he said. That effort is being led by 2,600 volunteers from the local Red Cross, with "surge support" from an international group of humanitarian aid workers, including Canadians.
Doctors and nurses from the Ministry of Health and officers of the Malagasy Red Cross staff a health-care checkpoint in Ampasapito district on Oct. 5, 2017, with the mission of informing passengers leaving Tananarive, and to potentially detect cases suspected of plague.

Doctors and nurses from the Ministry of Health and officers of the Malagasy Red Cross staff a health-care checkpoint in Ampasapito district on Oct. 5, 2017, with the mission of informing passengers leaving Tananarive, and to potentially detect cases suspected of plague.

RIJASOLO/AFP/GETTY IMAGES
A young woman, left, gestures as she is examined by doctors at the health-care checkpoint.

A young woman, left, gestures as she is examined by doctors at the health-care checkpoint. Two-thirds of Madagascar’s plague cases this year are the highly contagious and airborne pneumonic type.

RIJASOLO/AFP/GETTY IMAGES
Zoom/Pan
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Leaflet | © OpenStreetMap

The International Federation of the Red Cross is flying a specialized infectious disease field hospital to the region in case the situation worsens, and the WHO has sent 1.2 million doses of antibiotics to treat those infected and prevent illness in those exposed.

Lessons learned from the global Ebola epidemic in 2014 are being applied by international aid agencies. "We are validating the lessons we learned from Ebola," Mr. Michaud said. Those actions include five principles of epidemic containment, the most important of which is communicating with the public to demystify the illness and educate people about prevention methods. Battling stigma is a key priority.

Clinical treatment centres provide medical support to those infected while disease detectives map the disease and trace anyone who may have come into contact with an infected individual. Contacts are then provided with prophylactic antibiotics. The Red Cross is currently devising an approach to ensure the safe and dignified burial of those who die. Lastly, survivors and health care workers are offered psychological support; post traumatic stress disorder was a common consequence for those involved in the Ebola crisis.

A sixth strategy is specific to plague – vector control. "Prioritize the elimination of fleas before the [elimination of] rats, or else the fleas will hop to another host," Ms. Tingberg said. But that method of disinfection won't limit the spread of person-to-person transmission of the pneumonic plague.

It's too early to tell, says the Red Cross, if these containment strategies are working to stop the spread of the disease.

Ms. Tingberg believes two factors explain why this year's plague outbreak is worse than previous years. The highly contagious pneumonic variety of plague was introduced to the main city of Tananarive by a man who travelled to the city by taxi seeking medical help and later died. While the WHO describes plague as a "disease of poverty," the epidemic is affecting people across the socioeconomic spectrum as it spreads through the capital.
EXPLAINER
Pneumonic plague: Five things to know
Five skeletons are unearthed from England’s East Smithfield site, a ‘plague pit’ used in the 14th century as a mass grave for victims of the Black Death.

Five skeletons are unearthed from England’s East Smithfield site, a ‘plague pit’ used in the 14th century as a mass grave for victims of the Black Death.

MUSEUM OF LONDON

1. What is the plague?

Plague, famously known as the "Black Death" that killed 50 million Europeans in the 14th century, is a disease caused by the bacterium yersenia pestis, and is transmitted to humans by fleas and rat bites. While Canada hasn't had a case since 1939, the United States had 16 cases last year, and four deaths, according to the U.S. Centers for Disease Control and Prevention. The disease first arrived in North America on rat-infested 19th-century ships from Asia, where it can be traced back thousands of years. There is no vaccine, but it is easy to treat with antibiotics. It is still endemic in many developing countries.

2. Why is the current outbreak so worrisome?

The current outbreak is "pneumonic," meaning it affects the lungs and is easily transmitted between people through droplets in the air. That makes it highly contagious. There are approximately 400 cases of the less-transmissible "bubonic" plague each year in Madagascar, which can only be transmitted by fleas living on rats. Particularly worrisome is that this outbreak has spread to large, congested cities, increasing the risk that infected people will come in close contact with others and spread the disease. Complicating matters is the geography of Madagascar. It is a mostly rural country with poor road infrastructure, making it difficult for health teams to quickly respond to communities in need.

3. What is being done to contain the outbreak?

The Red Cross and other NGOs are on the ground assessing the situation. "We are adopting a no-regrets approach to this response," international Red Cross president Elhadj Sy said. "Our experience in responding to disease outbreaks is that quick, decisive action can save lives." The International Federation of the Red Cross is flying a specialized infectious disease field hospital to Madagascar should it need to be deployed. "Local plague treatment centres for the moment are coping, but we don't want to hold back and we are prepositioning it in case it is needed," Stéphane Michaud, director of emergencies at the Canadian Red Cross. People exposed to the disease are being tracked and provided with prophylactic antibiotics. "Vector control specialists" – rat chasers – are working to control the pest problem, and surveillance at ports of entry is being enhanced.

