Peru - outbreak of pneumonic plague

[alert]

Re: Peru - outbreak of pneumonic plague

And now we have a case of bubonic plague in the area as well.

http://www.correoperu.com.pe/correo...cci_parent=0&txtSecci_id=63&txtNota_id=396342

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IN THE YEAR TO BE THE SEVEN CASES HAVE BEEN SUBMITTED
Appears new case of bubonic plague
July 20, 2010


SECURITY. DOCTORS MUST ALSO USE PROTECTIVE EYE.


Datum
Bubonic plague is spread mainly by the bite of infected fleas in the area, housing and occasionally in the laboratory by direct contact with wounds or mucous tissues of infected animals.
It is also spread

LIBERTY | Pneumonic plague not only has alerted the public Libertad. Yesterday it was confirmed a new case of bubonic plague. This is less than six years from the people of Chur?n, in the province of Ascope.

"The child was transferred on July 17th Trujillo Regional Teaching Hospital and its evolution is favorable, to the point that tomorrow (today) would be [discharged]," said Victor Peralta, Manager of Health, adding that the other four were infected with pneumonic plague are still hospitalized.

SECURITY MEASURES.

In this situation the Commission was formed Regional Technical Operations for handling outbreak of bubonic plague, led by regional medical epidemiologist and chief Pedro Diaz Camacho, who said she has strengthened security measures not only to control the plague but also the pneumonic.

Among the measures that have been established for housing Ascope province, from which the cases listed are recommended: avoid sleeping on the floor or less than 90 inches above the ground and change the containers in which stores trash day.

Likewise, avoid calling the guinea pigs from entering the rooms of the house and stay in a cage, and storing food in rodent-proof containers such as metal or glass containers.

He said also that people who possibly are infected should be moved in ambulances and private cars not also required to wear masks.

ALSO IN THE NORTH. Diaz Camacho also said the northern macro-region is at risk of contracting the plague. "It was detected in the Chicama River watershed, Jequetepeque Huamcabamba Piura and wild rodents are presenting the bacterium Yersinia pestis, a native of both pests," said epidemiologist.

 

[alert]

Re: Peru - outbreak of pneumonic plague

It think the bold statement indicates that 40 contacts are being monitored and hopefully given preventative treatment.

http://www.diariolaprimeraperu.com/online/nacional/preocupacion-por-peste-bubonica_66584.html

Concern for bubonic plague



Pneumonic plague unleashed Chocope district, province of Ascope could affect other areas of La Libertad, including the city of Trujillo, due to the proliferation of rodents in the region, which has generated concern among the authorities and the population the area. The regional health manager, Victor Peralta Ch?vez yesterday hinted that markets such as the Hermelinda and sales centers in the heart of the city are a constant threat to attack this disease Trujillo.

The neighbors also expressed fears about the presence of huge rats in their homes, particularly those with patios or yards. The concern is increased due to cases of bubonic plague in the neighboring province of Ascope.

Three students are in serious condition and would have infected 40 people, so it has been asked to spray the fields, especially sugar cane, and homes throughout the Chicama valley.

The vectors are rodents, whose fleas bite people and thus spreading evil, what is called bubonic plague, and when art is known as pneumonic plague, because it attacks the bronchial tubes and causes high fevers. The affected person not to be cured can die immediately.

 

[alert]

Re: Peru - outbreak of pneumonic plague

http://www.laindustria.pe/index.php?option=com_content&task=view&id=17113&Itemid=18

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Health emergency declared in Liberty
Tuesday, July 20, 2010
Regional Management of Health declared a health emergency to Freedom after reporting three cases of pneumonic plague and a case of bubonic plague in a child of seven years. So regional adviser said yesterday the province of Ascope, Pedro Diaz Camacho, who in his capacity as an epidemiologist was appointed as Chairman of the Regional Operational Technician Pest Control.




He said the emergency declaration will facilitate investment in the campaign launched with the aim of combating the plague.

Announced it will develop a comprehensive plan for the entire region, because their main concern is to control the plague in La Libertad. "If this is not done a good job we run the risk not only of infecting neighboring regions, but the entire country," said the expert.

He noted that the river basins of Great Chimu, Jequetepeque Huancabamba and Chira, the last two in the Piura region, are infected with the bacteria that causes bubonic plague (Yersinia pestis) and therefore it is necessary to act urgently and effectively.

This is a problem that requires urgent attention of all authorities, hence called on municipal authorities to join the crusade. "The Municipal Act requires local governments to invest in health," he said.

Camacho D?az explained that in the risk zone Chicama Valley, there is a technical team consisting of three epidemiologists and two infectious disease specialists from Lima. The idea is working on all fronts to tackle the disease.
The specialist also announced that evaluate the possibility of using a lab at the National University of Trujillo (UNT) to make crops pest samples and to avoid moving the guides to Lima, where it takes up to eight days to get results.

It assesses whether the conditions of biosafety testing in Trujillo, whether it is favorable, in 24 or 72 hours will get the results of samples of plague.

On the other hand, announced that today at 2 pm in the auditorium of the City of Chicama, is meet with all the mayors of the province of Ascope to address the issue and make commitments on the issue of the plague.

The manager of the Regional Government, Juan Morillas Bulnes, argued that the region assessing the financing contingency plan co-financing of the Presidency of the Council of Ministers (PCM).

 

[alert]

Re: Peru - outbreak of pneumonic plague

According to the above post, the reported 8-year-old pneumonic plague case in #16 is the same child (now reported as 7 years old) as the 6-year-old bubonic plague case in #21, and is a bubonic plague case, not a pneumonic one. Both sources give a hospitalization date of the 17th.

So we might still only have the original three pneumonic cases, in which case, the incubation period has likely expired on all contacts.

