History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control Center for Food Security and Public Health Iowa State University 2011 The Organism Yersinia pestis ID: 814860
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Slide1
Plague
Slide2OverviewOrganismHistoryEpidemiologyTransmissionDisease in HumansDisease in AnimalsPrevention and Control Center for Food Security and Public Health, Iowa State University, 2011
Slide3The Organism
Slide4Yersinia pestisFamily EnterobacteriaceaeGram negativePleomorphic coccobacillusAerobic, facultatively anaerobic, facultatively intracellular
One serotypeT
hree
biovars
Multiple plasmids
and virulence
factors
Center for Food Security and Public Health, Iowa State University, 2011
Slide5Yersinia pestisDestroyed bySunlightDesiccationSurvival1 hour in airBriefly in soil1 week in soft tissueYears when frozen
Center for Food Security and Public Health, Iowa State University, 2011
Slide6History
Slide7History540-590 AD: Justinian’s pandemic10,000 deaths per dayFall of the Roman Empire1346~1400: Black Death pandemicQuarantine1/3 of European population diedFall of the feudal system1665: Great Plague of London
Center for Food Security and Public Health, Iowa State University, 2011
Slide8“Ring Around The RosyA Pocket Full Of PosiesAshes, AshesAll Fall Down”Center for Food Security and Public Health, Iowa State University, 2011
Slide9Discovery1894: Hong Kong Alexandre YersinIdentified Gram negative bacillus1896Developed antiserum
Center for Food Security and Public Health, Iowa State University, 2011
Slide10History: U.S.1899: HawaiiFrom ship rats to sylvatic rodentsSpread throughout the western U.S.1924: Los AngelesLast person-to-person case32 pneumonic cases; 31 deathsCurrently established in southwest
Center for Food Security and Public Health, Iowa State University, 2011
Slide11Plague as a DiseaseCDC Division of QuarantineReportable disease in the U.S.All U.S. cases reported to the WHO
Center for Food Security and Public Health, Iowa State University, 2011
Slide12Transmission
Slide13TransmissionFlea biteDirect animal contact Tissues, body fluids, scratches, bitesEnters through break in skinAerosolHuman casesApril through November
Increased activity of fleas and hosts
Center for Food Security and Public Health, Iowa State University, 2011
Slide14Flea VectorsCan live off host for monthsMany species can serve as vectorOropsylla montana Rock squirrels, California ground squirrels, prairie dogsMost important flea vector in U.S.Xenopsylla cheopisEpidemics in Asia, Africa, South America
Center for Food Security and Public Health, Iowa State University, 2011
Slide15Flea Transmission27°C (80°F)Blood clots in gut of fleaY. pestis trappedClotted blood regurgitatedEnters wound from flea bite
27°C
Blood clot in gut of flea dissolves
Y. pes
tis
passes
through
Center for Food Security and Public Health, Iowa State University, 2011
Slide16Epidemiology
Slide17Distribution: U.S.Southwest (87%)Northern New MexicoSouthern ColoradoNorthern ArizonaCalifornia1925-1964~2 cases/yr
Since 1970~13 cases/yr
Center for Food Security and Public Health, Iowa State University, 2011
Slide18Distribution: U.S.Center for Food Security and Public Health, Iowa State University, 2011
Reported Cases
Year
MMWR
45
40
35
30
25
20
15
10
5
0
1972 1977 1982 1987 1992 1997 2002
Slide19Center for Food Security and Public Health, Iowa State University, 2011
Slide20Disease CyclesSylvatic (wild)Urban (domestic)ReservoirsRock squirrelsGround squirrelsPrairie dogsMice, volesOthers
Center for Food Security and Public Health, Iowa State University, 2011
Dr. Lloyd Glenn Ingles
© California Academy of Sciences
Slide21Sylvatic PlagueEnzooticSteady level of diseaseLow rodent mortalityEpizooticIncreased rodent mortalityFleas seek out new hosts
Expansion into human occupied areasGreatest threat to humans
Center for Food Security and Public Health, Iowa State University, 2011
Slide22Urban PlagueInfected fleas or rodents move into urban areasDomestic rodents infected High rodent mortalityFleas seek new host
Domestic cats or humansAssociated with poverty in humans
Center for Food Security and Public Health, Iowa State University, 2011
Slide23Center for Food Security and Public Health, Iowa State University, 2011
Robert B. Crave. Plague. Infectious Diseases, 5
th
ed. J.B. Lippincott Co. 1994.
