Sign of the Apocalypse? Plague Is Back, With a Disturbing Twist

virus_crop380wIf you thought the film Contagion was frightening, this medical plot twist may scare you even more—because it’s real.

Back in November, the island nation of Madagascar confirmed 119 cases of plague, including 40 deaths. But the bad news recently took a disturbing turn: “The fleas that transmit this ancient disease from rats to humans have developed resistance to the first-line insecticide,” Margaret Chan, director-general of the World Health Organization, said in a new report.

You probably recognize the infectious disease as the one known as the “Black Death,” which during the 14th century became a devastating epidemic that claimed an estimated 50 million lives throughout Europe, Asia, and Africa. Caused by the bacteria Yersinia pestis, the disease spreads from rodents to humans via infected fleas. Those infected generally develop bubonic plague—exhibiting swollen lymph nodes and flu-like symptoms—or, if it spreads to the lungs, the deadlier advanced form, pneumonic plague. Caught early, antibiotics can effectively treat the disease; left untreated, however, plague kills 30 to 60 percent of those infected.

Steamboats from India carried plague to Madagascar in 1898. What makes the recent outbreak there particularly troubling is that scientists have been warning about insecticide resistance in fleas for years. Plague surveillance in Madagascar was discontinued in 2006 due to a lack of funding, but almost 17 years ago—and just six years after the first-line insecticide was initially used in Madagascar—an article published in the Journal for Emerging Infectious Diseases closed with the admonition, “the increasing resistance of fleas to insecticides have caused much concern.”

A November 2014 study conducted by the health research center Institut Pasteur in Madagascar found conclusive evidence that more than 80 percent of the fleas tested were resistant to Deltamethrin, the insecticide referenced in the WHO report. Out of the 32 flea populations examined, only two demonstrated susceptibility to the insecticide. The report’s authors conclude, “In the…re-emergence of plague…in Madagascar, Deltamethrin is ineffective against fleas. Its use in Madagascar should be stopped and the control program for plague diseases needs to change to another insecticide.”

While the study explains that many factors could contribute to the fleas’ increased resistance to insecticides—including environment, climate, geography, urbanization, and human social and cultural behaviors—the core mechanism at work is natural selection. Each time a population of fleas is treated with insecticide, fleas that by some quirk have a built-in resistance survive and breed to create the next generation of fleas, born genetically resistant to the insecticide that wiped out their parents’ peers. Over time, the insecticide becomes less effective as the flea populations are increasingly comprised of only those with the quirk of DNA that protects against it. To compensate for its lowered levels of efficacy, a higher concentration of the insecticide is often used—which breeds a generation of fleas even more resistant than the last.

For the people of Madagascar, Deltamethrin restistance is a case of déjà vu all over again. Use of the insecticide, a man-made version of a natural insecticide that chrysanthemum flowers produce, began in the 1990s after insects developed resistance to the flea-control chemical being used at the time. Some scientists have hypothesized that fleas’ resistance to Deltamethrin may be a result of the species’ exposure to the old insecticide.

What can be done? For now, Institut Pasteur researchers are testing 12 insecticides to see which will be most effective at controlling flea populations. Without plague surveillance, however, there is no way to tell how long it will take for the fleas to build resistance to the next line of insecticides. Funding shortfalls also continue to stand in the way of those trying to track and control plague in Madagascar—not to mention the growing number of other health concerns the institute must deal with: When Sébastien Boyer, head of the medical entomology unit at the institute, was contacted for comment on the status of the insecticides currently being tested, he responded by e-mail, “No time…we are currently in malaria outbreak in Farafangana…sorry.”

Ebola Virus Out Breaks by Year

The rate of infection has slowed in Guinea, but it has increased in neighboring Sierra Leone and Liberia.

As infection accelerates, some aid groups are pulling out to protect their own.

Samaritan’s Purse and the missionary group Serving in Mission have recalled all nonessential personnel from Liberia.

The Peace Corps announced Wednesday it is doing the same, removing its 340 volunteers from the three severely affected nations.

While there are no confirmed cases, a Peace Corps spokeswoman said two volunteers came into contact with someone who ended up dying from the virus.

Those Americans haven’t shown signs of Ebola but are being isolated just in case. The spokeswoman said they can’t return home until they get medical clearance.