 

[alert]

Re: Peru - outbreak of pneumonic plague

http://www.noticiastrujillo.com/index.php?option=com_content&task=view&id=40413&Itemid=56

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The bubonic plague and pneumonic concern in La Libertad
Tuesday, July 20, 2010
In the bubonic plague and pneumonic plague, authorities and health personnel attached to this disease
Because the three victims with pneumonic plague and bubonic plague registered with Libertad territory, authorities and health personnel gathered in the main auditorium of the Medical College of Peru to learn the main aspects of this disease and taking preventive measures.

The meeting convened by the Regional Directorate of Health in coordination with the Red Trujillo - Utes June, aimed to be aware of the specific imperatives of the plague and thus take preventive measures to combat it immediately, preventing their advance liberte?a mortality in .

Although fever is nothing new in our city, it is important to recall that is an acute, often fatal, and potentially epidemic caused by the bite of infected flea that feeds on the blood of rodents and domestic cats in which
lives.

From 1965 to 2010, this evil is entrenched in the mountain areas of northern Peru being Piura, Lambayeque, Trujillo and Cajamarca, where cases can be seen from this evil.

There are three clinical forms of manifestation, Bubonic plague, septicemic plague and pneumonic plague, being the first symptoms of sudden onset of fever, chills and severe headache in less than 24 hours, painful bubo appears 1-10 cm long (groin, armpit or neck.) Palpation is very painful. The clinical course can be fulminant, resulting in death in as little as 2-4 days after onset of symptoms.

In the second plague, septicemia patients may have primary or secondary and the fatality rate is 10-23% if you take the diagnosis and treatment. In addition, the incubation period is 1-7 days and the period of transmissibility can be several months and the susceptibility is large.

The symptoms of plague are third, infection in the lungs by air and hematogenous spread of bacteria from bubo.

The fatality rate may be higher than 50% even with treatment. It is noted that on the first day the symptoms are nonspecific, usually gastrointestinal. Also, the Bubonic plague is not spread from person to person as with Pneumonic Plague. From there, health officials are calling on people to come immediately to health centers in your area if they suspect of having any symptoms of the above.

Untreated bubonic plague has a fatality rate estimated at more than fifty percent. However, not all is lost, there are effective drugs like Streptomycin: 30 mg / kg / day in two doses intramuscularly for 7 days because the lethality delivered falls below five percent, doxycycline 100 mg C / 12 hx 7 days, Chloramphenicol: 50 mg / kg, divided into four oral doses and clinical improvement, up to 7 days.

Among the personnel involved in this preventive mission meeting highlighted by the Dean of the Medical College of Peru Regional Council I, Dr. John Namoc Medina, Dr. Jos? Luis Villanueva Villanueva, Executive Director of the Network of Health Services Trujillo, Dr. Javier Mas?as Mimbela, Director of the Office of Information Management of Joint Ventures in June, Dr. Manuel Agreda S?nchez, Director of the Center for Prevention and Control of Emergencies and Disasters, and finally, Dr. Paul Pachas Institute National Health Ministry of Health. The latter charge of the relevant exposures.

"A healthy population is the engine of a dynamic country and a fighter, though it sounds trite never too late to run the thought, rather than preventing regret, sentenced one of the authorities present.

 

[alert]

Re: Peru - outbreak of pneumonic plague

Status updates on the three pneumonic patients. The 36-year-old doctor is the same one that was 32 or 35 in above posts.

At least two, if not all three, patients are on ventilators.

http://www.laindustria.pe/index.php?option=com_content&task=view&id=17187&Itemid=18

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To combat infectious diseases will pneumonic plague
Thursday, July 22, 2010
Unity is strength. In order to enhance combat operations against the dreaded pneumonic plague in La Libertad, the Ministry of Health (MoH) will send to our city, from 9 to 12 August, the best physician infectious disease in the country, Eduardo Gotuzzo Herencia, who also will complement the management activities of the three patients infected with the disease.


Emergency Session
This was confirmed yesterday in an exclusive dialogue with the advisor to Industry Minister of Health and former regional manager of health, Henry Rebaza Iparraguirre, who revealed that the decision was made during a meeting in Lima between the National Director of Health MoH, Luis Miguel Leon, the head of the National Strategy and Zoonoses Control, Ana Maria Navarro, and himself.

"In addition, Gotuzzo doctor will meet with all professionals in the region of Infectious Diseases and Medical Intensive Care Units (ICUs) EsSalud. With the aim of strengthening their work and collaborate in the proper handling of the three cases raised mild or complicated because of pneumonic plague, "he said ahead of the Zoonosis Control director arrive next Monday, 2 August.

In the same vein, Rebaza Iparraguirre explained that the presence of two professionals in our city Lima (Ana Maria Navarro and Eduardo Gotuzzo) is also the intention to develop a work plan to convene a meeting with Trujillo authorities health Cajamarca, Lambayeque and Ancash. Thus, it will draw up a joint defense method, since it is the idea that pneumonic plague began in Cajamarca.

Your health concerns
On the other hand, Industry spoke yesterday with the head of the Intensive Care Unit (ICU) of Hospital Víctor Lazarte Echegaray, Jorge García Ventura, who denied rumors that the Friday evening the resident identified as Carlos PM (36), infected with pneumonic plague, was taken to Lima aboard a special plane.

"His condition is very delicate, but still in our hospital. It said it had been taken to National Hospital Rebagliati, but not true ", he said.

Meanwhile, Regional Director of Teaching, Cantera Raul Hurtado, confirmed that although the health of the fourth year student of Medicine at the Universidad Nacional de Trujillo (UNT) has presented a slight improvement, the women's 29-year chocopana still critical.

"The lady is still the same, ie no signs of recovery. We are providing Clorofenicol to stabilize it. On the other hand, we know that students of medicine is better because the level of oxygen consumption is lower, that is, their lungs do not make much effort to get air, "said clarifying that both patients remain connected to a ventilator.

Note
- The Regional Director expressed Teachers who have been studying the possibility of sending to Lima to the female patient aged 29 with the dreaded plague.