4. How does this outbreak differ from the West Africa Ebola epidemic of 2014?

Plague is a well-understood bacterium endemic to Madagascar. There is local expertise to recognize and treat it, and it can be cured with antibiotics. About 8 per cent of patients in this current outbreak have died. Ebola kills 80 per cent of those infected. A relatively new virus that causes bleeding, dehydration and shock, there is no cure and no vaccine. But plague is easier to transmit than Ebola – the pneumonic variant is spread by droplets in the air, while Ebola is transmitted by direct contact with feces or blood. That means more people might be infected in a plague epidemic, but fewer will die if the local health system is capable of treating them. Plague also presents with symptoms quickly – in about 24 hours – so infected individuals are often identified before they can spread the disease. Since 2014, international aid agencies such as the Red Cross have studied the Ebola outbreak and the failings of the response to the epidemic. They learned a lot – and those lessons are being put to the test right now on the streets of Tananarive and other cities in Madagascar.
The Ebola virus, shown in an undated handout from the U.S. Centers for Disease Control.

The Ebola virus, shown in an undated handout from the U.S. Centers for Disease Control.

U.S. CENTERS FOR DISEASE CONTROL/ASSOCIATED PRESS

5. Could the outbreak spread?

Yes. Sputum samples from multiple suspected cases in the Seychelles, an African archipelago hundreds of kilometres from Madagascar, have been shipped to the WHO's testing facility in France. All samples tested negative, but authorities are on alert. The outbreak could be spread to other countries by plane or ship, where it could spread from person to person. Because many African cities have limited health resources and little if any extra hospital capacity, even small outbreaks can get out of -control and devastate communities. The WHO is currently in seven African countries preparing for possible spread and classifies the risk of spread outside Madagascar as "moderate."
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500 km

Leaflet | © OpenStreetMap

The International Federation of the Red Cross is flying a specialized infectious disease field hospital to the region in case the situation worsens, and the WHO has sent 1.2 million doses of antibiotics to treat those infected and prevent illness in those exposed.

Lessons learned from the global Ebola epidemic in 2014 are being applied by international aid agencies. "We are validating the lessons we learned from Ebola," Mr. Michaud said. Those actions include five principles of epidemic containment, the most important of which is communicating with the public to demystify the illness and educate people about prevention methods. Battling stigma is a key priority.

Clinical treatment centres provide medical support to those infected while disease detectives map the disease and trace anyone who may have come into contact with an infected individual. Contacts are then provided with prophylactic antibiotics. The Red Cross is currently devising an approach to ensure the safe and dignified burial of those who die. Lastly, survivors and health care workers are offered psychological support; post traumatic stress disorder was a common consequence for those involved in the Ebola crisis.

A sixth strategy is specific to plague – vector control. "Prioritize the elimination of fleas before the [elimination of] rats, or else the fleas will hop to another host," Ms. Tingberg said. But that method of disinfection won't limit the spread of person-to-person transmission of the pneumonic plague.

It's too early to tell, says the Red Cross, if these containment strategies are working to stop the spread of the disease.

Ms. Tingberg believes two factors explain why this year's plague outbreak is worse than previous years. The highly contagious pneumonic variety of plague was introduced to the main city of Tananarive by a man who travelled to the city by taxi seeking medical help and later died. While the WHO describes plague as a "disease of poverty," the epidemic is affecting people across the socioeconomic spectrum as it spreads through the capital.

[blackjeep]

We really should bar people from flying from that region. Imagine someone hopping on a plane and going to a major city, during flu season.

You can bet that some people infected with this plague will somehow make it over here. I'd also bet that TPTB already have a vaccine (with a witch's brew of toxic ingredients) ready to go. Vaccinations would, of course, be mandatory....

[bbbuddy]

For anyone who isn't already frightened by this news, I recommend reading the Pandemic series, by Bobby Akart. It's a 4-part doomer fiction series about the pneumonic plague, genetically modified by ISIS to be antibiotic resistant, and dispersed around the world as bioterrorism. I was just recommending this series a month or two ago. Here's hoping some nefarious group didn't use the novels as a blueprint. Seriously scary stuff.

I'm reading that series, thanks to you! Within 60 some days, only 1% of the human population on earth is still alive.

[Oreally]

fortunately there isn't much commerce and travel between east africa and Madagascar, but there is some.

can you imagine if this got loose in the crowded cites there, Nairobi, the slums of J'berg ? already they are vigilantes killing vampires in Zambia. . .

[Tristan]

I read Daniel Defoe's "Journal of the Plague Year" when I was around 12 and it made a huge impression on me. I highly recommend it, it's not very long, and it is online. I read it again about 10 or more years ago when H5N1 news was big.

Second link has different formats.

http://www.gutenberg.org/files/376/376-h/376-h.htm

http://www.gutenberg.org/ebooks/376

Interesting book; read it years ago. Keep-you-up-at-night type of read.

I hope the people 'pulling out' of Madagascar are at least self-isolating themselves until the danger period is over.

I know, what a 'Polly' thought...

[bbbuddy]

In the book series about this plague, jihadists infected themselves and then spread it through crowds, they also aerosolized it and sprayed it in crowds, etc,etc. Of course, that version had no cure...