Slide24Disease in Humans
Slide25Human DiseaseThree major forms of plagueBubonicSepticemicPneumonicPrimarySecondaryCenter for Food Security and Public Health, Iowa State University, 2011
Slide26Bubonic PlagueMost common form~80% of casesIncubation 2 to 6 daysClinical signsFever, malaise, chills, headacheBubo: swollen, painful lymph node
Mortality (untreated): 50-60%
Center for Food Security and Public Health, Iowa State University, 2011
Slide27Septicemic PlaguePrimary or secondaryRapid onsetClinical signsSigns of sepsis ± buboNecrosis of extremitiesMicrothrombi block capillaries
“Black Death”Mortality (untreated): 100%
Center for Food Security and Public Health, Iowa State University, 2011
Slide28Pneumonic PlagueIncubation: 1 to 6 daysPrimary—Y. pestis inhaledSecondary—septicemic form spreadsClinical signsFever, chills, headache, septicemia
Respiratory distress, hemoptysisPerson-to-person possible
Potential use as bioweapon
Center for Food Security and Public Health, Iowa State University, 2011
Slide29DiagnosisIdentification of organismSerologyIsolation of organismDifferential diagnosesTularemiaHantavirusStreptococcusStaphylococcus aureus
Center for Food Security and Public Health, Iowa State University, 2011
Slide30TreatmentEarly treatment, survival ~100%Supportive careAntibioticsAminoglycosidesDoxycycline, tetracycline, chloramphenicolPenicillins and cephalosporins are
NOT
effective
Center for Food Security and Public Health, Iowa State University, 2011
Slide31Case ReportNew York, 2002Married couple from New MexicoFever, unilateral inguinal adenopathyBubonic plague diagnosedAntibiotic treatmentDeteriorated (septicemic spread)Sent to ICURecovered after 6 weeks
Center for Food Security and Public Health, Iowa State University, 2011
Slide32Case Report: ImportanceNMDPH and CDC investigationTrapped rodents and fleas around homeY. pestis isolatedImportancePlague outside of endemic areaShould raise
suspicionPrompt detection important
Center for Food Security and Public Health, Iowa State University, 2011
Slide33Disease in Animals
Slide34AnimalsHost speciesRodents, lagomorphsNo clinical signsOther mammalsMost infections incidental
Felids very susceptibleHousecats
Wild cats
Ungulates,
canids
Occasional infections reported
Center for Food Security and Public Health, Iowa State University, 2011
Slide35Center for Food Security and Public Health, Iowa State University, 2011Animal Sources of Human Infection in the U.S. 1970
-1993
N=319
Slide36Carnivore Source of Human Plague Infection, 1970-98
Center for Food Security and Public Health, Iowa State University, 2011
Slide37Cats and PlagueHuman cases from cats unknown prior to 1977By 199823 cases; 5 fatalCats develop severe illness and dieCan transfer disease to humans
Owners, veterinarians or staffPneumonic, fleas, bite, scratch
Center for Food Security and Public Health, Iowa State University, 2011
Slide38Cats and PlagueClinical signsSevere illnessSigns mimic human illnessBubonic, septicemic, pneumonicFever, lethargy, anorexiaLymphadenopathySubmandibular, cervical, othersDIC, death
Center for Food Security and Public Health, Iowa State University, 2011
Slide39Cats and Plague: Experimental Infection16 catsEach fed a plague infected mouse All showed illness by day 3-4Lymphadenopathy by days 4-66 cats died (37.5%)75%Blood culture positiveCulture positive throat/oral cavity
Center for Food Security and Public Health, Iowa State University, 2011
Slide40Case Report: Cat to Human New Mexico, 19776 yr. old boySeptember 6Fever, chills, vomiting, bilateral axillary painInsect bites & scratches on armsHospitalized with deliriumSeptember 8