-------------------------

http://www.noticiastrujillo.com/index.php?option=com_content&task=view&id=40490&Itemid=56

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UNT Authorities met with directors of the Regional Hospital
Thursday, July 22, 2010
Page 1 of 2
In formulating strategies for the development of pneumonic plague

The highest authorities of the National University of Trujillo met with the directors of the Trujillo Regional Teaching Hospital (HRDT) to continue with the levels of coordination in order to support the guidelines issued by the Ministry of Health to prevent and counteract any progress of pneumonic plague , whose focus was initiated in Ascope, with three cases reported to date.




Were present at the meeting the rector UNT, Dr. Orlando Velásquez Benites, the administrative vice chancellor Dr. Flor Luna Victoria Mori, the chief of Emergency HRDT, Dr. Jose Antonio Caballero, the chief of epidemiology at HRDT, Dr. Maria Elena Luna Farro, later joined HRDT executive director, Dr. Raul Hurtado Cantera.

First Dr. Cantera Hurtado, said that patients who reported positive for the bacterium Yersinia pestis (the cause of pneumonic plague) were treated entirely on their medical treatment and medication for the Regional hospital of the Ministry of Health and hospital EsSalud Víctor Lazarte Echegaray.

He noted that there are high chances of controlling the spread of the bacteria, as has always been presented although outbreaks of pneumonic plague by the proliferation of rats in sugarcane fields in the Chicama Valley, but currently working in the field in control rats and fleas, as well as people who were in contact with the first case.

"In this control is called ring or epidemiological health security: one is in the Chicama Valley and the other is in the town El Milagro, in order to avoid getting it in Trujillo. We also prepare a contingency area HRDT in the case of having to face new to receive treatment within a much faster, "he said.

Also welcomed the initiative of a joint effort between the Regional Government, Ministry of Health and the UNT to implement in the shortest period of a biosafety cabinet (Laminar flow hood) into the Laboratory of Parasitology at the National University Trujillo.

For its part, the head of Emergency, Dr. Caballero said that the fight to prevent the plague from spreading is necessary that emergency personnel acting under the standards of biosecurity, ie wear masks, caps, aprons and gloves.

Finally, the Dean of the Faculty of Medicine, Dr. Lourdes Armas Fava reported that it submitted a request to the Executive Directorate of the MoH Environmental Health to take samples of laboratory animal medicine UNT (place of rearing rats) to rule the presence of the bacterium Yersinia pestis.


More information:

1 .- On the situation of the patients reported that Carlos PM (35) is that "because dopamine was removed," the fourth year student at NTU Medical Felix UL (21) and awake and improvement in sight, and on women aged 29, from Mariposa sector Leyva (Chocope) was reported despite a delicate box on Wednesday, Thursday improved compared to previous days, but its status remains being extremely sensitive.

2 .- The UNT will provide a financial subsidy to the family of a medical student.

 

[alert]

Re: Peru - outbreak of pneumonic plague

And they have announced the outbreak as contained, as it has now been about two weeks since the last isolation of a suspected case.

No word yet on the condition of the three pneumonic plague cases.

http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1060,83832

Spanish to English translationShow romanization
Archive Number 20100726.2503
Posted 26-JUL-2010
Title PRO / ESP> Plague neum? ?? ? ?? nica, health personnel: Actualizaci? ?? ? ?? n - Peri ?? ? ?? (Ascope)

Pneumonic plague, PERSONAL HEALTH: UPDATE - PERU (Ascope)
************************************************** ****
A statement by ProMED-mail
<http://www.promedmail.org>
ProMED-mail is a program
International Society of Infectious Diseases
<http://www.isid.org>

Date: July 26, 2010
Source: Peru 21, Peru
<http://peru21.pe/noticia/614022/peste-anulada-mas-tres-anos>
[Edited by J. Torres]

Pneumonic and bubonic plague can not be eliminated in the short
term. The Technical Committee Chairman Regional Operational Control
Pest, Pedro Diaz Camacho, said that they must spend at least
three years to eradicate the population. Although less upbeat
Health regional manager of La Libertad, V?ctor Peralta Chavez
who said that three years is very little time and could be
many more.

? Plague is very old as humanity, and throughout the
time has tried to eradicate it, has been very difficult. You can
calm, but later appears? said.

Peralta revealed that the pneumonia in the population has been controlled, but
that plague has been detected in dogs and cats in the district
Razuri, a disease that can infect humans and become,
In turn, pneumonic.

On the other hand, reported that the World Health Organization sent
La Libertad, four experts on urban rat, lab
fever, rapid test, port health and epidemic pneumonic
from Madagascar? country with highest rate of cases with this
plague? and that they will on 4 August.

? Everyone knows that in Peru there is fever, which is why WHO has
acting to control the disease because, otherwise,
would have to close the ports and would be a negative impact on the
economy of the region and across the country? he said.

Reported by: Jaime R. Torres <torresjaime@cantv.net>

- ProMED-ESP


[See also:

Pneumonic plague, health personnel - Peru (Ascope) 20100716.2385
Bubonic plague outbreak - Peru (La Libertad) 20100711.2321]

 

[alert]

Re: Peru - outbreak of pneumonic plague

And now we have a 30 year-old HCW who was involved in intubating the original patient (on the 8th or so) who has developed flu-like symptoms and been isolated as a precaution, although rapid tests are negative (and the incubation period would likely be about 14-17 days, which would be exceptional for plague, assuming he didn't have additional exposures such as to the other two doctors).

There are many diseases which case present with flu-like symptoms, including flu. It is the winter in Peru after all.

http://www.laindustria.pe/index.php?option=com_content&task=view&id=17291&Itemid=5

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-------------------------------------------------- ------------------------------


Trujillo dropped if you have terrible plague doctor
Tuesday, July 27, 2010
A new case of pneumonic plague in other medical specialists seeking to dismiss the Regional Hospital of Trujillo. It is a physician who treated the woman Chocope suffering from the disease and that, days earlier, caught a resident and a student of fourth year medical student.


