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  • Suspected pneumonic plague in the Democratic Republic of Congo

    http://hisz.rsoe.hu/alertmap/woalert...t=dis&lang=eng

    10/2/06


    A deadly epidemic feared to be
    pneumonic plague has broken out in eastern Democratic Republic of Congo, the World Health Organization (WHO) said on Friday. There are dozens of suspect cases and up to 20 deaths in the outbreak, which a WHO team is investigating along with health ministry officials, WHO plague expert Eric Bertherat said. "There is an epidemic which we are trying to confirm is the plague in the northeast Ituri region," said Bertherat. Preliminary indications point to pneumonic plague, the most deadly and least common form of the disease, which can be spread by humans without involvement of fleas, he said. "It seems it could be the pneumonic form, which is extremely contagious with a high mortality rate of about 50 percent...At least several dozen cases are reported and up to 20 fatalities," Bertherat said. The outbreak is around Isiro, northeast of the eastern city of Kisangani in the remote, mineral-rich Ituri region. In early 2005, 150 cases of plague were confirmed in Zobia, north of Kisangani, half of them fatal, according to the WHO. Many of the miners working at the diamond mine in Zobia fled the outbreak and spread the highly contagious disease.
    <code>
    10/4/06
    Update:
    Medair leads an emergency response to control a suspected outbreak of pneumonic plague in the Democratic Republic of Congo.In mid-September, a Medair team received news of nine mysterious deaths to the south of Isiro
    , in the U&#233;l&#233; district of DRC. The team was returning from 5 days of monitoring the restoration of the road from Isiro to Nia Nia. Based on the information available, Medair suspected the deaths might be from pneumonic plague. They left immediately to coordinate with local health officials and conduct a thorough investigation.

    Medair sent three treatment kits to respond to the suspected 60 to 90 cases of pneumonic plague. However, Medair's preliminary investigation discovered 517 suspected cases and 30 deceased within three different health zones. They immediately contacted the World Health Organization and medical authorities, informing them of the outbreak. As the first NGO on-the-ground handling the crisis, Medair responded with urgency. They dispatched teams with treatment kits to 15 different health centres and hospitals, provided a lab technician for clinical testing, two satellite phones for further communications, and trained local health officials to recognize symptoms and treat them accordingly.

    Medair conducted secondary investigations from September 26 to October 2, finding an additional 47 suspected cases and seven more deceased, raising the death toll to 37 people. The infected people are displaying clinical features that are compatible with pneumonic plague. They are now being hospitalised or treated in health centres, and are responding well to initial treatments of medications and antibiotics.

    This outbreak is particularly difficult to contain because of the inaccessibility of the affected areas. Most severely affected is the village of Bolebole, which cannot be reached by road. Access to Bolebole requires crossing a river by boat and then walking nearly four hours (20 km) through the marshy thickness of the jungle. Medair has a team in Bolebole, and their residents are providing assistance by transporting treatment kits to the village.

    It now appears that the first case of this epidemic occurred in mid-August in the village of Zobia, where confirmed cases of pneumonic plague occurred back in February 2005. The contamination likely spread to Bolebole because of the continuous movement of workers to the gold and diamond mines in this surrounding area. Plague was previously unknown around here, so it took time to recognize the symptoms, and many people were infected before the problem could be identified.

    Medair continues to pursue vigorous action to control and stop this deadly outbreak. They have sent additional staff and supplies from their other base in Bunia to reinforce substantial ongoing efforts. Different actors in the health sector are now contributing their own resources to help stem the tide of this epidemic. The coordinated efforts of different agencies will increase the effectiveness of this emergency response, helping restore health to this area of the DRC.