Needle aspirate of lymph nodePositive on staining and FA for plagueIV antibiotics
Center for Food Security and Public Health, Iowa State University, 2011
Slide41Case Report: Cat to HumanImproved, fever continued for 8 daysBuboes incised & drained on day 13Released on day 16HistoryGrandfather shot rabbits
Fed to cats and dogsBoy took one cat home
Bit and scratched him
Cat later died of plague
Center for Food Security and Public Health, Iowa State University, 2011
Slide42Dogs and PlagueRarely show signsFever, lethargy, oral lesions, lymph node lesionsMay seroconvertMay carry infected fleasDiagnosis and treatmentSame as catsSentinels
Center for Food Security and Public Health, Iowa State University, 2011
Slide43DiagnosisContact state public health laboratory or CDC before samplingDiagnosisIdentification of organismSerologyIsolation of organismTreatment
Aminoglycosides, tetracyclines
Center for Food Security and Public Health, Iowa State University, 2011
Slide44Prevention and Control
Slide45Prevention and ControlIsolate infected animalsLimit number of people in contact Personal protectionSurgical mask, gloves, eye protectionFlea controlDogs and catsSpring to fallEnvironment
Center for Food Security and Public Health, Iowa State University, 2011
Slide46Prevention and ControlPrevent roaming or hunting of petsRodent controlEliminate rodent habitat around homeBrush, food sources, firewood, junkUndertaken only after insecticide useInsect repellents for skin & clothesInsecticide use in epizootic areas
Center for Food Security and Public Health, Iowa State University, 2011
Slide47Center for Food Security and Public Health, Iowa State University, 2011
Slide48Prevention and ControlPublic health educationProphylactic antibioticsPlague outbreak/flea bitesHandled infected animalClose contact with plague caseVaccineLive and killed developedNo longer available in the U.S.
Center for Food Security and Public Health, Iowa State University, 2011
Slide49Prevention and AwarenessReport suspected animal casesState health departmentState veterinarianAnimals may serve as sentinelsEducation of clients and publicRisks, transmission, preventionTake precautions in enzootic and epizootic areas
Center for Food Security and Public Health, Iowa State University, 2011
Slide50Plague as a Biological Weapon1970 WHO estimate50 kg agent on city of 5 million150,000 pneumonic cases36,000 deaths80,000 to 100,000 hospitalized500,000 secondary casesUp to 100,000 deaths total
Center for Food Security and Public Health, Iowa State University, 2011
Slide51Additional ResourcesWorld Organization for Animal Health (OIE)www.oie.intU.S. Department of Agriculture (USDA)
www.aphis.usda.govCenter for Food Security and Public Health
www.cfsph.iastate.edu
USAHA Foreign Animal Diseases
(“The Gray Book”)
www.usaha.org/pubs/fad.pdf
Center for Food Security and Public Health, Iowa State University, 2011
Slide52Additional ResourcesCDC - Division of Vector-borne Infectious Diseaseswww.cdc.gov/ncidod/dvbid/index.htmCDC - Plague information
www.bt.cdc.gov/agent/plague/index.asp
Center for Food Security and Public Health, Iowa State University, 2011
Slide53AcknowledgmentsDevelopment of this presentationwas funded by grants from
the Centers for Disease Control and Prevention,
the Iowa Homeland Security and Emergency Management Division,
and
the Iowa Department of Agriculture and Land Stewardship
to the Center for Food Security and Public Health at Iowa State University.
Authors:
Radford Davis, DVM, MPH; Glenda Dvorak, DVM, MS, MPH, DACVPM
Reviewers:
Nichollette
Rider, MS; Jean
G
ladon
, BS; Kerry Leedom Larson, DVM, MPH, PhD
Center for Food Security and Public Health, Iowa State University, 2011