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Plague alert information sheet on plague.

Early diagnosis, proper treatment and quarantine of suspected cases are of paramount importance. It is important to keep the public informed through information and educational media messages. Panic is not a substitute for alertness.

The outbreak of plague which occurred in the city of Surat in Western Indiah as now spread to 6 other Indian states. Nearly 60 people have been reported dead from this killer disease while hundreds of others have been affected. Besides loss of life, this epidemic has been a tremendous setback to the Indian economy resulting in the loss of millions of dollars. Several countries of the world, including Pakistan have banned the entry of all foreigners coming from India in an attempt to curtail the possible spread of disease.

The health authorities in Pakistan have adopted strong precautionary measures to prevent the possibility of an outbreak. These include the implementation of international regulations concerning plague. Strict vigilance is being maintained at the borders and other ports of entry from air and sea. The Department of Health, Government of Sindh is very actively monitoring the situation. Special arrangements have been made at the Civil Hospital, Jinnah Postgraduate Medical Centre and the Abbassi Shaheed Hospital to deal with emergency situations.

If we are cautious and vigilant, then there may not be any major cause of worry. Even then we need to be fully prepared. This information sheet has been prepared by UNICEF, WHO and Pakistan Society for Microbiology to advise necessary precautionary measures.

Identification: Plague is a disease involving rodents and their fleas which transfer the infection to various animals including man. Since it spreads rapidly, it has the potential of becoming an epidemic affecting large numbers of human populations.

Signs and Symptoms: The initial response is commonly a lymphadenitis in the nodes receiving drainage from the site of the flea bite. This is bubonic plague and occurs more often in lymph nodes in the inguinal area and less commonly in those in the axillary or cervical areas. The involved nodes are swollen, inflamed and tender and may sudpurate. Fever is usually present. All forms, including instances in. which lymphadenopathy is not apparent, may progress to septicemic plague with dissemination by the blood to diverse parts of the body including the meninges. Secondary involvement of the lungs results in pneumonia. Mediastinitis or pleural effusion can also develop. Pneumonic plague is special significance since aerosolized droplets of sputum may serve as the source of primary pneumonic or of pharyngeal plague. Further person-to-person transfer can result in localized out breaks or in devastating epidemics. The signs and symptoms are similar to other infections such as tularemia, meningococcemia, gram negative sepsis, and rickettsial infection. History of exposure to rodents and fleas requires the inclusion of plague bacillus in the differential diagnosis.

Specific Treatment: Untreated bubonic plague has a case fatality rate of nearly 50% while untreated primary septicemic and pneumonic plague are invariably fatal. Modern therapy has markedly reduces fatality from bubonic plague. If recognized and treated early pneumonic and septicemic plague. Antibiotics such as streptomycin, tetracycline and chloramphenicol are highly effective if used within 8-24 hours after onset of pneumonic plague.


Causative organism and Diagnosis: Plague is caused by a bacillus called Yersinia pestis. Diagnosis is confirmed by culture and identification of the causative organism from fluid aspirated from buboes, blood, CSF, sputum or throat swab.

Incubation Period: is generally from 2 to 6 days. The period of communicability is longer as fleas remain infective for months under suitable conditions of temperature and humidity and pneumonic plague is highly communicable under conditions such as overcrowding and lack of proper hygiene which facilitate transmission.

Precautionary Measures

The basic objective of control against plague is to avoid the likelihood of humans being bitten by the infected fleas or being exposed to pneumonic patients. 1. Prevent the access of rats and other rodents to food, grains, garbage by taking adequate and appropriate measures of storage and disposal. 2. Use of insecticides or insect repellents to avoid flea bites especially for agriculture workers since rodents in the field can be infected. 3. If rats and other rodents are seen to be dying or sick, then the be handled but should immediately be reported to the health authorities. 4. Dogs, cats and other domestic animals should be treated periodically with insecticides. 5. Postpone travel plan to the infected area until it is declared plague free area (at least 7 days after last reported case). 6. A person who travel from infected area or has history of close contact with a pneumonic case during the last 6 days should be kept under close observation by health authorities and provided with appropriate antibiotic for 7 days. 7. Vaccine is available internationally but it is not as effective as above precautionary measures.

Control of Contacts, Patients and Immediate Environment

1. Proper sanitation and control of rat population are important for the long term prevention of epidemic. Civic agencies and NGOs can avail of those opportunity to emphasize proper hygiene, sanitation and garbage disposal. 2. Insecticides must be used to control the vector and its transfer between animals and man and animal. 3. Suspect and confirmed cases must be reported to the health authorities. 4. Those who have been in epidemic areas or in contact with patients of plague should be placed in quarantine under surveillance for 7 days and provided chemoprophylaxis. 5. The health care workers should avoid exposure. The use of masks to cover mouth and nose, and goggles to protect eyes is essential. Every member of the health learn should be regarded as a contact and must receive daily dose of antibiotics for the whole period of activity and additional 5 days after leaving the area.
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Publication:Economic Review
Date:Sep 1, 1994
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