Human Plague India - /Vol 43 No 38 689 Human Plague—...

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Unformatted text preview: September 30, 1994/Vol. 43/ No. 38 689 Human Plague— India, 1994 691 Update: influenza Activity — Worldwide, 1994 693 Rift Valley Fever —— Egypt, 1993 701 Health Status of Displaced Persons Following Civil War —- Printed and distributed by lhe Massachusetts Medical Society, . publishers of The New England Journal of Medicine $3.23 geéiember 1993‘ W International Notes m If. ! Human Plague — India, 1994;. Since August 26, 1994, outbreaks of bubonic and pneumonic plague have been reported in south-central, southwestern, and northern India. Because most of the re- ports are unconfirmed, the extent of the outbreaks is unclear. On August 26, following reports of a rat die—off, the first human cases were reported in Bir district, Maharashtra state, approximately 300 km east of Bombay. On September 22, cases of pneumdnic plague were reported from the city of Surat, Gujarat state, approximately'zeo km north of Bombay. As of September 26, several hundred pneumonic plague cases and numerous deaths have been reported from Surat. On September 26 ”and 27 cases were reported from Bombay and Calcutta, and on September 27, cases of pneumonic plague were reported from Delhi Reported by: Div of Quarantine, National Center for Prevention Svcs; Bacterial Zoonoses BI; Div of Vector-Borne infectious Diseases, National Center for infectious Diseases, CDC. Editorial Note: Plague Is caused by infection with Yersinia pestis, a bacterium carried by rodents and transmitted by fleas commonly found in parts of Asia, Africa, and North and South America (1,2 l. Sporadic human cases associated with epizootics in wild rodents occur annually in the western United States (3); however, no pneumonic plague cases resulting from person—to-person spread have been reported in the United States since 1924(1). In India, large plague outbreaks occurred during the first half of the 20th century; however, the last laboratory-confirmed human cases were reported in 1966 (4,5). in 1992 {the most recent year for which complete data are avail~ able}, human plague cases were reported from nine Countries (Brazil, China, Madagascar, Mongolia, Myanmar, Peru, the United States, Vietnam, and Zaire) (5 1. Most human plague is the bubonic form, which results from the bites of infected fleas; however, plague also can be transmitted to humans by handling infected ani- mals or by inhaling infectious aerosols from persons with pneumonic plague. The incubation period for plague ranges from 1 to '7 days, and manifestations of the illness include rapid onset of fever, chills, headache, malaise, myalgias, and prostration, often with nausea. in particuiar, bubonic plague is characterized by painful swelling of lymph nodes (buboes) in the inguinal, axiilary, or cervical regions; pneumonic plague is characterized by cough and dyspnea; and septicemic plague may result in fulminant 690 MMWR September 30, 1994 . Human Plague — Continued gram—negative shock without localized signs of infection (2,6). Multiple clinical pres- - entations can occur in one patient. _ Travelers to Indiafind other plague-endemic countries are at low risk for infection with Y pestis. To redace risk, travelers should avoid areas with recently reported hu- man plague cases. Persons who must travel'to't'hese' areas should 1) avoid rat-infested areas—especially areas where dead rats have. .beertobserved; 2) apply insect repel— lents to ankles and legs, and apply repellents and insecticides to clothingand-outer ated. For all suspected cases, appropriate diagnostic specimens include blood for culture and serum antibodies; for suspected pneumonic cases, sputum samples; and for suspected bubonic cases, sepirates from affected lymph nodes. Streptomycin is the preferred drug for treatment of plague, but gentamicin, tetracyclines, and chloramphenicol also are effective (2,7). Prompt treatment can redUCe overall plagfle mortality from 60%-100% to 10%—15%. " Prophylactic antibiotic treatment should be administered to all persons whohave had face-to-face contact or who have occupied a closed space with a person with pneumonic plague. Household contacts of bubonic plague patients also should re- ceive prophylactic antibiotic treatment. Suspected human plague cases in international