    For more details, please contact: David Sauter Congo (DRC) Desk Officer (English, French) Phone: +41 (0)21 694 3535 david.sauter(at)medair.org </code>

    <script type="text/javascript">linkset(document.getElementById('253') ,document.getElementById('zar253'));</script>



    "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

  • #2
    Re: Suspected pneumonic plague in the Democratic Republic of Congo




    http://health.allrefer.com/health/plague-symptoms.html


    Plague Symptoms & Signs

    <!--startofinnercontent--> BUBONIC PLAGUE
    • Sudden onset of high fever
    • Chills
    • General discomfort, uneasiness, or ill feeling (malaise)
    • Muscular pains
    • Severe headache
    • Smooth, oval, reddened, painful swellings of swollen lymph glands called buboes in the groin, armpits, neck, or elsewhere in the body. Pain may occur in the area before the swelling; the most common area is in the groin
    • Seizures
    PNEUMONIC PLAGUESEPTICEMIC PLAGUE
    "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

    Comment


    • #3
      Re: Suspected pneumonic plague in the Democratic Republic of Congo

      VIRAL HEMORRHAGIC FEVER EMERGENCY INFORMATION:
      TRANSMISSION, PREVENTION, & INFECTION CONTROL
      WHAT IS VIRAL

      HEMORRHAGIC
      FEVER?
      ?VHF?s are caused by viruses of four distinct families ? arenaviruses, filoviruses,
      bunyaviruses, and flaviviruses
      ?Examples of VHF illness are Ebola, Marburg, Lassa, & Crimean-Congo fevers
      ?VHF is uncommon in U.S. and one case should be considered a marker for a
      possible bioterrorist event
      ?Specific symptoms vary by type of VHF but initial symptoms include marked
      fever, fatigue, dizziness, muscle aches, loss of strength, exhaustion
      ?Latter symptoms include maculopapular rash prominent on trunk, nervous
      system malfunction, renal failure, and bleeding under the skin and from body
      orifices

      Comment


      • #4
        Re: Suspected pneumonic plague in the Democratic Republic of Congo

        See thread:

        Mystery illness kills at least six in Panama

        Sounds like could be same symptoms

        Comment


        • #5
          Re: Suspected pneumonic plague in the Democratic Republic of Congo

          It does not appear to be the same illness as in Panama. Symptoms in that disease are characterized by renal failure.

          Symptoms reported in the Panama illness:

          Nausea
          Vomiting
          High Fever
          Diarrhea
          Severe Headache
          Kidney Failure
          Paralysis, especially around the face
          Difficulty Walking and Physical Coordination
          Eventually, death if the patient does not receive dialysis.

          Comment


          • #6
            Re: Suspected pneumonic plague in the Democratic Republic of Congo

            Originally posted by Florida1
            It does not appear to be the same illness as in Panama. Symptoms in that disease are characterized by renal failure.

            Symptoms reported in the Panama illness:

            Nausea
            Vomiting
            High Fever
            Diarrhea
            Severe Headache
            Kidney Failure
            Paralysis, especially around the face
            Difficulty Walking and Physical Coordination
            Eventually, death if the patient does not receive dialysis.
            See post #3 above, "renal failure" in VHF?
            Maybe I'm reading something wrong?
            Some of the symptoms of the two are similar to other diseases also, so maybe no connection.
            Last edited by under the radar; October 5, 2006, 01:50 PM.

            Comment


            • #7
              Re: Suspected pneumonic plague in the Democratic Republic of Congo

              My read of post #3 is that renal failure can be a symptom of hemorrhagic fever.

              My read of post # 2 is that renal failure is not a symptom of plague although all organs can be affected.

              Therefore, since the illness in Panama is specific for renal failure, it is most probably not plague.

              Comment


              • #8
                Re: Suspected pneumonic plague in the Democratic Republic of Congo

                I would give more weight to the above post by MHSC of report from Medair since Medair has "boots on the ground".

                UN Office for the Coordination of Humanitarian Affairs
                Thursday 5 October 2006

                DRC: Plague kills 29 in Orientale Province, infects 500, WHO says

                KINSHASA, 3 Oct 2006 (IRIN) - Pneumonic plague has since 16 August claimed 29 lives and infected another 500 people in the Pawa and Wemba areas of Isiro District in northeastern Democratic Republic of Congo, according to the World Health Organization.

                Dr Florent Ekwanzala, an epidemiologist with the WHO, said on Monday a WHO-backed health team comprising a supervisor, laboratory nurse and members of an international NGO had collected samples that were sent to the National Institute of Bio-Medical Research in Kinshasa to confirm the diagnosis.