He said that it is a resident of FNC initial (30), who presented with fever, malaise, hoarseness and chills. "In the first symptoms, the physician took him to submit samples for laboratory tests and so rule out the disease," said the director.

At the same time indicated that the doctor was isolated and receive preventive treatment, while receiving the final results of the laboratory.

Although the epidemiologist and chairman of the Regional Committee Technical Operational Pest Control, Pedro Diaz Camacho, said the rapid test done the doctor came out negative, await the results sent to the laboratory of the National Institute of Health.

"For the time being treated for pneumonic plague (streptomycin and amofloxacina). The probability is low but is being treated for caution, "said the doctor.

He said the resident physician, now sick, also participated tubing to the woman when she entered the grave to the hospital emergency unit, so that specialists are suspicious of a possible spread of plague.

In laboratory tests confirmed it would be the fourth case, three of which are nosocomial (infected in the hospital).

Camacho Díaz explained that the period of encubación of the bacteria that causes plague (Yersinia pestis) in the human body is 14 days and in rare cases up to 21.

No better
According to the medical report sent to Cantera Hurtado of the first three patients, the health of the resident physician of 35 years, hospitalized Víctor Lazarte Echegaray, reflecting a slight improvement over the previous days.

While the medical student (21), admitted to the Regional Teaching Hospital, the situation was complicated with a picture of pneumonia. The 29-year-old from Chocope, which spread to health professionals, offers no improvement. The doctors conclude that the situation is critical of the three infected.

Action taken
Quarry Howard commented that the Regional Teaching Hospital implements a unique care area for patients with symptoms of plague. Located in the Academic Complex, an isolated area for rapid diagnostic care and treatment of plague. This area will become operational on 1 August of the current.

He also indicated that primers have been developed guidance on biosecurity measures to conduct themselves within the hospital. At the same time, said that calm has returned to the hospital, after all the hospital staff were trained in prevention and provided with proper implementation (masks, gloves, etc..) To enter areas of care.


Hernan Flores Rodríguez
hernanflores@laindustria.comEsta email address is being protected from spam bots, you need JavaScript enabled to view it


Last Updated (Tuesday, July 27, 2010)

 

[alert]

Re: Peru - outbreak of pneumonic plague

And we get a report of what appears to be a septicemic plague fatality from the same area.

http://www.correoperu.com.pe/correo...cci_parent=0&txtSecci_id=63&txtNota_id=402370

Spanish to English translationShow romanization
WHILE IN FIRST REGISTRATION TRUJILLO CASE of bubonic plague
Death takes its first victim
July 28, 2010







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LIBERTY | Apparently, the efforts of health authorities to control the pneumonic plague are not enough.

Yesterday, in Cartavio died the first victim of this dreaded disease.

DEATH. This is a 14-year initial Ohura, who died Monday afternoon.

"Since last week the child had any symptoms of respiratory infection a strong just yesterday his family took him to San Francisco hospital Cartavio company, and that certified his death," said Pedro Diaz Camacho, president of the Regional Technical Committee Operations Management of outbreaks.

It was learned that the child had made before he died and had swollen glands shed blood, which could also be a septicemic plague, ie the bacterium Yersinia pestis was not only present in the lungs, but would have attacked blood.

The Regional Health Bureau ordered the respective analysis to rule out the deceased's family in the presence of the plague.

EN TRUJILLO. Meanwhile, in Trujillo first detected spread of bubonic plague: a child under six, who would have been infected with this disease after visiting the Chicama Valley. This was confirmed by Diaz Camacho, who said that the hit is located in the Trujillo Regional Teaching Hospital.

 

[alert]

Re: Peru - outbreak of pneumonic plague

And we get a whole bunch more cases. Yikes.

http://www.laindustria.pe/index.php?option=com_content&task=view&id=17328&Itemid=18

Spanish to English translationShow romanization
Death would have taken its first victim
Wednesday, July 28, 2010
The sudden death of a 14-year Sumanique, jurisdiction of the district of Santiago de Cao, led the specialists of the Ministry of Health to assume that died of pneumonic plague infection, since presenting symptoms and their relationship with a disease (a disease in which infected animals to humans). If confirmed, this would be the first fatality since the beginning of recorded outbreak of evil in our region and country.

So far, there have been 15 cases of bubonic plague, of which six have already been confirmed by the laboratory, and nine cases of pneumonia, with four validated.

Most alarming is that the death of a child in Cartavio would add the probable spread of a little girl two years, who lives in the same household. The lower a fever and pneumonia symptoms, so doctors arranged their rapid placement in the Regional Teaching Hospital to receive specialized treatment of infectious disease physicians.

The rapid test also showed negative for fever, but still sent samples to Lima to rule out or confirm the disease. It was learned that his health is stable and is already receiving treatment.

It was also reported that a niece of the first woman infected with evil have been infected and you get your dose combative in the Regional hospital.

Too late
The epidemiologist and chairman of the Regional Committee Technical Operational Pest Control, Pedro Diaz Camacho, said that last Monday, a woman moved her son to San Francisco hospital Cartavio Agroindustrial Complex in search of medical help, but the hospital was limited to certify his death. The body of puberty entered the hospital at 5 pm and nothing could be done.

It was a special child with down syndrome. According to experts, these people have depressed immune response, ie, very low defenses, deficiencies that have fostered the development of the disease.
The teenager's mother, whose name was not released, confessed to doctors that four days before the death of his son, he had high fever, shortness of breath and left groin pain (left leg ganglia). The mother confessed to her son self-medicated with pills antalgina and promptly took him to hospital.

Also that the July 19 killing two guinea pigs (disease) in your home, history suggests that the specialists there the infection originated and death from fever septis?mica.

Once certified the death of a teenager, doctors Cartavio hospital informed the Ascope Health Network, whose headquarters is located in the district of Paij?n. They were the ones who called for Diaz Camacho, who immediately moved to the valley Libertad.