Ebola is outstripping control efforts, top WHO official warns

Fears rose Friday that the Ebola virus may have spread as Nigerian authorities said they have quarantined two people who may have the disease and have another 69 under observation.

With fears the disease may get a toehold in Nigeria’s most populous city, Lagos, the head of the World Health Organization warned that the virus in West Africa was outstripping efforts to control it.

Dr. Margaret Chan was speaking at a meeting of the leaders of four West African countries in Conakry, the capital of Guinea, to discuss measures to bring the disease under control. The WHO said it planned to release $100 million to deploy hundreds of medical staff to fight the disease.

More than 1,300 people have been infected in the West African countries of Guinea, Sierra Leone and Liberia in the worst Ebola outbreak on record. Of those, 729 have died, according to the WHO.

In recent weeks the epicenter of the outbreak has shifted from Guinea to Sierra Leone.

“This outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries,” Chan said. “This meeting must mark a turning point in the outbreak response.”

In Nigeria, authorities insisted they had the situation under control after a Liberian, Patrick Sawyer, 40, became ill with Ebola while flying into the commercial capital, Lagos, and later died there in a hospital. The spread of the disease to Lagos has raised fears that cases may emerge farther afield in other parts of Africa, Europe, the United States or elsewhere.

The immediate worst-case scenario would be for the disease to take hold in Lagos – crowded, poverty-stricken in many areas, and at times chaotic, posing the risk it could spread throughout Africa’s most populous country.

“It would be foolish for us to think it couldn’t spread. I think this is a potential worldwide threat,” said Ebola expert G. Richard Olds, dean of the School of Medicine at UC Riverside, noting that in past outbreaks of highly infectious diseases, including SARS, AIDS and monkey pox, the diseases eventually reached the U.S.

“If it takes hold in Nigeria, we have a real problem on our hands. I’d be very concerned about that because Lagos would be the most concerning situation: It’s a very densely populated area and is in a situation where the healthcare infrastructure is probably ill prepared to deal with this type of virus.”

The chief medical officer of the Lagos Teaching Hospital, Akin Osibogun, said the hospital had tested 20 blood samples for possible Ebola cases, all of which tested negative, Nigerian media reported Friday.

However, there were signs of panic and chaos. A man’s corpse was brought into Anambra state in recent days as cargo from Liberia, underscoring doubts about whether adequate measures are in place to control the disease. The cause of the man’s death wasn’t known.

Authorities on Thursday cordoned off the morgue where the body was being held.

“We are surprised how the corpse came into Nigeria and Anambra state. It is shocking to us,” a local health official, Josephat Akabike, said. “We have directed the police to cordon off the area. Ebola is a very big threat and that is why we are taking all the measures.”

Uganda, Kenya and South Africa all said Friday they had no suspected cases of the disease.

South African authorities warned they would not allow anyone into the country who knowingly arrived with the Ebola virus — but said they would admit and treat anyone who arrived with symptoms if they were not aware they had the disease. The country has thermal scanners at airports capable of detecting people with elevated temperatures.

South Africa has had two reports of Ebola-like symptoms, both which turned out not to be Ebola, according to South Africa’s National Institute of Communicable Desease.

Ebola initially presents with common, flu-like symptoms — fever, headache and body aches. The disease, while highly contagious, is not airborne and is transmitted through contact with bodily fluids, including sweat and blood.

The terror in West Africa has hampered efforts to control it, with people running away rather than going into isolation wards, which are associated with death.

In her remarks, Chan said it was important to combat the popular view that Ebola was a certain death sentence, which impeded efforts to get people to seek help in hospitals and treatment facilities. People instead keep their loved ones hidden at home or turn to traditional healers, causing the virus to spread.

She warned that “public attitudes can create a security threat to response teams when fear and misunderstanding turn to anger, hostility, or violence.”

Chan also said it was also important to change cultural attitudes around burial.

For relatives of victims, washing and burying the body is culturally important, but also highly dangerous and one way in which the disease has spun out of control.

Olds said that while the disease has a high fatality rate – more than 50% – and was highly contagious, it is not as contagious as SARS, because it is not an airborne virus.

Previous outbreaks had occurred in remote areas of Africa, where the population wasn’t mobile, making it easier to contain, but this outbreak occurred in a more densely populated region with a highly mobile population, accounting for the rapid spread of the disease and difficulties containing it.

