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NICD to release plague alert
Tripti Nath
Tribune News Service

New Delhi, February 20
The National Institute of Communicable Diseases, NICD, here plans to bring out a communicable disease (CD) alert on plague in the coming week. NICD Director, Usha Baveja told TNS here today that the institute had started the process of compiling information for the 16-page bulletin on plague. She said the bulletin would be released as soon as it was approved by the Director-General Health Services, Dr S.P. Aggarwal.

She said the South-East Asia regional office of WHO would bear the costs of printing and mailing.

Dr Baveja said the CD alert would cover various aspects of the disease including symptoms types, treatment, prevention and control. She said the bulletin aimed at creating awareness on the disease and would be sent to all primary health centres and government doctors free of cost. “We have planned a print order of 30,000 and every district officer will be given 40 to 50 copies of the CD alert on plague for distribution to primary health centres.

WHO representative to India, Robert Kim-Farley from the Centre for Disease Control, Atlanta, Georgia, (on deputation here) confirmed their support to the printing of the CD alert on plague.

She said the NICD had released alerts on various diseases in the past three years including cholera, dengue, haemorrhagic fever, viral hepatitis, Japanese encaphilitis and anthrax. Dr Baveja said the NICD plans to send a proposal to the DGHS offering its technical expertise in strengthening surveillance in Himachal Pradesh. She said the endemic areas include Andhra Pradesh, Gujarat, affected area of Himachal Pradesh, Karnataka and Tamil Nadu. Sources in NICD said the samples collected by the three-member team of the NICD would be processed for detailed analysis and were of academic interest as well.

Thakur to visit plague patients
Tribune News Service

A patient suffering from plague is helped by his wife in a hospital in Chandigarh on Wednesday.  — Reuters photo

Meanwhile, the condition of one of the six patients admitted here, Rakesh, is said to be serious while Parshotam, Satya and Naveen are on intermittent oxygen. Jyoti's condition has reportedly improved slightly. No new patient with similar symptoms from Himachal Pradesh or any other area has been admitted.

Biological attacks make plague serious threat
Tribune News Service

Chandigarh, February 20
it could be true that a killer disease like plague, due to its extreme virulent and easily communicable nature, refuses to be eradicated as it exists in reserve with nations for use in the biological warfare?

Plague is endemic in many countries in Africa, the Americas and Asia. In 1999, 14 countries reported 2,603 cases to the WHO (including 212 deaths). These figures are comparable with the annual average figures (2,547 cases, 181 deaths) for the previous 10 years (1988-1997). Over the past decade, 76.2 per cent of the cases and 81.8 per cent of the deaths were reported from Africa.

In the first half of the 20th century, India recorded more deaths from plague than any other country. Plague, which has existed in India for hundreds of years, is usually confined to rodents. Unfortunately, conditions in India persist which allow for continuing outbreaks in human populations, the most recent of which has been witnessed in Himachal Pradesh.

Advances in living conditions, public health and antibiotic therapy have made natural epidemics improbable, but plague outbreaks following a biological weapon attack do pose a serious threat.

Plague is one of the very few diseases which can create widespread panic following the discovery of even a small number of cases. In the 1950s and 1960s, reportedly, the US and Soviet biological weapons programs developed techniques to directly aerosolise plague particles, a technique that leads to pneumonic plague. A modern attack would most probably occur via aerosol dissemination of Y pestis, and the ensuing outbreak would be almost entirely pneumonic plague.

More than 10 institutes and thousands of scientists were reported to have worked with plague in the former Soviet Union. Given the availability of Y pestis in microbe banks around the world, reports that techniques for mass production and aerosol dissemination of plague have been developed, the high fatality rate in untreated cases and the potential for secondary spread, a biological attack with plague is a serious concern.

An understanding of the epidemiology, clinical presentation and the recommended medical and public health response following a biological attack with plague could substantially decrease the morbidity and mortality of such an event. A plague outbreak developing after the use of a biological weapon would follow a very different epidemiologic pattern than a naturally occurring plague epidemic.

The size of a pneumonic plague epidemic following an aerosol attack would depend on a number of factors, including the amount of agent used, the meteorological conditions and methods of aerosolisation and dissemination.

A 1970 World Health Organization assessment asserted that, in a worst case scenario, a dissemination of 50 kg of Y pestis in an aerosol cloud over a city of five million might result in 150,000 cases of pneumonic plague, 80,000-100,000 of which would require hospitalisation, and 36,000 of which would be expected to die.

There are no effective environmental warning systems to detect an aerosol cloud of plague bacilli, and there are no widely available rapid, diagnostic tests of utility. The first sign of a bioterrorist attack with plague would most likely be a sudden outbreak of displaying with severe symptoms.