Rare Bubonic Plague outbreak from pet dog – and possible human transmission

Two exceptions to the rule – bubonic plague not from rat fleas, but from a pet dog; and possible human to human transmission – the first in USA in 90 years.

As a former laboratory manager I was mindful of the “rare ones” i.e. identifying diseases that are exotic or rarely seen – or more importantly, missing the diagnosis. More so if the disease is communicable.

In a recent CDC MMWR, Runfola, House, Miller, et al. published such an event occurring in Colorado.

The index patient was admitted to hospital ill with fever and cough, worsening to pneumonia. A lab culture automatedly misidentified the pathogen as Pseudomonas luteola but as the patient’s condition worsened, the culture was sent to the state lab and correctly identified as Yersinia pestis, the cause of bubonic plague.

Investigation revealed the dog had recently died, and three persons who had contact with the dog were found to be ill, two with pneumonia. One of the three had contact with the index patient and human to human transmission could not be ruled out. Two of the cases were veterinary employees who euthanized the ill dog.

In total, 114 people were investigated as they had contact with the dog or the index patient. No other cases were detected and the four patients recovered with appropriate therapy.

Untreated Bubonic plague (the “Black Death”) can be fatal in 93% of cases and although the initial laboratory misidentification resulted in occult exposure to numerous healthcare workers, an astute physician and rapid investigation resulted in zero fatalities in this outbreak.

The lesson: double-check organism identification if patient has plague-like symptoms (this is third time Y. pestis has been mistaken for P. luteola).

 

PS. I returned home this week from Sierra Leone and will write an “update” post asap.

 

Day 13 – Sierra Leone

Hi all,

I haven’t “gone to ground” – just full-on training 75 nurses/docs in Infection Prevention & Control – 10 hrs teaching a day – v rewarding – group is amazing – intelligent, fun and passionate about IPC – all passed Week 1 exam – now in week 2 (practice, practice, practice).

Ebola has devastated SL economically, socially and educationally – schools and univ have been closed 8 months (teachers not paid), still no body contact, all shops must close at 6pm to avoid crowds (beaches are closed to SL’s – but strangely we were allowed to enter beach – ??expats can’t spread Ebola.

Do not touch dead bodies

Signs everywhere remind us of Ebola threat. In developing countries Ebola’s “Reproductive Number” is 2 (i.e. 1 case leads to 2 others) but last week a single case in a remote village led to 57 cases! The reason – “women’s secret things” (incl bathing of children in dead body wash-water to pass on “power’ of female leader) and “exorcism” – emphasizing persistent need for health education in remote areas – hence intense training of 75 to “spread (the correct) word”.

PS. I have never seen so many humanitarian organizations in one place! Amazing inflow of compassion.

Good news is that beds in “Ebola Treatment Centres” are at 12% capacity – we’re meeting this weekend to discuss decommissioning and recovery of resources for distribution to “non-Ebola” resource-poor healthcare facilities (after disinfection of course).

Liberia discharged its last case of Ebola last week – we hope Sierra Leone can do same within 3 months?

Regards to you all, Terry

Sierra Leone – Rule #1 – no handshakes

After a 15 hr event-full trip from WHO Geneva I arrived in Freetown, Sierra Leone (SL) capital, yesterday at 8am to the sound of crowing roosters (they got up late).

Jet lag, hungry (I can never decide) – breakfast won and I was immediately “adopted” by Michael Cosby (USA) and Shoaib Hussan (India), two WHO volunteers.

An hour later I was sitting in the midst of their weekly “Epi” (Epidemiology) meeting – a boiler-room of amazing teamwork and activity coordinating all intelligence on cases as they are confirmed – I say amazing as they are all on 6-12 week deployments, all work 7 days a week – Johann Conzalez (Columbia) was up till 1am completing a survey map for a news release that day. Their dedication under the leadership of Eilish Cleary (Canada) was humbling.

Twice I forgot and extended my hand – only to be embarrassingly reminded “No handshakes here“.

Eilish took me to “IPC” (infection Prevention & Control) and had to reassure Mandy (Canada) she was not poaching me (newbies are grabbed by anyone – there is such a need). To my surprise the IPC Leader is Julie Storr (UK), former UK IPS President.

Talk again soon. My CDC-ICAN Train The Trainer (TTT) colleagues arrive tmrw – we start Monday.

Rooster is crowing again – poor thing needs a clock.

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Sierra Leone – rule #1 – No handsake

After a 15 hr event-full trip from WHO Geneva I arrived in Freetown, Sierra Leone (SL) capital, yesterday 8am to the sound of crowing roosters (they got up late).

Jet lag, hungry (I can never decide) – breakfast won and I was immediately “adopted” by Michael Cosby (USA) and Shoaib Hussan (India), two WHO volunteers.

An hour later I was sitting in the midst of their weekly “Epi” (Epidemiology) meeting – a boiler-room of amazing teamwork and activity coordinating all intelligence on cases as they are confirmed – I say amazing as they are all on 6-12 week deployments, all work 7 days a week – Johann was up till 1am completing a survey map for a news release that day. Their dedication under the leadership of Eilish Cleary (Canada) was humbling.

Twice I forgot and extended my hand – only to be embarrassingly reminded “No handshakes here“.

Eilish took me to “IPC” (infection Prevention & Control) and had to reassure Mandy (Canada) she was not poaching me (newbies are grabbed by anyone – there is such a need). To my surprise the IPC Leader is Julie Storr (UK), former UK IPS President.

Talk again soon. My CDC-ICAN Train The Trainer (TTT) colleagues arrive tmrw – we start Monday.

The rooster’s still crowing – poor thing needs a clock.

Which patient clipboard is more sanitary – wood or plastic?

In this week’s APIC Listserve, Kim Roberts posed a great Q…Which clipboard is more sanitary – wood or plastic/metal?
All answers received to date state that plastic/metal clipboards would be more hygienic than wood as the latter was porous and could not be as easily decontaminated as non-porous plastic/metal.
In this specific case I agree. Wooden clipboards are commonly made of compressed wood fibre and are usually quite porous.
The above conclusion is reasonable, but not evidence-based.
In fact the literature supports a contrary view – that wood is better.
In 1992 Kass et al found that Californian households using wooden chopping boards suffered Salmonella food poisoning at half the state average, and those using plastic boards were twice the state average.
Independent of Kass et al, in 1994 Ak, Cliver and Kaspar at Univ Wisconsin-Madison challenged wooden and plastic boards with pathogens and found they disappeared in a short time from wooden boards but persisted on plastic boards, Furthermore they found nicks in plastic boards were harder to disinfect.
Cliver, now at UC Davis, commented on both studies and concluded in 2005 that, “…wooden cutting boards are not a hazard to human health, but plastic cutting boards may be.”
But I suspect the results with dense-wood chopping boards do not apply to porous fibre clipboards.

So keep writing on plastic and chopping on wood.