"They conducted a verbal autopsy. Then, with tax approval, we conducted a quick test, the same who were negative for pneumonic plague. However, it sent samples of a nasopharyngeal swab and Lima abdominal puncture to rule out or confirm the disease, "said epidemiologist.

The first case in Trujillo
Also, a seven year old girl who lives in the town Miracle in Trujillo, also has symptoms of bubonic plague. The epidemiologist said that when investigating the background of the child, able to establish who was at Chicama Valley, where he probably became infected with the plague.

The minor presents a bubo in the right armpit (axillary lymph node) and other symptoms of the bubonic plague. The child lives in a building where they keep vehicles from the Chicama Valley, Malabrigo.

Following the detection of the disease, and treated to cure.

Given this, Trujillo Network staff undertook a series of promotional activities ? preventive urban to prevent the spread of the disease.

The manager Luis Villanueva Villanueva was observed coordinating with the mayors of El Milagro, Huanchaco, Trujillo Alto and NGOs to develop prevention activities.

By: Hernan Rodriguez Flores

 

[alert]

Re: Peru - outbreak of pneumonic plague

And a 5-year-old who lives with the index case is hospitalized with pneumonic plague as well.

http://www.andina.com.pe/Espanol/Noticia.aspx?id=Rq63M8BeOe0=

Spanish to English translationShow romanization
Confirmed cases and contacts are treated
11:04 Minsa multidisciplinary team faced an outbreak of plague in La Libertad


Trujillo, July. 28 (ANDINA). After learning the outbreak of pneumonic plague in the province of Ascope, La Libertad, a brigade of the Ministry of Health (MoH) was dispatched to the affected area to assess the situation and provide technical assistance to solve the problem, said Achilles Vilchez Executive Director of the Department of Epidemiology (DGE).
He said the team consists of specialists from the National Institute of Health (NIH), General Directorate of Environmental Health (Digesa), Directorate of Health Promotion and Department of Health of the People to implement control measures adequate.

He said that the census is carried out and contact tracing (who were associated with infected people) to detect probable cases of pneumonic plague and to administer appropriate treatment psycoprophylactic.

In addition, he said, was disinfected housing districts and Chocop Chicama.
"So far it has been sanitized to 100 percent in Chicama (3,000 houses) and is in the disinfecting process Chocope" said. This is done with 3.900 kilos of insecticides.

He also remarked, strengthened epidemiological surveillance in the health facilities of La Libertad to rapidly detect cases that might arise.

Vilchez noted that "management is doing Digesa to complete the second stage of disinfection. For its part, the INS provides assistance for diagnosis and sample processing, infection control and biosafety.

On the other hand, the Directorate of Health Promotion working on prevention with local governments and other sectors, while the Directorate General of Health of the People addresses-in the affected area, the investigation of cases and the strengthening of attention.

He noted that as part of an immediate response, the CEO issued a national epidemiological alert recommending that provisions for control of transmission and the strengthening of biosecurity measures at the hospital where cases are handled and other health facilities jurisdiction.

Another measure taken was the creation of a macro-regional workshop to assist in the formulation of the Strategic Plan Monitoring and Pest Control in Northern Peru, with the participation of Health addresses Piura, Sullana, Lambayeque, Cajamarca and La Freedom.

In La Libertad, three confirmed cases and one probable. A woman aged 29, from the province Ascope is admitted to the Regional Hospital of Trujillo, a doctor of 35 years who treated this patient and is in the Intensive Care Unit of Hospital V?ctor Lazarte and a medical student 21 years, admitted to the Regional Hospital of Trujillo.

In the latter two cases there is a high probability that both have not complied with the standard bio-security standards by treating the first patient.

The case likely corresponds to less than five years, from the Mariposa town Lewis, who lives with the woman above 29 years. He has been admitted to the Hospital Chocope EsSalud.

The four cases required care in the Intensive Care Unit. Liver and respiratory complications were the second and fourth, respectively. The third case has evolved best to date.

Now being conducted epidemiological research in the field has been able to identify the primary case corresponds to the 29-year-old who comes from the town Mariposa Leiva, where the infection would have occurred.

The specialist explained that after an analysis determined that the infection in cases 2 and 3 was due to a nosocomial transmission from person to person via air.

While in the first and fourth case there is a possibility that the bacteria was transmitted by flea bites or scratching of the skin or by air from a pet or insect.

On the other hand, said that given that the town is surrounded by sugar cane crops and ditches where rodents proliferate, the regional government initiated meetings with the sugar companies to solicit support in disease control.

 

[alert]

Re: Peru - outbreak of pneumonic plague

The pneumonic plague outbreak is a bit too large to track accurately now, but here's what i see:

Cluster #1:

1. 29 year old woman - onset July 3rd, hospitalized on the 8th, on a ventilator
2. 35 year old doctor, treated case #1 on the 8th, hospitalized on the 10th, on a ventilator.
3. 21 year old medical student, treated case #1 on the 8th, hospitalized on the 13th, now on a ventilator, but showing signs of improvement.
4. 30 year old HCW, intubated case #1 on the 8th, hospitalized around the 24th, condition unknown, preliminary tests negative.
5. 5 year old child, lived with case #1, onset date unknown, hospitalized

Cluster #2

6 (?). 14 year old girl, onset around the 19th, contact with infected guinea pigs (cuyes), died 27th.
7. 2 year old girl, sibling of case #6, currently hospitalized.

I can't determine any possible identities of cases #8 and #9 (as per post #30), and it is complicated by the fact that the same case can be reported as bubonic or septicemic or pneumonic plague, because any or all presentations can occur in the same individual. There is a report in post #30 that one of the cases is the niece of case #1, but that could already be counted as case #5. I am also not sure on case #6, as it has also been reported as bubonic or septicemic.