travelers should be reported through state and local health departments to CDC's Division of Quarantine, National Center for Prevention Services, telephone (404) 639-8107 or (404) 639-2888 (nights, Sundays, and holidays). Specimens for confirmatory testing can be submitted through state health departments to CDC. inquiries about the availability of strepto- mycin should be directed to Pfizer, lnc.,* telephone (800) 254-4445. Additional informa- tion about plague is available to physicians and the general public from the CDC Voice Information System, telephone (404) 332-4555, and to physicians and labo- ratory personnel froijDC’s Division of Vector-Borne infectious Diseases, National Center for infectious Diseases, telephone (303) 221-6453. References 1. Barnes AM. Surveillance and control of bubonic plague in the United States. in: Edwards MA, McDonnel U, eds. Animal disease in relation to conservation. New York: Academy Press, 1982:237—70. Vol. 43 I No. 38 MMWR 691 Human Plague — Continued 2. Poland JD. Plague. In: Hoeprich PD, Jordan MC. eds. Infectious diseases. Grand Rapids, Michi- gan: JB Lippincott, 1989212964306. 3. CDC. Human plague—United States, 1993—4994. MMWR 43:242—6. 4. World Health Organization. Epidemiology and incidence of plague in the world, 1958-79. Buii WHO 1982;60:165—9. 5. World Health Organization. Human plague in 1992. Wkly Epidemioi Rec 1994;2: 8—10. 6. Hull HF, Montes JM, Mann JM. Septicemic plague in New Mexico. J Infect Dis 1987;155:113—8. . 7. Medical Economics Data Production Company. Physicians' desk reference. 48th ed. Montvale. 5 New Jersey: Medical Economics Data Production Company. 1994:1610—1. Current "Ii-ends Update: Influenza Activity —-~ Worldwide, 1994 From October 1993 through August 1994, influenza activity occurred at moderate to moderateiy severe levels worldwide. Influenza AiH3N2) viruses predominated during the 1993~94 season, but influenza B viruses also were isolated from persons with spo- radic illness and from outbreak-associated cases. Cocirculation of influenza AiH3N2l and influenza B viruses is continuing throughout the world; however, the isolation of influenza AlH1N1) viruses has been extremeiy rare (1). This report summarizes influ- enza activity worldwide from March through August 1994. Africa. In Africa, influenza activity occurred from May through July. Zambia and South Africa reported influenza B as the predominant virus isolated. South Africa identified sporadic cases of influenza AlH3N2i. ' ' Asia. Cocirculation of influenza AIH3N2) and influenza B viruses has been reported in Asia. During March and April, both influenza A and B were reported during out- breaks in Taiwan. Thailand reported influenza B in March and April and infiuenza A and B from May through July, with influenza B predominating. Hong Kong reported ,, only influenza B through June; during Juiy, moderate levels of influenza AIH3N2) ac- ' tivity occurred. Since March, only influenza B viruses have been isolated in China in association with outbreaks or sporadic cases of influenza-like illness (ILII. Europe. In March, ali reporting countries except Russia reported influenza activity either at or approaching normal ievels. In Russia, influenza activity continued through March with the isolation of both influenza A and B viruses. Isolation of influenza AlH3N2) viruses from Sporadic cases was reported in the United Kingdom in June. Since June, the Netherlands and the United Kingdom each have reported one influ- enza B isolate. 7 North America. in the United States, type AfHSNZ). viruses from outbreaks contin— ued to be reported in March along with isolates from sporadic cases that continued into April. Sporadic cases of influenza B occurred in March, April, and May. Influenza A viruses were isolated from six sporadic cases in July and August. Of these, three have been indentified as influenza AlH3N2). Canada reported the detection of both infiuenza A and B through the beginning of May. Central and South America. Based on serologic studies, an increase in acute respi- ratory illness (ARI) in Panama in June was attributed to influenza AiH3N2i. Sporadic isolation of influenza A and B viruses was reported in Argentina, Brazil, and Chile from April through "June. In April, an outbreak of ARI associated with influenza AIH3N2) mural?“ _, ...
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