“It’s particularly dangerous when it gets into areas that are densely populated and have weak health infrastructure,” he said.

<A NOTE FROM DOOM> An aid worker  with Ebola was flown into Atlanta yesterday for experimental treatment.

Nigerian Government Confirms Ebola Death In City Of Lagos

ABUJA/GENEVA, July 25 (Reuters) – A Liberian man who died in Nigeria’s commercial capital Lagos on Friday tested positive for the deadly Ebola virus, Health Minister Onyebuchi Chukwu said.

Patrick Sawyer, a consultant for the Liberian finance ministry in his 40s, collapsed on Sunday after flying into Lagos, a city of 21 million people, and was taken from the airport and put in isolation in a local hospital. Nigeria confirmed earlier on Friday that he had died in quarantine.

“His blood sample was taken to the advance laboratory at the Lagos university teaching hospital, which confirmed the diagnosis of the Ebola virus disease in the patient,” Chukwu told a press conference on Friday. “This result was corroborated by other laboratories outside Nigeria.”

However, at a separate press conference held by the Lagos state government at the same time, the city’s health commissioner, Jide Idris, said that they were only “assuming that it was Ebola” because they were “waiting for a confirmative test to double check” from a laboratory in Dakar.

Paul Garwood, spokesman for the World Health Organization (WHO) in Geneva, said the U.N. health agency was also still waiting for test results.

“We’re still waiting for laboratory-confirmed results as to whether he died of Ebola or not,” he said.

It could not be immediately determined why there was a contradiction in the comments from central government and city officials.

If confirmed, the man would be the first case on record of one of the world’s deadliest diseases in Nigeria, Africa’s biggest economy and with 170 million people, its most populous country. Ebola has killed 660 people across Guinea, Liberia and Sierra Leone since it was first diagnosed in February.

Sawyer was quarantined on arrival and had not entered the city, a Nigerian official told Reuters.

“While he was quarantined he passed away. Everyone who has had contact with him has been quarantined,” the official said.

Liberia’s finance minister Amara Konneh said Sawyer was a consultant for the country’s finance ministry.

“Our understanding is that the cause of death was Ebola,” Konneh told Reuters.

The victim’s sister had died of the virus three weeks previously, and the degree of contact between the two was being investigated by Liberian health ministry officials, he said.

Earlier on Friday, WHO spokesman Paul Garwood said: “I understand that he was vomiting and he then turned himself over basically, he made it known that he wasn’t feeling well. Nigerian health authorities took him and put him in isolation.”

Nigeria has some of the continent’s least adequate healthcare infrastructure, despite access to billions of dollars of oil money as Africa’s biggest producer of crude.

Some officials think the disease is easier to contain in cities than in remote rural areas.

“The fear of spread within a dense population would be offset by better healthcare and a willingness to use it, easier contact tracing and, I assume for an urban population, less risky funerary and family rites,” Ian Jones, a professor of virology at the University of Reading in Britain, said.

“It would be contained more easily than in rural populations.”

There have been 1,093 Ebola cases to date in West Africa’s first outbreak, including the 660 who have died, according to the WHO.

Ebola: A swift, effective and bloody killer

By Dr. Sanjay Gupta, CNN Chief Medical Correspondent
updated 7:01 PM EDT, Tue April 15, 2014

Conakry, Guinea (CNN) — It took only moments to feel the impact of what was happening here.

We had just landed in Conakry, the capital of Guinea. In the fields right outside the airport, a young woman was in tears. She started to wail and shout in Susu, one of the 40 languages spoken in this tiny country of 12 million people. The gathered crowd became silent and listened intently

We had just landed in Conakry, the capital of Guinea. In the fields right outside the airport, a young woman was in tears. She started to wail and shout in Susu, one of the 40 languages spoken in this tiny country of 12 million people. The gathered crowd became silent and listened intently.
The young man sitting next to me quietly translated, although I already had my suspicions. He told me the woman’s husband had died of Ebola, and then quickly ushered us away.

It is probably not surprising the airplane bringing us into Conakry was nearly empty, as are all the hotels here. Not many people in the United States have ever visited Guinea, or could even identify where it sits in West Africa. It is already one of the world’s poorest countries, and the panic around Ebola is only making that worse.