                Pneumonic plague is a bacterial infection that can be transmitted to humans by the bite of infected fleas, direct contact with infected patients, and inhalation or, rarely, ingestion of infective materials such as infected tissue. Infected persons usually develop flu-like symptoms after an incubation period of three to seven days. The disease is contagious and mortality rates can be high.

                The WHO team has been informing the local population on how to avoid the disease by taking precautions against flea bites, avoiding the handling of carcasses in plague-endemic areas and contact with infective tissues, or being exposed to patients with pneumonic plague.

                "The samples are expected to be compared with those of other lung diseases as it could also turn out to be leptospirosis," Ekwanzala said.

                The symptoms of leptospirosis include high fever, severe headache, muscle pain, jaundice, haemorrhages in skin and mucus membranes (including pulmonary bleeding), vomiting and diarrhoea.

                Ekwanzala said the same area recently experienced a similar epidemic on a smaller scale, which could have spread from the neighbouring region. A few cases were recorded in the Reti, Ringa and Zobia zones of the Bas-Uele District.

                There were 19 deaths and 100 suspected cases in June in the neighbouring district of Ituri which, according to the WHO, is the most active breeding ground for the human strain in the world, with an average of 1,000 cases per year.

                Plague is endemic in many countries in Africa, in the former Soviet Union, the Americas and Asia. In 2003, nine countries reported 2,118 cases and 182 deaths, almost all in Africa.

                ei/fo/mw/oss

                [ENDS]

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                "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

                Comment


                • #9
                  Re: Suspected pneumonic plague in the Democratic Republic of Congo

                  WHO: Plague Outbreak in Congo Kills 42
                  6:42 PM PDT, October 13, 2006

                  GENEVA -- Pneumonic plague is suspected to have broken out in two areas in Congo, causing a reported 42 deaths, the World Health Organization said Friday.

                  WHO said it had received reports of 626 cases, mostly in the town of Wamba in northern Oriental province.

                  The reports, which covered July 31 to Oct. 8, were investigated by a team from Congo's provincial health authority, WHO and Doctors Without Borders.

                  The U.N. health body said final laboratory confirmation of the presence of pneumonic plague was pending, but preliminary results from a rapid diagnosis test in the field found three out of eight samples positive.

                  Pneumonic plague is spread mainly by fleas, and causes an infection in the lungs that slowly suffocates its victims. If diagnosed in time, it can be treated with antibiotics.

                  "In the beginning of change, the patriot is a scarce man (or woman https://flutrackers.com/forum/core/i...ilies/wink.png), and brave, and hated and scorned. When his cause succeeds, the timid join him, for it then costs nothing to be a patriot."- Mark TwainReason obeys itself; and ignorance submits to whatever is dictated to it. -Thomas Paine

                  Comment


                  • #10
                    Re: Suspected pneumonic plague in the Democratic Republic of Congo

                    PLAGUE
                    (Bubonic Plague; Pestis; Black Death)
                    An acute, severe infection appearing most commonly in a bubonic or pneumonic form, caused by the bacillus Yersinia pestis.

                    Etiology and Epidemiology
                    Yersinia pestis (formerly Pasteurella pestis) is a short bacillus that often shows bipolar staining (especially with Giemsa stain) and may resemble safety pins.

                    Plague occurs primarily in wild rodents (eg, rats, mice, squirrels, prairie dogs); it may be acute, subacute, or chronic, and urban (mainly murine) or sylvatic. Massive human epidemics have occurred (eg, the Black Death of the Middle Ages); more recently, plague has occurred sporadically or in limited outbreaks. In the USA, > 90% of human plague occurs in the southwestern states, especially New Mexico, Arizona, California, and Colorado. Bubonic plague is the most common form.

                    Plague is transmitted from rodent to humans by the bite of an infected flea vector. Human-to-human transmission occurs by inhaling droplet nuclei through the cough of patients with bubonic or septicemic plague who have pulmonary lesions (primary pneumonic plague). In endemic areas in the USA, a number of cases have been associated with household pets, especially cats. Transmission from cats can be by bite, or, if the cat has pneumonic plague, by inhalation of infected droplets.

