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28 - Plague

from Section 5 - Bacterial infections

Published online by Cambridge University Press:  05 March 2013

David Mabey
London School of Hygiene and Tropical Medicine
Geoffrey Gill
University of Liverpool
Eldryd Parry
Tropical Health Education Trust
Martin W. Weber
World Health Organization, Jakarta
Christopher J. M. Whitty
London School of Hygiene and Tropical Medicine
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The problem in Africa

Plague remains endemic in several parts of Africa (Fig. 28.1). Its incidence in Africa has probably declined over the last century, but it is unlikely ever to be eliminated, and there may even be an upsurge at present (Neerinckx et al., 2010). Africa currently has 95 per cent of the world's human plague, with an estimated 1800 cases per year (WHO, 2010), although data should be interpreted with caution. Good epidemiological studies consistently show that cases of plague are missed and that, conversely, during epidemics it is over-diagnosed. Plague has a very uneven distribution throughout the continent, and over time, with DRC, Madagascar, Tanzania, Uganda, Malawi, Mozambique and Algeria all reporting cases.

The importance of plague does not lie in the fact it is common (it is not), but that it is essential not to miss it when it occurs. This is for the sake of the individual, for health care workers caring for the patient, and for public health reasons. Plague, with its overtones of the Black Death decimating populations in major pandemics, has induced mass panic when potential outbreaks are announced. This panic, which has serious implications for public health, is partially justified. Untreated, even the mildest (bubonic) form has a mortality of over 50 per cent, and untreated pneumonic plague is almost 100 per cent fatal. The risk of infection is, however, very low.

Publisher: Cambridge University Press
Print publication year: 2013

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Begier, EM, Asiki, G, Anywaine, Z et al. (2006). Pneumonic plague cluster, Uganda, 2004. Emerg Infect Dis; 12: 460–7.CrossRefGoogle Scholar
Chanteau, S, Rahalison, L, Ralafiarisoa, L, Foulon, J, Ratsitorahina, M et al. (2003). Development and testing of a rapid diagnostic test for bubonic and pneumonic plague. Lancet; 361: 211–16.CrossRefGoogle ScholarPubMed
Galimand, M, Guiyoule, A, Gerbaud, G et al. (1997). Multidrug resistance in Yersinia pestis mediated by a transferable plasmid. N Engl J Med; 337: 677–80.CrossRefGoogle ScholarPubMed
Jefferson, T, Demicheli, V, Pratt, M (2000). Vaccines for preventing plague. Cochrane Database Syst Rev; 2, CD000976.Google Scholar
Kilonzo, BS (1999). Plague epidemiology and control in eastern and southern Africa during the period 1978–1997. Cent Afr J Med; 45: 70–6.Google Scholar
Neerinckx, S, Bertherat, E, Leirs, H (2010). Human plague occurrences in Africa: an overview from 1877 to 2008. Trans R Soc Trop Med Hyg; 104: 97–103.CrossRefGoogle ScholarPubMed
Rahalison, L, Vololonirina, E, Ratsitorahina, M, Chanteau, S (2000). Diagnosis of bubonic plague by PCR in Madagascar under field conditions. J Clin Microbiol; 38: 260–3.Google ScholarPubMed
Ratsitorahina, M, Chanteau, S, Rahalison, L, Ratsifasoamanana, L, Boisier, P (2000). Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar. Lancet; 355: 111–13.CrossRefGoogle ScholarPubMed
Rajerison, M, Dartevelle, S, Ralafiarisoa, LA et al. (2009). Development and evaluation of two simple, rapid immunochromatographic tests for the detection of Yersinia pestis antibodies in humans and reservoirs. PLoS Negl Trop Dis.; 3: e421.CrossRefGoogle ScholarPubMed
WHO Expert Panel on Plague (1999). Plague Manual: Epidemiology, Distribution. Geneva: WHO.Google Scholar
World Health Organization (2010). Human plague review of regional morbidity and mortality, 2004–2009. Wkly Epidemiol Rec; 85: 40–5.Google Scholar

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