“It’s just completely wrong.” A Daily Maverick report says this is according to World Health Organisation (WHO) spokesperson Tarik Jasarevic who said that the for last week he had been fielding questions about a list of nine countries at “high risk” of importing the plague currently affecting Madagascar, South Africa among them. Only, it was a list that never existed. “It is not correct that a number of African states have been ‘put on high risk for plague’,” Jasarevic insisted.
The report says plague is an annual occurrence in Madagascar. But this year’s outbreak has raised particular concerns after infiltrating urban centres and taking on a pneumonic form, spreading from person to person via droplets in the air.
Last week the National Institute for Communicable Diseases (NICD) released a statement on the steps South Africa was taking to prevent a spread of the disease. The reporting that followed has all been “a bit hysterical and sensationalist”, NICD associate professor John Frean is quoted in the report as saying. “Obviously we want people to be aware of the situation and to avoid possible exposure,” he said. But there was no need to panic: “We’re not expecting a plague outbreak in South Africa. We’re just being vigilant for the possibility that infected people may return to South Africa.”
The WHO hasn’t even advised that travel restrictions be implemented. In fact, it recommended the opposite, advising in last week’s situation report “against any restriction on travel or trade on Madagascar based on the available information”.
The risk of international spread remained “very low”, the report said, while the region faced “moderate” risk – unchanged since the outbreak began.
The report also advised that nine countries focus on preparedness because of their “trade and travel links” to Madagascar. But this did not mean they were at “high risk” of importing the plague, insisted WHO’s Jasarevic. The only country facing any kind of “high” risk of further spread was Madagascar itself. “It’s normal that if you have an outbreak nearby you do preparedness,” Jasarevic said in the report.
A disease best known for killing tens of millions of people during the Middle Ages, it’s understandable why the reporting around the plague has taken on a panicked tone. “But we’re not living in the Middle Ages now,” said Frean. Since the outbreak began, health workers have been at pains to explain that the disease need not be fatal. In fact, it’s easily cured with antibiotics, if caught early.
Spread most commonly by infected fleas, the plague is also a disease that has existed around us for millennia. The report says the first decade of this century alone saw 21,725 cases of plague recorded in 16 countries – but just 1,612 deaths. The vast majority of those cases were from Africa, particularly the Democratic Republic of Congo, which recorded pneumonic plague outbreaks in both 2005 and 2006. Outbreaks were also reported in Uganda in 2006, in Libya in 2009, and in Algeria in both 2003 and 2008.
But another country making the list? The US. It reported cases every year that decade, including a 2007 case in which a wildlife biologist died after performing an autopsy on a mountain lion.
“It’s a disease of animals,” explained Frean in the report. “It has a reservoir in wild rodents, meaning that it circulates naturally in those populations without us necessarily being aware that it’s there.”
A rat collected from a Midrand informal settlement just last year tested positive for plague antibodies. A few years earlier, another was found in the village of Coega in the Eastern Cape – the site of South Africa’s last plague outbreak 35 years ago, which killed a 42-year-old man. “It’s a fact of nature,” said Frean. “Under the right circumstances, it will always be there.”
Business Day quotes Professor Lucille Blumberg‚ consultant at the NICD‚ about the facts of the plague.
1. Calm down and don’t call it the Black Death: Scientists don’t call even call the disease the Black Plague anymore. “It is just called the plague.” Blumberg explained that the “black plague” and the words “black death” refer to the disease in the Middle Ages‚ when it killed millions of people in Europe. But 1346 was before the age of antibiotics. In the 14th century‚ people’s fingers and toes may have gone black due to the infection in their blood. Today plague is a treatable disease with commonly used antibiotics.
2. The disease has not spread across borders in three months: the plague has been in Madagascar since August‚ where there have been 124 deaths‚ and not one case has spread to any neighbouring countries. The Seychelles public healthcare system is so well run‚ it picked up a suspected case‚ but confirmed through tests the patient didn’t have the plague. This shows the level of preparation in neighbouring countries to detect possible cases‚ says Blumberg. “South Africa needs to be prepared and vigilant and we are.”
3. If you haven’t been to Madagascar‚ you have practically no risk of getting plague‚ says Blumberg.
4. South Africa is already prepared to detect a case‚ if it arrives here. South Africa has one direct flight a week from Madagascar, and travellers are screened at the airport for fever or cough. Anyone sick will be sent to the airport clinic for tests. Madagascar is screening all travellers leaving the country and Blumberg says this is working. The NICD has specialised testing available to detect the plague. If there is a case in South Africa‚ the country has good epidemiologists who would trace the patient’s relatives and colleagues, and offer preventative antibiotics.
5. If you go to Madagascar and get sick‚ see a doctor. There is a serious plague in Madagascar and people have died‚ but Blumberg says this is primarily because sick people are not getting treatment in time. They may not know they have plague and think they have flu or a cough. So if you go to Madagascar and develop a cough‚ fever or swollen groin‚ go to the doctor without delay. Travellers to Madagascar should apply insect repellent as the disease is spread by fleas.
6. Antibiotics work. In an age of increasing resistance to antibiotics‚ plague remains treatable with commonly available antibiotics. Blumberg says: “Plague is not resistant to antibiotics.”
7. What you should really be worried about: malaria. Blumberg says a traveller is more likely to get malaria in Madagascar than plague‚ and travellers must take prophylactic malaria medication. She says travellers may come back from Madagascar with a fever and think they have plague‚ when they actually have malaria. This may mean the malaria is not detected in time‚ which can be deadly.