Quick control of bubonic plague outbreak in Uttar Kashi, India

A localized outbreak of bubonic plague occurred in village Dangud (population 332), district Uttar Kashi, Uttaranchal, India in the second week of October 2004. 8 cases were considered outbreak associated based on their clinical and epidemiological characteristics; 3 (27.3%) of them died within 48 hours of developing illness. All the 3 fatal cases and five surviving cases had enlargement of inguinal lymph nodes. None of them had pneumonia. The age of the cases ranged from 23-70 years and both sexes were affected. No such illness was reported from adjoining villages. The outbreak was fully contained within two weeks of its onset by supervised comprehensive chemoprophylaxis using tetracycline. A total of approximately 1250 persons were given chemoprophylaxis in three villages. There was no clear history of rat fall in the village. No flea was found on rodents or animals. 16 animal serum samples were found to be negative for antibodies against F-1 antigen of Y. pestis. However, Y. pestis was isolated from two rodents (Rattus rattus and Mus musculus) trapped in the village. One case and three animal sera showed borderline sero-positivity against rickettsial infection. The diagnosis of plague was confirmed by detection of four fold rise of antibody titre against F-1 antigen of Yersinia pestis in paired sera of three cases (one of the WHO approved criteria of diagnosis of confirmed plague). This outbreak and the occurrence of earlier outbreaks of plague in Surat (Gujarat) and Beed (Maharashtra) in 1994 and in district Shimla (Himachal Pradesh) in 2002 confirm that plague infection continue to exist in sylvatic foci in many parts of India which is transmitted to humans occasionally. Thus, there is a strong need for the States to monitor the plague activity in known sylvatic foci regularly and have a system of surveillance to facilitate prompt diagnosis and treatment of cases to control the disease. This investigation highlights that with high index of suspicion the disease can be diagnosed early and mounting of supervised comprehensive response can prevent the disease to proceed to pneumonic stage where man to man transmission gets established and outbreak assumes larger dimensions.     

Making a timely diagnosis of pulmonary tuberculosis

Making a timely diagnosis of adult-type pulmonary tuberculosis (TB) is critical to interrupting transmission and optimizing treatment outcomes. A hypothesis based on clinical experience is that a timely diagnosis may be made by addressing seven clinical rubrics: six related to history, one to the laboratory. Responses may be considered to be part of a clinical heuristic for making a timely diagnosis of pulmonary TB. The larger the number of affirmative responses, the more likely the diagnosis, although it is probable some questions carry more weight than others. The radiograph is key and may almost be considered to be confirmatory of the history. Collectively, the responses should prompt suspicion of pulmonary TB – submission of sputum for acid-fast bacilli smear and culture, and respiratory isolation.     

云南勐海县一起人间鼠疫疫情的调查处置分析

目的 对2020年勐海县1起人间鼠疫疫情的调查处置进行分析,为完善家鼠鼠疫的监测和防控提供依据。方法 采用病例个案调查、宿主媒介监测等流行病学方法开展调查,对患者的血液、淋巴结穿刺液以及采集的鼠类标本进行细菌学检测、抗原检测和荧光定量PCR检测;对患者的血清进行抗体检测;采用灭鼠、灭蚤等综合措施对疫区进行处置。结果 本次疫情共确诊1例腺鼠疫病例,从黄胸鼠分离到鼠疫杆菌10株;通过采取患者隔离治疗、环境卫生整治,灭鼠、灭蚤等综合处置措施,疫情得到及时有效控制。结论 本例人间鼠疫病例感染来源是当地鼠间鼠疫,跳蚤叮咬可能为其感染途径。及时有效控制鼠间鼠疫疫情是家鼠鼠疫防控的关键。     

An outbreak of plague in Hlegu, Burma in 1977.

An outbreak of plague occurred in Hlegu Town, Burma in February and March 1977. Altogether 14 bubonic plague cases, with 2 deaths were reported, mostly children under 15 years of age. Twice as many males as females were affected. A retrospective investigation showed that a rat fall took place in the last week of January. Only 9.5% of the rodents which died in the epizootic were found to be infected with Y. pestis; this apparent low infection rate probably resulted from the inclusion in the survey of some dead rats which died of other causes. 14.5% out of 48 trapped rodents were found to be serologically positive. The general flea and cheopis indices were rather high, perhaps because fleas were found to be partially resistant to DDT and also because spraying of insecticide did not effect fleas on the hosts. The cheopis index in Hlegu Town was 1.17, and less than 0.5 in Hlegu suburb (Yankin-Yat) where no epizootic was reported. An active case search revealed 76 suspected plague cases out of which 11 were found to have bubonic plague. A field trial showed that plague vaccination during the outbreak did not result in a rise of detectable antibodies in persons inoculated.     

兴海县重大鼠疫疫情灾害后宿主动物及其体表寄生蚤生态流行病学调查

目的了解青海省兴海县重大鼠疫疫情灾害后宿主动物及其体表寄生蚤生态学特征,探讨其在鼠疫防治中的流行病学意义。方法采用现场流行病学调查方法,在青海省i江源区域内发生过肺鼠疫暴发流行的兴海县对鼠疫宿主动物和媒介蚤种群分布和密度进行调查,分析鼠疫宿主动物和媒介蚤的生态学特征。结果兴海县调查区旱獭平均密度为0．07只／hm2。捕获动物13种245只,其中啮齿目8种,兔形目3种,食肉目2种。采获蚤类25种458匹,其种群构成以斧形盖蚤为主,占总蚤数的37．99％（174／458）;其次为谢氏山蚤,占10．70％（49／458）。鼠体寄生蚤丰富,以根田鼠体寄生蚤的多样性指数最高,为2．494;其次是青海田鼠,为1．611;旱獭寄生蚤多样性指数为1．001。结论兴海县喜马拉雅旱獭鼠疫疫源地内有青海田鼠分布,鼠体寄生蚤的多样性指数较高。提示该地区的鼠疫疫源地可能具有多元性,应加强这一地区鼠疫的全面监测。     