Some of it is justified. That’s because this time, the outbreak is different. In the past, Ebola rarely made it out of the remote forested areas of Africa.

Key to that is a grim version of good news/bad news: because Ebola tends to incapacitate its victims and kill them quickly, they rarely have a chance to travel and spread the disease beyond their small villages. Now, however, Ebola is in Conakry, the capital city, with 2 million residents. Equally concerning: it’s just a short distance from where we touched down, at an international airport.

It has gone “viral,” and now the hope is that it doesn’t go global.

When I asked doctors on the ground about that scenario, they had split opinions. Several told me the concern is real but unlikely. Most patients with Ebola come from small villages in the forest and are unlikely to be flying on international trips, they told me. Furthermore, they don’t think Ebola would spread widely in a western country; our medical expertise and our culture — not touching the dead — would prevent it.

Others aren’t so sure.

No one wants to test that theory.

With Ebola, there is an incubation period of two to 21 days. Remember these numbers. This is the range of time it takes to develop symptoms after someone has been exposed.

With an international airport close by, that means you could be on the other side of the world before you develop the headache, fever, fatigue and joint pain which make up the early symptoms of an Ebola infection. The diarrhea, rash and bleeding come later. Hiccups is a particularly grave sign with Ebola. It means your diaphragm, which allows you to breathe, is starting to get irritated.

There is a lot we know about Ebola, and it scares us almost as much as what we don’t know.

We do know Ebola, a simple virus with a small genome, is a swift, effective and bloody killer. The mortality rate is higher than 50% and in some outbreaks reaches 90%.

Ebola appears to kill in a clever way. Early on, it strategically disarms your immune system, allowing the virus to replicate unchecked until it invades organs all over your body. It convinces your blood to clot in overdrive, but only inside your blood vessels. While those blood vessels choke up, the rest of your body starts to ooze because the clotting mechanisms are all busy.

You start to hemorrhage on the outside of your body. Nose bleeds, bruising, even a simple needle stick will refuse to clot. But, it is the bleeding you don’t see — the bleeding on the inside — that causes even more catastrophic problems.

Many patients die of shock, within an average of 10 days.

 

It sounds like the stuff of horror movies. But despite the real danger, Ebola is not at all easy to “catch.” If it were, my wife would have refused to let me come in the midst of an outbreak.

 

To become infected, you generally need to spend extended time with someone who is gravely ill, and come into contact with his or her infected body fluids. That’s why family members and health care workers are the most likely to get sick.

 

Over the last three weeks, at least 112 people have died, including 14 health care workers.

 

With some infections, you can shed and spread the virus long before you get ill. That’s not the case with Ebola. It’s only after you are sick and feverish do you become contagious. However, it only takes a miniscule amount to infect and kill. A microscopic droplet of blood or saliva on your bare hand could enter through a break in your skin. And, whether you realize it or not, we all have breaks in our skin.

 

Since I was a kid, I have been fascinated with outbreaks. I learned in medical school that new pathogens generally make a jump from animals to humans, a process called zoonosis.

 

This is happening in areas where human and animals come into continuous contact. David Quammen refers to it as “Spillover,” in his book of the same name. A stew of ducks, geese, chickens, pigs and humans in southeast Asia led to the spillover of avian flu, H5N1. Contact between pigs and humans in Mexico led to swine flu, H1N1; pigs and fruit bats were the recipe for Nipah fever in Malaysia.

 

The best guess is that fruit bats may be a natural reservoir for the Ebola virus too, but this has not been confirmed. Quammen makes the point: Ebola didn’t enter our world — we entered its world.

 

Pathogens can be predators, like lions, tigers and bears. A virus may not plan the way a big cat does, but in a sense it stalks its prey — waiting for the moment of opportunity, then attacking with fury. Because it can lie silent for years, it’s also easy to see Ebola as a killing ghost, like Jack the Ripper.

 

Presumably outbreaks begin through some human-animal contact, but since that contact is ongoing we don’t know what it is that leads Ebola to rear its ugly head. We don’t know how to treat the illness or vaccinate against it. We certainly don’t know how to cure it.

 

I thought about all of this as I left that woman in the airport, and I have thought about her a great deal since then. Her grief made an impression on all of us.

