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A Death Sentence Long Ago, Disease Can Now Be Beaten -- WSJ

17 Nov 2017 7:32 am

Quicker diagnosis, treatment give patients better outlook
By Betsy McKay 

This article is being republished as part of our daily reproduction of WSJ.com articles that also appeared in the U.S. print edition of The Wall Street Journal (November 17, 2017).

Madagascar has had its worst outbreak of plague in at least a half-century this year, with more than 2,000 cases reported and more than 170 deaths. Here are some facts about this highly infectious disease.

What is plague?

Plague is an infectious disease caused by the bacterium Yersinia pestis, which is found in rodents and their fleas. There are two forms of the disease. Most common is bubonic plague, so-called because it produces swollen lymph nodes, or "buboes." Human-to-human transmission of this form is rare.

But if bubonic plague becomes advanced it can spread to the lungs, leading to the less common but much deadlier pneumonic plague. Pneumonic plague is highly contagious and almost always fatal unless treated quickly.

The disease is transmitted to people when they are bitten by infected fleas, handle an infected animal, or, in the case of pneumonic plague, inhale infected respiratory droplets from other people who are sick.

Both forms of plague have been reported in Madagascar since its outbreak began in August. But more than three-quarters of the cases have been pneumonic plague, which has spread for the first time in the country's densely populated cities.

What are the symptoms of plague?

People who are infected experience sudden onset of fever, chills, head and body aches, weakness, vomiting and nausea. The disease has an incubation period ranging from 24 hours, for pneumonic plague in particular, to seven days.

How deadly has plague been over the ages?

Plague has played an outsize role in history and the development of civilization. Some scholars believe it led to the downfall of the Roman Empire, when Roman soldiers carried the pestilence home from battle in 165 A.D. Famously called the "Black Death, it is blamed for wiping out as much as 60% of Europe's population in the mid-14th century, tearing through port cities and claiming so many people at times that historical accounts recall few left to bury the dead. No one at the time could understand what caused the disease, which could strike and kill within hours; it was named for the black boils it caused on the bodies of the infected that oozed blood and pus. Scientists now say the disease was carried to Europe from Asia on ships infested with infected rats. Another "modern plague" began in China in the 1860s and spread to port cities around the world, causing 10 million deaths.

Can plague be treated?

Today, plague can be treated and cured with antibiotics. The key is diagnosing it quickly. If antibiotics aren't started within a day or two of onset of symptoms, or 18 to 24 hours for pneumonic plague, the chance of survival even with antibiotics dims, experts say.

Infection is diagnosed in a lab, which used to take time, threatening survival, but a rapid dipstick test developed a few years ago by the Centers for Disease Control and Prevention now can detect antibodies or parts of the bacteria within 15 minutes.

Where do cases or outbreaks of plague usually occur?

Most cases have occurred in Africa since the 1990s, but parts of Asia, South America, and the western U.S. also have cases. The three most endemic countries are the Democratic Republic of Congo, Madagascar -- where cases are reported every year -- and Peru, according to the World Health Organization. Between 2010 and 2015, there were 3,248 cases reported world-wide, including 584 deaths. Since August, the outbreak in Madagascar has caused 2,119 cases, including 171 deaths. More than three-quarters of the cases have been pneumonic plague.

What should travelers do?

The Centers for Disease Control has issued a travel notice, recommending that travelers to Madagascar use insect repellent to protect against fleas and avoid contact with seriously ill people, especially those who are coughing up blood. Anyone who experiences symptoms should seek medical care, and may require antibiotics. Notices posted at airports in Africa advise travelers of the outbreak in Madagascar, with guidance for avoiding infection and monitoring for symptoms.

Write to Betsy McKay at betsy.mckay@wsj.com

(END) Dow Jones Newswires

November 17, 2017 02:32 ET (07:32 GMT)

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