Malaria outbreak in a tribal area of Gujarat state, India

Malaria incidence in Gujarat state had been on a general decline since 1989. However in some tribal villages in forested areas of Valsad district, southern Gujarat, there was an outbreak of malaria in September 1995. Five children died in Ashlona village. During investigation conducted in October 1995 in affected villages, the malaria parasite rate was 26% (217/833) with >91% infections due to P. falciparum. A high proportion of P. falciparum infections had ring stages suggesting active transmission. Against a minimum norm of 10% annual blood examination rate, there was a major breakdown of active surveillance for malaria. In the absence of health agencies in or near affected villages, the malaria parasite load continued to build up leading to an outbreak towards the end of monsoon season. Indoor residual spraying with deltamethrin caused significant reduction in densities of malaria vector An. culicifacies. Measures to prevent malaria outbreaks in inaccessible areas have been discussed.     

Successful containment of a COVID-19 outbreak in Bach Mai Hospital by prompt and decisive responses

正In low-and middle-income countries, tertiary care hospitals frequently face an extremely heavy workload and shoulder an even heavier burden during the COVID-19 pandemic. Bach Mai Hospital(BMH), one of the leading tertiary hospitals in Vietnam, is on the frontline in the fierce battle against COVID-19. This letter aims to describe how BMH tackles the COVID-19 outbreak in the hospitallevel battle, which could support policymakers in time-management and well-preparation for this unpredictable pandemic.     

Impediments to timely diagnosis of Alzheimer's disease in African Americans

The purpose of this study was to identify early patterns of care for Alzheimer's disease (AD) in a cohort of African-American patients and their caregivers presenting at an inner city clinic and a suburban memory assessment clinic. Caregivers (N=79) of patients diagnosed with probable AD were interviewed. Data were collected about the delay from noticing first AD signs until recognition that a problem existed and delay from problem recognition until first physician consultation. Patients and caregivers had lower educational status, and patients had been diagnosed more recently at the inner city clinic than at the suburban clinic, although MMSE scores of patients at the two clinics did not differ; median delays in caregivers' recognizing a problem and in consulting a physician were also similar across clinics. Delay was as long as 7 years between noticing symptoms and problem recognition and between problem recognition and physician consultation. Although patients attending the suburban clinic were more likely to have previously seen a physician than those attending the inner city clinic, they were no more likely to have received a prior diagnosis of AD. Lack of physician contact is likely to be widespread in families caring for African Americans with AD. Physician consultation is more characteristic of more highly educated families but may not yield a correct diagnosis for the patient. Intensive efforts are needed to connect African-American families with physicians and to achieve more timely diagnosis of AD to enable families to understand the illness, plan for patient safety, and make long-term plans.     

An urban outbreak of leptospirosis in Mumbai,India

An outbreak of leptospirosis occurred during the rainy season in the city of Mumbai, India. Out of 169 suspected cases, 74 (43.7%) were determined serologically positive by microagglutination test (MAT) carried out with a battery of eight pathogenic serovars, while 78 (46.1%) were shown positive for IgM antibodies to leptospira by enzyme-linked immunosorbent assay. On the basis of MAT, serovar Copenhageni accounted for 66 (89.1%) out of the 74 cases admitted during the period of the outbreak. Myalgia, conjunctival suffusion, cough with hemoptysis, icterus, and oliguria were significantly more common in patients whose samples were determined positive by MAT. The presence of pulmonary signs and symptoms and renal failure were significantly associated with mortality in patients presumed to be suffering from leptospirosis.     

Human plague outbreak in two villages, Yunnan Province, China, 2005

Plague is still a serious public health problem in Asia. On July 5, 2005, a suspected outbreak of human plague in two Chinese villages was reported to Yunnan Institute of Endemic Disease Control and Prevention (YIEDC). Active case finding, laboratory investigation, environmental inspection, and control measures were conducted by provincial and local health authorities. A suspected case was an individual who resided in one of the two villages and developed fever and painful swollen lymph nodes in the groin, axilla, and neck between June 26 and July 11, 2005. Confirmation was by indirect hemagglutination test (IHA) for plague F1 antibody. A confirmed animal plague case was an animal that tested positive for one of the following tests: IIA, reverse indirect hemagglutination, or bacterial culture. There were three confirmed and one suspected case of human plague. Of nine retrieved rats, three were confirmed cases. Most surveyed houses had poor sanitation, and there was a history of dead rats observed in the villages. After control measures were implemented, the rat density and flea index decreased to acceptable levels and no new cases occurred. The cause of this outbreak was likely due to rat die off in the villages, such that rat flea populations migrated to humans under environmentally favorable conditions. The outbreak was controlled after implementing environmental and educational control measures.     

An outbreak of human anthrax in Mysore (India)

Anthrax is a zoonotic disease caused by Bacillus anthracis. Intestinal anthrax though a rare entity mostly ends with fatal outcome. Very few cases of intestinal anthrax are reported. Present outbreak of intestinal anthrax is unique in itself that four cases succumbed to the illness within a span of 48-72 hours in a small hamlet of Mysore district of Karnataka, after consuming diseased deer meat. Confirmation of the diagnosis was carried out at NICD, Delhi by bacteriological culture isolation, biochemical tests, animal pathogenicity and polymerase chain reaction (PCR). This outbreak clearly indicates surveillance of anthrax in animals in endemic areas is an essential part in the control of the disease with intersectoral coordination between the departments of health, animal husbandary, agriculture and forest.