There was a report earlier in this thread of a 6-8 year old child who lived near case #1, but it seems that case was only bubonic and not pneumonic.

 

[Vibrant62]

Re: Peru - outbreak of pneumonic plague

Thank you alert for keeping track of this evolving situation. What is your present risk analysis?

 

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Re: Peru - outbreak of pneumonic plague

In the area, the risk is very high. They seem to have no control on plague in animals, and there seems to be poor, if any, contact tracing. They likely have at least four generations of human-to-human plague transmission, and pneumonic plague cases are appearing that are not previously recognized contacts of known cases. Case #1 was hospitalized on the 8th, and there is still no information as to the status of her family, with the exception of today's report that one other family member has been hospitalized. The risk to HCW in the area is extremely high as any febrile patient could potentially be carrying the plague bacteria. The HCW in post #28 who they believe contracted pneumonic plague with an incubation period of about 16 days likely had exposure to another, still unidentified, pneumonic plague case. The most recent count seems to be fifteen probable or confirmed bubonc/septicemic plague cases and at least nine pneumonic ones.

As far as the risk for spread to other areas, assuming one is aware of the outbreak, the risk is not high. Plague is still very treatable with antibiotics, and actually antibiotics can apparently be used as a preventative as well. If I was travelling to Trujillo, I would definitely as my health care provider about prophylactic antibiotics. I am aware that there is some concern about overuse/resistance of antibiotics, but an antibiotic blanket is still an efficient way to snuff out a pneumonic plague outbreak.

In 1994, a very large pneumonic plague outbreak occurred in Surat, India, with about 5000 probable pneumonic plague cases, but still no international export. But, as SARS showed in 2003, it only takes one case in the wrong place to produce such an exportation.

 

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Re: Peru - outbreak of pneumonic plague

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/plague.aspx

Plague (Bubonic, Pneumonic, Septicemic)
Paul S. Mead, Ingrid B. Weber

Infectious Agent
Plague is caused by gram-negative bacterium, Yersinia pestis.

Mode of Transmission
?Zoonotic disease is usually transmitted to humans by the bites of infected rodent fleas.
?Less common exposures include handling infected animal tissues (hunters, wildlife personnel); inhalation of infectious droplets from cats with plague; and, rarely, contact with a pneumonic plague patient.
Occurrence
?1,000 to 2,000 cases occur globally each year.
?Rural areas in central and southern Africa, central Asia and the Indian subcontinent, the northeastern part of South America, and parts of the southwestern United States.
?Although rare, urban outbreaks of plague have been reported in Majunga, Madagascar.
Risk for Travelers
?All ages are at risk for infection; however, risk to travelers is largely restricted to rural endemic areas.
?Only one case associated with international travel has been reported in the United States in the past two decades.
Clinical Presentation
?Incubation period is typically 1?6 days.
?History is suggestive of exposure to rodents, rodent fleas, wild rabbits, sick or dead carnivores, or patients with pneumonic plague.
?Symptoms and signs of the three clinical presentations of plague illness include:
◦Bubonic (>80%)?rapid onset of fever; painful, swollen and tender lymph node, usually inguinal, axillary, or cervical
◦Pneumonic?high fever; overwhelming pneumonia; cough; bloody sputum; chills
◦Septicemic?prostration, hemorrhagic and/or thrombotic phenomena progressing to acral gangrene
Diagnosis
?Specimens: bubo aspirates; blood cultures; sputum culture if pneumonic
?Microscopic identification, culture confirmation; confirmatory and rapid assays available through public health laboratories
?Serologic tests: fourfold change in antibody titer to F1 antigen between acute- and convalescent-phase sera
Treatment
?Physicians should report all suspected plague cases to state or local health departments and/or consult with CDC to obtain information and access diagnostic services.
?Parenteral antibiotic therapy with streptomycin is the recommended first-line therapy; alternatively, gentamicin; or where treatment is limited to oral therapy, doxycycline.
?Additional information can be found on the Division of Vector-Borne Infectious Diseases website at www.cdc.gov/ncidod/dvbid/plague/index.htm.
Preventive Measures for Travelers
?No vaccine is currently available in the United States.
?Preventive measures are aimed at reducing contact with fleas and potentially infected rodents and other wildlife.
?Health-care workers should follow droplet precautions while working with suspected plague patients, especially if patient is coughing.
?Prophylactic antibiotic treatment is given only in the event of exposure to bites of wild rodent fleas during an outbreak, exposure to tissues of a plague-infected animal, or close exposure to another person or animal with suspected plague pneumonia.
References
1.Inglesby TV, Dennis DT, Henderson DA, et al. Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA. 2000;283:2281?90.
2.Dennis DT, Campbell GL. Plague and other Yersinia infections. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison?s principles of internal medicine. 17th ed. New York: McGraw-Hill Medical Publishing Division; 2008. p. 980?6.
3.Gage KL. Plague. In: Collier L, editor. Microbiology and microbial infections. 9th ed. New York: Arnold; 1998.
4.Perry RD, Fetherston JD. Yersinia pestis?etiologic agent of plague. Clin Microbiol Rev. 1997;10(1):35?66.
5.CDC. Human plague?India, 1994. MMWR Morb Mortal Wkly Rep. 1994;43(38):689?91.
6.Boisier P, Rasolomaharo M, Ranaivoson G, et al. Urban epidemic of bubonic plague in Majunga, Madagascar: epidemiological aspects. Trop Med Int Health. 1997;2(5):422?7.
7.Boulanger LL, Ettestad P, Fogarty JD, et al. Gentamicin and tetracyclines for the treatment of human plague: review of 75 cases in New Mexico, 1985?1999. Clin Infect Dis. 2004;38(5):663?9.
8.CDC. Prevention of plague: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1996;45(RR-14):1?15.
9.Kool JL. Risk of person-to-person transmission of pneumonic plague. Clin Infect Dis. 2005;40(8):1166?72.