                    Symptoms and Signs
                    In bubonic plague, the incubation period is usually 2 to 5 days but varies from a few hours to 12 days. Onset is abrupt and often associated with chills; the temperature rises to 39.5 to 41? C (103 to 106? F). The pulse may be rapid and thready; hypotension may occur. Enlarged lymph nodes (buboes) appear with or shortly before the fever. The femoral or inguinal lymph nodes are most commonly involved (50%), followed by axillary (22%), cervical (10%), or multiple (13%) nodes. Typically, the nodes are extremely tender and firm, surrounded by considerable edema; they may suppurate in the 2nd wk. The overlying skin is smooth and reddened but often not warm. A primary cutaneous lesion, varying from a small vesicle with slight local lymphangitis to an eschar, occasionally appears at the bite. The patient may be restless, delirious, confused, and uncoordinated. The liver and spleen may be palpable. The WBC count is usually 10,000 to 20,000/?L with a predominance of immature and mature neutrophils. The nodes may suppurate in the 2nd wk.

                    Primary pneumonic plague has a 2- to 3-day incubation period, followed by abrupt onset of high fever, chills, tachycardia, and headache, often severe. Cough, not prominent initially, develops within 20 to 24 h; sputum is mucoid at first, rapidly shows blood specks, and then becomes uniformly pink or bright red (resembling raspberry syrup) and foamy. Tachypnea and dyspnea are present, but pleurisy is not. Signs of consolidation are rare, and rales may be absent. Chest x-rays show a rapidly progressing pneumonia.

                    Septicemic plague usually occurs with the bubonic form as an acute, fulminant illness. Abdominal pain, presumably due to mesenteric lymphadenopathy, occurs in 40% of patients. Pharyngeal plague and plague meningitis are less common forms. Pestis minor, a benign form of bubonic plague, usually occurs only in endemic areas. Lymphadenitis, fever, headache, and prostration subside within a week.

                    Diagnosis and Prognosis
                    Diagnosis is based on recovery of the organism, which may be cultured from blood, sputum, or lymph node aspirate. Because surgical drainage may disseminate the organism, needle aspiration of a bubo is preferred. Y. pestis can grow on ordinary culture media or be isolated by animal (especially guinea pig) inoculation. Serologic tests include complement fixation, passive hemagglutination, and immunofluorescent staining of a node or tissue biopsy or secretions. Prior vaccination does not exclude plague in the differential diagnosis, since clinical illness may occur in vaccinated persons.

                    The mortality rate for untreated patients with bubonic plague is about 60%, with most deaths occurring from sepsis in 3 to 5 days. Most untreated patients with pneumonic plague die within 48 h of symptom onset. Septicemic plague may be fatal before bubonic or pulmonary manifestations predominate.

                    Prophylaxis and Treatment
                    Rodents should be controlled and repellents used to minimize fleabites. Although immunization with standard killed plague vaccine gives protection, vaccination is not indicated for most travelers to countries reporting cases of plague. Travelers should consider prophylaxis with tetracycline 500 mg po q 6 h during exposure periods.

                    Immediate treatment reduces mortality to < 5%. In septicemic or pneumonic plague, treatment must begin within 24 h with streptomycin 30 mg/kg/day IM in 4 divided doses q 6 h for 7 to 10 days. Many physicians give higher initial dosages, up to 0.5 g IM q 3 h for 48 h. Tetracycline 30 mg/kg IV or po in 4 divided doses is an alternative. Gentamicin is probably also effective, although no controlled clinical trials have been conducted. For plague meningitis, chloramphenicol should be given in a loading dose of 25 mg/kg IV, followed by 50 mg/kg/day in 4 divided doses IV or po. A multidrug-resistant strain has been reported from Madagascar.

                    Routine aseptic precautions are adequate for patients with bubonic plague. Those with primary or secondary pneumonic plague require strict (airborne agent) isolation. All pneumonic plague contacts should be under medical surveillance; their temperatures should be taken q 4 h for 6 days. If this is not possible, tetracycline 1 g/day po for 6 days can be given; however, this can produce drug-resistant strains.

                    The Merck Manuals (known as the MSD Manuals outside US & Canada) are the global standard in medical reference for Doctors, Students & Consumers - since 1899.

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