 

It also made this mysterious, exotic virus the world knows, but doesn’t fully understand, so much more real and frightening. For the next 21 days (the outer range of the incubation period) the woman we saw will be monitored for a fever or any early signs she may have contracted Ebola from her husband. If she exhibits symptoms, she will be isolated and treated with fluids, oxygen and nutrition.

 

That is all that can really be offered. Again, there is no cure for Ebola.

 

For her neighbors, in Guinea and across its border, another critical number is 42 — as in 42 days, or two incubation periods. If the health care teams here don’t see any new cases during that time then they officially say the outbreak is over. We are not there yet, not even close.

 

The clock is ticking.

 

103 Ebola cases registered in Guinea as deadly virus hits capital, neighboring states.

Guinea's capital Conakry was on high alert on Friday after a deadly Ebola epidemic which has killed dozens in the southern forests was confirmed to have spread to the sprawling port city of two million people.

Guinea’s capital Conakry was on high alert on Friday after a deadly Ebola epidemic which has killed dozens in the southern forests was confirmed to have spread to the sprawling port city of two million people.

Guinea’s capital Conakry was on high alert on Friday after a deadly Ebola epidemic which has killed dozens in the southern forests was confirmed to have spread to the sprawling port city of two million people. Four people believed to have been infected after attending the funeral of a brother in central Guinea have been put into isolation centres to avoid the highly contagious virus getting into the population.

Aid organisations have sent dozens of workers to help the poor west African country combat a haemorrhagic fever outbreak which has killed at least 66 people, many of whom have been confirmed to have been infected by Ebola.

“Intensive case investigations are underway to identify the source and route of these patients’ infection, record their travel histories before arrival in Conakry and determine their period of infectivity for the purposes of contact tracing,” the World Health Organisation (WHO) said in a statement.

Guinea is one of the world’s poorest nations despite vast untapped mineral wealth, with a stagnating economy, youth unemployment at 60 percent and a rank of 178th out of 187 countries on the UN’s Human Development Index.

Residents of Conakry’s suburbs said they feared venturing into the city centre to shop and were keeping their children home from school.

“I wonder what Guinea has done to God to make him send us this untreatable disease… I’m wary of anything that moves that could be a carrier of the disease,” said unemployed graduate Abdoulaye Soumah.

The 15-member Economic Community of West African States said the outbreak was now “a serious threat to regional security” and appealed for help from the international community. Fifteen new confirmed or suspected cases, including in the Conakry outbreak, were reported on Thursday, the health ministry said, bringing the total in Guinea to 103. The tropical virus – described in some health publications as a “molecular shark” – causes severe fever and muscle pain, weakness, vomiting, diarrhoea and, in severe cases, organ failure and unstoppable bleeding.Ebola had never spread among humans in west Africa before the current outbreak, but further suspected cases being investigated in Liberia and Sierra Leone could bring the total death toll to at least 77.
Scientists have examined 41 samples from victims, Guinea’s health ministry said, with 15 testing positive for the Zaire strain of Ebola, the most virulent.

The WHO said Liberia had reported eight suspected cases of Ebola fever, including six deaths, while Sierra Leone had reported six suspected cases, five of them fatal. Transmission of Ebola to humans can come from wild animals, direct contact from another human’s blood, faeces or sweat, as well as sexual contact or the unprotected handling of contaminated corpses.

The health charity Doctors Without Borders, known by its French initials MSF, said the spread of the disease was being exacerbated by people travelling to funerals in which mourners touch the bodies of the dead.

Guinea has banned the consumption of bat soup, a popular delicacy in the country, as the fruit bat is believed to be the host species. No treatment or vaccine is available, and the Zaire strain detected in Guinea – first observed 38 years ago in what is today called the Democratic Republic of Congo – has a 90 percent death rate.Customers in a suburban cafe in Conakry described the epidemic as “divine retribution” and “a curse that has befallen us and will allow us to reflect on our daily behaviour”.

“There is total panic among the population,” said Fanta Traore. But the WHO played down fears of a massive spread, pointing out that the disease typically caused much less death and sickness than influenza, and adding that it was not recommending travel restrictions.

“Outbreaks tend to be limited. But certainly we need to watch this extremely carefully because there is no treatment, there is no cure and the course of the disease is more often than not fatal,” WHO spokesman Gregory Hartl told reporters in Geneva.