 

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Re: Peru - outbreak of pneumonic plague

http://www.correoperu.com.pe/correo...cci_id=64&txtSecci_parent=0&txtNota_id=402537

Spanish to English translationShow romanization
REGIONAL

FINAL RESULTS IN 15 DAYS will be known
There are 16 probable cases of bubonic plague
July 29, 2010


GROWS. HOSPITALS RECEIVE INCREASINGLY MORE CASES OF POSSIBLE bubonic plague.


Datum
With regard to pneumonic plague, four cases were confirmed.
The first case, a 29-year-Chocope the second, a resident physician who treated the patient and the third is a fourth year student of Medicine, and the fourth case, an n




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LIBERTY | TRUJILLO. The bubonic plague in Freedom is not a disease that has recently come to light. So far this year six patients were confirmed infected, but still are being studied in another 16 cases which come mainly from the Chicama Valley.

This was announced by the regional manager of Health, Victor Peralta Chavez, who did not hesitate to state that in La Libertad "is living among the rats."

CONTENTS catch. Chavez Peralta based its sentence on the basis of catch rats in various areas, an activity known as an index of catch and pick up a small percentage must be at least 5%, a figure that was surpassed in several areas, as follows: in Puerto Salaverry, the catch rate of rats was 18%, in the Hermelinda, 26%, in Florencia de Mora, 11.4% and El Milagro, 20%.

The samples from rodents trapped were sent to Lima for the National Institute of Health (NIH) to conduct the necessary analysis that ultimately reveal whether these animals were evil.

INFECTED. Meanwhile, the situation in the province of Ascope remains alarming.

Here we found that 85% of wild rats, as well as urban areas, were infected, which puts them at increased risk to the population.

SPECIALISTS. Therefore, the Regional Health Bureau requested the Central Government on the issue more special. "The Regional Technical Committee Operational Pest Control consists of an environmental health specialist, an epidemiologist and a member of INS," said Victor Peralta, who announced in August that four doctors come from Madagascar.

He noted that these physicians are specialists in urban rats in the laboratory of plague in plague epidemiology and rapid diagnostic test.

 

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Re: Peru - outbreak of pneumonic plague

OK. Case #5 in my list above is now identified as a male child, so if the niece of case #1 really is infected, she is an additional case.

Curiously, this article does not mention case #4 in the third HCW, nor any of the other clusters.

http://www.larepublica.pe/sociedad/28/07/2010/minsa-enfrenta-brote-de-peste-en-la-libertad

Spanish to English translationShow romanization
Main
Minsa faces outbreak of plague in La Libertad
Wed, 28/07/2010 - 21:06

Average
Select Best ratingMaloBuenoMuy BuenoExcelenteEl
Best BuenoExcelenteEl MaloBuenoMuy.

.

Just called the outbreak of pneumonic plague in the province of Ascope, La Libertad, a brigade of specialists from the Ministry of Health was sent to the affected area to assess the situation and gave technical assistance to solve this problem that required a response immediately.

So informed, Achilles Vilchez, executive director of the Department of Epidemiology (DGE), detailing the technical team consists of specialists from the National Institute of Health (NIH), General Directorate of Environmental Health (Digesa) Promotion Health and Surgeon General of the People, to implement appropriate control measures.

The specialist said it is conducting the census and monitoring of contacts (who have been involved with infected people) to detect probable cases of pneumonic plague to identify and administer treatment for psycoprophylactic.

Disinfection of housing

Moreover, it has disinfecting housing district and Chocope Chicama. "So far it has been disinfected in 100% of dwellings in the district of Chicama (3000 households) and is in the process of disinfecting homes Chocope" he said. He added that this will have used approximately 3900 kilos of insecticides.

It has also been strengthened epidemiological surveillance in health facilities in the region to rapidly detect cases that might arise.

Gutarra V?lchez reported that "the management is doing Digesa to complete the second stage of disinfection. For its part, the INS currently provides assistance for diagnosis and sample processing, infection control and biosecurity. "

On the other hand, health promotion work in the field of prevention with local governments and other sectors, while addressing People's Health in the affected area, the subject of investigation of cases and the strengthening of the attention, "he said.

Epidemiological alert

The official said that as part of the immediate response to cases of pneumonic plague, the CEO issued a national epidemiological alert which has recommended provisions to control the transmission as the strengthening of biosecurity measures at the hospital where they treated cases and other health facilities in the jurisdiction to control the transmission.

Another measure taken was the creation of a Macro Regional workshop to assist in the formulation of the Strategic Plan Monitoring and Pest Control in Northern Peru, where he participated dires Piura, Sullana, Lambayeque, Lucio Castillo, and Cajamarca, La Libertad .

Cases

There are three confirmed cases and a probable fourth case. A woman aged 29, from the province Ascope who is hospitalized in the Regional Hospital of Trujillo. A doctor of 35 years who attended the patient and is referred to in the service of Victor Lazarte Hospital ICU and a medical student 21 years male, admitted to the Regional Hospital of Trujillo.

In the latter two cases there is a high probability that both have not complied with the standard bio-security standards by treating the first patient.

The probable case is a male child under 5 years old, from the Mariposa town Leiva, who lives with the wife of 29 years, above and has been hospitalized in the hospital Chocope EsSalud.

The four cases have needed attention in the intensive care unit, where the evolution with liver and respiratory complications in case the second and fourth respectively. The third case is who to date has performed better.

Currently research is being carried out epidemiological field where it was determined that the primary case corresponds to the 29-year-old who comes from the town Mariposa Leiva, where the infection would have occurred.

The specialist explained that after an analysis determined that for the form of contagion is assumed that there was nosocomial transmission from person to person via air in cases 2 and 3. While in the first and fourth case there is a possibility that the bacteria was transmitted by flea bites or scratching of the skin or by air from a pet or insect.

Meeting

On the other hand, reported taking into account that the town is surrounded by sugar cane crops and irrigation done rodents proliferate, the regional government has initiated meetings with the sugar companies to solicit support in disease control.

