Plague Presentation Final
Plague Presentation Final
Plague Presentation Final
DR BALVINDER SINGH GILL Senior Assistant Director Disease Control Division Ministry of Health Malaysia
MBBS MPH
Overview
Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control
The Organism
Yersinia pestis
Family Enterobacteriaceae
Gram negative coccobacillus, pleomorphic Aerobic, facultative anaerobic, and facultative intracellular
Yersinia pestis
Destroyed by
Sunlight
Desiccation
Survival
1
hour in air Briefly in soil 1 week in soft tissue Years when frozen
History
deaths.
English writer Daniel Defoe in A Journal of the Plague Year (1722), " People ran mad in the streets, raving and distracted, oftentimes laying violent hands on themselves, throwing themselves out at their windows, shooting themselves, mothers [murdering] their own children in their lunacy."
Ring Around The Rosy A Pocket Full Of Posies Ashes, Ashes All Fall Down
Discovery
negative Bacillus
1896
Developed
antiserum
Plague as a Disease
Notifiable disease under the CDC Act 1988 (342) Class 1 quarantinable disease (WHO)
Transmission
Transmission
Flea Vectors
Can live off host for months Many species can serve as vector Xenopsylla cheopis
Epidemics flea
Oropsylla montana
vector in U.S.
Flea Transmission
27C (80F)
Blood
27C
Blood
clot in gut of flea dissolves Organism passes through Transmission less likely
Epidemiology
Epidemiology in Nature
Sylvatic Plague
Enzootic
Steady level in rodent populations Low death rates
Epizootic
Large die-offs fleas change hosts Amplifying hosts
Urban Plague
Infected fleas or rodents move to urban area Commensal (domestic) rodents infected
cats or humans
Disease in Humans
Human Disease
Continuum of illness
Bubonic
Septicemic Pneumonic
Primary Secondary
Bubonic Plague
malaise, chills, headache Bubo: swollen, painful lymph node vomiting, abdominal pain, nausea, petechiae
Mortality (untreated):
50-60%
Septicemic Plague
to bubonic, plus Prostration, circulatory collapse, septic shock, organ failure, hemorrhage, DIC Necrosis of extremities
Pneumonic Plague
Incubation: 1-6 days Primary - Y. pestis inhaled Secondary - septicemic form spreads Clinical signs
Fever,
Person-to-person possible
Diagnosis
Isolation of organism Fourfold rise in antibody titer Single titer of >1:128 Differential diagnoses
Tularemia Hantavirus
Streptococcus
Staphylococcus
aureus
Treatment
Supportive Antibiotics
Aminoglycosides
Streptomycin, kanamycin
Doxycycline,
Animals
Rodents
Most
Bears, bobcats, badgers, fox, ringtails, skunks, Mountain lion, deer, African elephant, African buffalo, camel, coyote, more
of
Human risk
cases - 5 fatal
Cats develop severe illness and die Can transfer disease to humans
Owners,
as cats
Sentinels
Flea control
Dogs
and cats
Spring to fall
Premise
Undertaken
Insect repellents for skin & clothes Insecticide use in epizootic areas
outbreak/flea bites Handled infected animal Close contact with plague case
Vaccine
Live
/ State health department District / State veterinarian Animals may serve as sentinels
transmission, prevention
Up
Additional Information
www.bt.cdc.gov/agent/plague/index.asp
THANK YOU