# 2582
In 1975, after completing my paramedic training in Florida, I was offered an ALS (Advance Life Support) ambulance job in Phoenix, Arizona.
On my first day there, I was given an orientation, which included information about threats I hadn't dealt with in my home state of Florida: Scorpion stings, Gila Monster bites, and bubonic plague.
Yes, believe it or not, bubonic plague still occurs, although rarely, in the United States. This map, from the CDC, shows areas of the world where plague is endemic, mostly in rodents.
The last major urban outbreak of plague in the United States occurred in 1924-25 in Los Angeles. Since then, only scattered cases have been reported, with about 10-15 cases each year.
Worldwide, on average, anywhere between 1,000 and 3,000 cases are reported each year.
Bubonic Plague (Yersinia Pestis) is a bacterial infection transmitted by fleas, carried by infected rats. The infection generally sets up in the lymphatic system, resulting in the tell-tale buboes, or swollen lymph glands in the the groin, armpits, and neck.
In rare cases, however, Pneumonic Plague may develop. Here the infected person develops a severe pneumonia, with coughing and hemoptysis (expectoration of blood), and may spread the disease from human-to-human.
Luckily modern antibiotics are pretty good at treating bubonic plague. Without treatment, however, mortality rates run 40%-60%. Untreated, pneumonic plague is almost always fatal.
In 1994, the last big plague year, 5000 suspected cases of bubonic plague and pneumonic plague occurred in Surat, India, with 100 deaths.
Here is the WHO (World Health Organization) summary of that event as of Oct 21st, 1994.
During August 26-October 5, 1994, a total of 5150 suspected pneumonic or bubonic plague cases and 53 deaths were reported from eight states of India, primarily in the south-central and southwestern regions.
Of the 5150 cases, 2793 (54.2%) were reported from Maharashtra state (including Bombay), 1391 (27.0%) from Gujarat state (including the city of Surat), 749 (14.5%) from Delhi, and 169 (3.3%) from the states of Andhar Pradesh, Haryana, Madhya Pradesh, Rajasthan, Uttar Pradesh, and West Bengal (including Calcutta).
As of October 5, a total of 167 (3.2%) of these cases were confirmed by serology. Confirmed cases were reported from Delhi (44 cases); Gujarat (35 cases); Maharashtra (79 cases); and Haryana, Madhya Pradesh, and Uttar Pradesh (9 cases). Of the 53 deaths (crude case-fatality ratio=1.0%), 49 (92.5%) were reported from Surat.
In Uganda this year at least 68 people have died from bubonic plague. Accurate counts of the number of cases, and fatalities, are hard to get - so that tally may be low.
Critics worry, that without a coordinated governmental response, that these numbers may rise.
A reminder that even in this 21st century - while we are on the lookout for new emerging diseases - that old deadly foes like Yersinia Pestis still prey on victims, particularly in developing countries.
This from The East African (hat tip Shiloh on Flutrackers).
Bubonic plague outbreak intensifies in Uganda
Posted Saturday, December 20 2008 at 10:50
The death toll from the bubonic plague in Uganda continues to rise as the government struggles to come up with a clear response even though early signs of the disease were detected at the beginning this year.
At least 68 people have died since February when the plague was first reported, and now health experts warn that it could spread rapidly in the absence of an adequate response from health workers and local communities. About 32,000 people are at risk of catching the disease if they do not take precautions.
The outbreak was initially restricted to one district but has now spread to two others, where 73 cases have been reported.
Arua District Health Officer Dr Patrick Anguzu said the area has been registering a few cases every year, but this year the numbers started rising, reaching alarming levels in August.
All the deaths are as a result of delays in seeking medical treatment as victims associate the disease with witchcraft and opt for traditional medicine, health officials claim.
Critics, however, say the government’s response, whose main thrust is behaviour change, is uncoordinated. It lacks the means to adequately educate the public, and funds have also not been allocated for these initiatives.
Dr William Mbabazi of the World Health Organisation said the rising rates of the epidemic are due to poor hygiene and sanitation because people do not clean their houses, allowing germ infected wild rats to find a conducive environment in dirty homes, thus spreading the deadly fleas.
Domestic rats then picking the fleas and due to their contact with humans, they pass on the disease.
Bubonic plague is not usually spread from one person to another, but rather from small rodents such as rats and mice to human beings.
Fleas that live on these animals act as ‘vectors’ and carry the infection from the rodents to humans once they are exposed to the bacteria from flea bites or from direct contact with an infected animal.
The plague, which mainly affects women and children, has spread into the districts of Arua and Nebbi, where residents still live in mud huts.
WHO says the casualties in these districts are victims of a cultural belief that women and children must sleep on the floor while the men sleep on beds.
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