 

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Re: Peru - outbreak of pneumonic plague

This article suggests that case #6 above, the only announced fatality, is a septicemic case and not a pneumonic one.

http://www.rpp.com.pe/2010-07-29-es...en-la-libertad-es-critico-noticia_283681.html

State-infected pneumonic plague in La Libertad is critical
A woman (29) and a medical student is faced with grave prognosis. However, a doctor, also infected with this disease, improving.

ComentariosFoto: EFE (Reference) Share EmailNoticias Related EFE
AUDIO: Jack can be the cause of spreading pneumonic plague, pneumonic plague warn cases cause alarm in Ascope Three cases of pneumonic plague can occur in La Libertad

Critical is the health of a woman of 29 years and a medical student, infected by pneumonic plague, who remain confined in the regional hospital of Trujillo, told RPP health regional manager of Liberty, Víctor Peralta.


He added that the resident also infected with the disease, hospitalized in the hospital EsSalud, improving.


On the other hand, said the cause of death of a niño14 years were in septicemic plague. The child died in Sumanique sector, district Cartavio Ascope province, where they have detected cases of bubonic plague and pneumonic.

 

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Re: Peru - outbreak of pneumonic plague

It looks like the first two HCW are starting to recover, but the woman and the child are still critical. No word on the third HCW (discarded?), the sister of the fatality, or any other suspected pneumonic plague cases.

http://peru21.pe/noticia/615931/crecen-casos-peste-expansion-ratas

Spanish to English translationShow romanization
Grow cases of plague rats
In La Libertad studied 16 cases of people suspected of having contracted the disease. 85% of Ascope rodents are infected.
Comments (31) 3
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Take precautions to avoid contracting the plague. (USI)
The cases of fever transmitted by rats are still in the province increased Ascope Libertad. Following confirmation of four cases of pneumonic plague, and six patients infected with bubonic plague, it was learned that there are another 16 suspected cases of peasants who come from the Chicama Valley and have contracted the disease.

The regional manager of Health, Victor Peralta Chavez, said the situation is very serious. "It's practically living with rats," he said, noting that these animals, whose fleas transmit the disease, have proliferated in recent months in various jurisdictions of the city of Trujillo.

For example, in Puerto Salaverry, the rate of trapped rats was 18%, in the Hermelinda, 26%, in Florencia de Mora, 11.4%, and El Milagro, 20%, normal is that only catch May 1 %.

Peralta Chavez said Ascope if the situation is worse, a study by the National Institute of Health (NIH) revealed that 85% of rats infected with the plague bacteria yersinia, which transmitted the plague. In response, urged the municipalities to work in coordination in the work of prevention and disinfection.

He also said that with the help of soldiers of the Peruvian army, strengthen the work of disinfection of about three thousand houses in the districts of Chicama and Chocop.

GET HELP. Meanwhile, the physician announced that four medical specialists in urban rats in laboratory diagnosis of plague, and epidemiology of plague, will arrive on August 4 to the region to help with pest control.

Regarding the pneumonic plague, Peralta reported that there are now four confirmed cases: the first is a 29-year-Chocop who is unconscious, the second a 35-year resident doctor who treated the patient was infected and now recovers slowly.

The third, a student 21 years of fourth-year medical that currently only responds to stimuli, and the fourth, a five year old child who lived with the infected woman and, after contracting the disease does not respond. In addition, there is still studying the case of a child under 14 years who died in Cartavio and presented all the symptoms of the disease.

 

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Re: Peru - outbreak of pneumonic plague

I'm not sure who the two girls referred to by the red text are. The only previous refernece to (alive) infected female minors would be the niece of case #1, and the sister of the fatality.

It seems that the 21 year old student may have picked up some kind of hospital acquired additional infection too.

http://www.laindustria.pe/index.php?option=com_content&task=view&id=17373&Itemid=5

Spanish to English translationShow romanization
-------------------------------------------------- ------------------------------


Student health worsens Medicine
Friday, July 30, 2010
The health of medical student 21 years of age infected with pneumonic plague, was complicated and his life hangs by a thread. "It's in a coma and doctors at Regional Teaching Hospital makes every effort to cure his illness, but he fears for his life."

So said an epidemiologist and chairman of the Regional Committee Technical Operational Pest Control, Pedro Diaz Camacho, noting that the latest hope is lost and that faith in God is present.

Since 13 of the current remains hospitalized in the Regional hospital and had a slight improvement but the early days of detention, this week the situation worsened.

The physician said his condition is serious, because they suffered from pneumonic plague is complicated by a lung infection caused by a bacterium highly resistant to antibiotics of last generation.

The young student who was in the fourth year of Human Medicine at the Universidad Nacional de Trujillo (UNT) was infected by contact with the first woman infected with pneumonic plague in the region, who arrived from Chocope.
For other infected Camacho Diaz explained that the first resident physician infected by the woman is conscious and unresponsive to commands. Meanwhile, women from Chocope, which caused the infection site, their health is stable, while the two girls with probable transmission of plague experience marked improvement.

Intervention in El Milagro
On the other hand, in the presence of a case of bubonic plague in a girl of seven years, in the town El Milagro, a technical team of the Health Network Trujillo reinforced preventive measures in the area and also in the criminal where there is about 640 thousand inmates.

It is feared that one infected with the plague from entering the prison and spread to the inmate population. "This would have unpredictable consequences," said a technician from the brigade.

"We coordinate various preventive actions the executive manager of the Network, José Luis Villanueva Villanueva, to avoid a possible infection in inmates," said prison director Cabada Israel Vasquez.

Technicians from the brigade expressed concern about the large number of visitors arriving by Fiestas Patrias to the city of Trujillo.

It is expected an influx of 3000 visitors, including children and adults of both sexes. According to prison records, on normal days, 900 visitors entered and between Saturday and Sunday 2000 300.

By: Randy Cardozo