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Pulmonary plague in DRC In the Ituri district, in the north-east of Democratic Republic of Congo, the number of pulmonary plague cases is decreasing but there is still a threat that the situation will worsen. Anne Perrocheau is a medical advisor on epidemics in the medical department in MSF’s head office in Geneva. Since the beginning of June 2006, she’s ensured that our intervention for sufferers of the disease is monitored, working in collaboration with the teams in the field. She’s currently producing a report on the situation. After twelve weeks of intervention from MSF medical teams in the health zones of Rethy and Linga, can we assume that the situation is currently under control? The impact of pulmonary plague is on the decline but some cases are persisting. In the last 6 weeks, we’ve seen a progressive decline in the number of cases with a maximum of 5 new cases per week and the epidemic has been able to be contained within the health zones that were initially affected. In total, we’ve treated 269 people suspected of being infected by pulmonary plague since June 2006. Unfortunately, we weren’t able to do anything for 36 patients who died from the disease. However, in the last two weeks, we haven’t recorded any deaths. What have been the activities put in place by MSF and are they ongoing? We immediately set up medical treatment for suspected cases, isolating the patients and treating them with suitable antibiotics. For the past three weeks, we’ve also been treating people who’ve come into contact with a sick family member. Two isolation centres have been opened, one in Veduza in the Linga zone and the other in Kwandroma in the Rethy zone. Care has been given by Congolese health staff who are supported by a team of volunteers from MSF. The Kwandroma centre is now shut and we are currently finishing the handover of the last cases and of our treatment program in the Rethy Hospital. There’s no longer any reason to keep our expatriate volunteers in the program so we’ve decided to withdraw. However, we’ve set up an alert system which will allow Congolese doctors from Rethy Hospital to communicate information with us in real time on the development of the situation. Our medical teams based in Bunia, the capital city of the Ituri province, will liaise with these Congolese hospital authorities. In terms of hygiene, what measures have been taken in the field to make the living environment more sanitary and to limit transmission? The efforts of the Congolese Red Cross volunteers doing door-to-door visits in the villages of the region have led to larger levels of awareness. MSF has been able to supply insecticides and the Congolese teams, for their part, have spread the message to improve basic hygiene. Essentially, we must increase the population’s awareness of the need to keep food away from living areas in order to keep away rats carrying the plague, to regularly remove rubbish and to regularly spray houses where suspected cases have been identified. It has also been necessary to raise awareness among the families affected by the disease regarding the basic rules regarding the burial of the deceased: no contact with the body without protection, only one person should prepare the body of the deceased and regularly wash hands after the preparation of the body. It’s an unpleasant task but this warning is needed in case of future contaminations. What information can we learn from this intervention? The clinical treatment of suspected cases is not sufficient. From the beginning of the epidemic, it’s imperative to have a pre-emptive method of detection and to monitor family members who could have been in contact with patients suspected of suffering from the disease. The control of vector transmission remains difficult in the current context of DRC and the many health and hygiene shortages. Intensive deforestation in the region also brings rats as they can’t find anything sufficient to eat in their natural environments. Should we fear another epidemic in the near future? What’s certain is that we have not seen an epidemic like this for a long time. We’re faced with an epidemic on a grand scale even though we haven’t been able to confirm that 100% of the cases are due to the plague. The quick reaction to the crisis has meant that the spread of the disease has been limited and remains localised. The reluctance of people to move about in this endemic but remote region, which is vulnerable to insecurity, has also played a role in the restriction of the epidemic. However, the larger contamination risks cannot be avoided and it’s easy to imagine the disastrous consequences we could face if the disease spreads to the big cities in the region, like Kampala in Uganda or Kisangani in DRC. The rapid multiplication of rats, their contact with humans and winter being the season of transmission are also risk factors that we must continue to monitor closely. Pulmonary plague, a relatively rare form of plague, is fatal. The bacteria responsible for the infection attack the lungs, which makes the disease more contagious. Contagion is caused by expectorations when the infected person coughs or sneezes. One can also be affected by contact with contaminated clothes or bedding. The incubation period is very short: from a few hours to three days. Without treatment, pulmonary plague is fatal in three days. However, treatment, based on antibiotics, is simple. The most important method is isolation of patients, who can therefore be treated without risk of contaminating other patients in the hospital or even their own family members. » Read about other featured projects
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