Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 24, Number 1—January 2018
Letter

Investigation of Pneumonic Plague, Madagascar

On This Page
Article Metrics
6
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: In an investigation of a pneumonic plague outbreak in Madagascar, Ramasindrazana et al. reported isolation of Yersinia pestis from 2 patients and seroconversion in 2 additional patients; these data indicated 4 (28.7%) of 14 diagnosed cases among described cases (1). The risk for overestimation of pneumonic plague contagion was illustrated by an outbreak in the Democratic Republic of the Congo that included cases of leptospirosis (2). In fact, thorough investigations in Uganda indicated that 2 index patients transmitted Y. pestis to only 1 caregiver each and none to 23 additional untreated close contacts (3). Another investigation in China showed that 3 index patients exposed 214 contacts during 3–13 days; all contacts were quarantined, and no secondary cases were reported (4). Transmission of Y. pestis by respiratory droplets requires face-to-face exposure with a coughing patient, as can occur during funerals by close contact with coughing persons who may have been exposed to the pathogen while visiting or attending the patient before he or she died. Therefore, the threat for plague epidemics fueled by pneumonic plague can be reduced by measures such as isolating patients and wearing a mask when exposure is likely (5).

We propose the hypothesis that only the transmission of Y. pestis by ectoparasites, such as lice and fleas, by close contact with infected humans can sustain outbreaks and epidemics. In plague-endemic regions, to support the appropriate management of patients and provide a rapid and accurate microbiological diagnosis, we recommend point-of-care laboratories, some of which are now operating in a few remote regions of Africa. In addition to direct diagnosis of disease in humans, direct detection of Y. pestis at the point-of-care in potential sources and vectors would facilitate understanding of how plague epidemics sustain.

Top

Michel DrancourtComments to Author  and Didier Raoult
Author affiliations: MEPHI, UMR, IRD, Aix-Marseille Université, Marseille, France

Top

References

  1. Ramasindrazana  B, Andrianaivoarimanana  V, Rakotondramanga  JM, Birdsell  DN, Ratsitorahina  M, Rajerison  M. Pneumonic plague transmission, Moramanga, Madagascar, 2015. Emerg Infect Dis. 2017;23:5214. DOIPubMedGoogle Scholar
  2. Bertherat  E, Mueller  MJ, Shako  JC, Picardeau  M. Discovery of a leptospirosis cluster amidst a pneumonic plague outbreak in a miners’ camp in the Democratic Republic of the Congo. Int J Environ Res Public Health. 2014;11:182433. DOIPubMedGoogle Scholar
  3. Begier  EM, Asiki  G, Anywaine  Z, Yockey  B, Schriefer  ME, Aleti  P, et al. Pneumonic plague cluster, Uganda, 2004. Emerg Infect Dis. 2006;12:4607. DOIPubMedGoogle Scholar
  4. Li  YF, Li  DB, Shao  HS, Li  HJ, Han  YD. Plague in China 2014-All sporadic case report of pneumonic plague. BMC Infect Dis. 2016;16:85. DOIPubMedGoogle Scholar
  5. Ratsitorahina  M, Chanteau  S, Rahalison  L, Ratsifasoamanana  L, Boisier  P. Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar. Lancet. 2000;355:1113. DOIPubMedGoogle Scholar

Top

Cite This Article

DOI: 10.3201/eid2401.170760

Related Links

Top

Table of Contents – Volume 24, Number 1—January 2018

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Michel Drancourt, MEPHI, UMR, Aix-Marsille Université, IRD, IHU Mediterranee Infection, 19-21 Blvd, Jean Moulin, 13005 Marseille, France

Send To

10000 character(s) remaining.

Top

Page created: December 19, 2017
Page updated: December 19, 2017
Page reviewed: December 19, 2017
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external