But if they were to do the same with the real version, and had enough suiciders, we would quickly run out of enough antibiotics in many places to stop it - because of just in time delivery.

[ainitfunny]

With THIS form of Plague (Airborne, Pneumonic Bubonic Plague), YOU DON'T NEED rats or fleas, to suddenly, OVERNIGHT quickly have it out of control in a first world city like NEW YORK CITY!

Within three to five days, a pneumonic Plague victim, arriving on a plane into New York, may well expose and infect Thousands as they immediately (within 24 hours) pass on to other "healthy wealthy and wise" New Yorkers what he infected them just by breathing!

I do NOT gIve a damn how "offended and stigmatized" Pneumonic plague victims FEEL, THEY MUST BE ISOLATED or we could see another HISTORY MAKING DIE OFF of HUGE Populations rich and poor, , Even in this advanced age!!!

If you Do not NOW have N-95 masks and some anti-plague antibiotics (listed in an earlier post ) in your "preps" GET THEM NOW. If, and when pneumonic plague arrives, the modern American medical care system will be IMMEDIATELY, within days, overwhelmed, and you would not want to go near a hospital anyway, as they will be out of control, overwhelmed with patients, and that will be the most likely place to CONTRACT Pneumonic Plague! The public is ALWAYS kept from the truth!!

You will NOT find out from the government and health authorities when it arrives in America UNTIL it cannot be kept hidden any more, People will be dropping dead in the streets.

ALL TRAVELERS from that nation and area should be required to spend 3 Days in isolation before departing from that country! And all travelers from nations with ANY airborne plague should be isolated for three days immediately upon their arrival in America! Too bad if they do not like it. ISOLATION is the best way to stop the spread of airborne epidemics!

"Bubonic Plague" is blamed for previous "great die-offs" of human populations, but research has shown it was NOT the "regular" Bubonic Plague spread by rats and fleas, but THIS HIGHLY CONTAGIOUS, AIRBORNE PNEUMONIC BUBONIC PLAGUE FORM that historically wiped out most of the people of whole cities all over the world!

It is WAY past time we stopped talking about "rats and fleas" and focused upon CONTAINING this person to person airborne outbreak by ISOATION, effective masks and preventing strangers from assembling.

It may well come to the CHOICE of either temporarily SUSPENDING "normal life, commerce, travel, movement, etc" OR FORFEITING the survival of the majority of people and any chance for what we once knew as "normal" to resume.

[Melodi]

There have been isolated cases of Pneumonic Plague in the US - it can happen anywhere that the Bubonic form is endemic (and that includes the US Southwest and parts of the Western Mountian areas); it has just been good luck that it hasn't spread or been limited to very few individuals.

The last case I remember that probably was this form of Plague was a park ranger in Yosemite that caught it from her sick cat (yes cats can get it but so can lots of critters no reason to get rid of the family cat) she called a friend that her cat seemed to "have the flu" when she got off work and that she planned to take it to the vet in the morning.

She went to bed and just like a story out of the European Middle Ages she died there in the night; from perfectly healthy to dead in a few hours and thankfully not one else but the cat also died because she was found; the disease recognized and everyone was treated with antibiotics that had come into contact with her (including the medical staff).

I agree that at the very least the UK system of testing everyone incoming from the affected area is a good idea and quarantine of the Island may be indicated; however, it is foolish to pretend this can't break out at any time in the US without a single foreign visitor being involved; that's because the disease already exists in the US and it is only a matter of time before it tries to jump species again (to humans).

Many good "after the disaster" novels use this to make the West Coast or the South West "no-go" zones (including SM Sterling in The Change novels) because once there is no real medical care or antibiotics being produced (or distributed) people WILL die and the waves WILL come back.

Like the 14th century, modern populations have almost no immunity and huge numbers of people would be wiped out; and then like the second wave of the 14th century and the waves that came later; fewer would die (but still large numbers) especially the children who were not born during the last attack.

People don't realize it but the real destruction of the old system and start of the news occurred AFTER the SECOND wave of the Plague went through Europe about 12 years after the first one; it killed nearly all the children born since the first wave; the desponded parents were left utterly defected and EVERYTHING changed - God became a distant figure who probably wouldn't listen to you and Mary a Distant Queen of Heaven who just might if she felt like it.

There were similar changes in art, medicine, culture and the beginning of the end of the former systems of government and the way society was arranged; some of this, in the long run, was positive but it must have been hell on Earth to live through.

[Jubilee on Earth]

I'm reading that series, thanks to you! Within 60 some days, only 1% of the human population on earth is still alive.

I'm glad you're enjoying. It was just all fun doomer fiction, until this little piece of real news came to light. It makes this all so much more frightening. Especially when you consider this from a bioterror perspective. Not saying that's what this is at all, but the implication is seriuosly scary.

[Cardinal]

A Grand Solar Minimum preceded both the 6th century and the 13th century plagues. The Wolf minumum preceded the 1400s plague. We are headed into another now.