Prompt Interventions Prevented Spread of Pneumonic Plague in Uganda

A case of pneumonic plague imported to Uganda from Democratic Republic of Congo (DRC) last year demonstrated how effective response efforts can prevent spread of the disease.

A recent Morbidity and Mortality Weekly Report from the US Centers for Disease Control and Prevention (CDC) detailed an instance of the rare but highly fatal pneumonic plague caused by Yersinia pestis after a woman living in the DRC contracted it and was transported to her family’s village in Uganda, where her sister also fell ill about 72 hours after caring for the patient.

“Rapid identification of suspected pneumonic plague in the remote West Nile region of Uganda and the timely response by well-trained Ugandan health officials in the form of contact tracing, antibiotic prophylaxis, and community education, prevented additional cases of plague from occurring,” CDC epidemiologist Kiersten Kugeler, PhD, told Contagion^®.

The patient was found gravely ill by family members who traveled to the DRC from Uganda on Feb. 27, 2019, to attend the funeral of the patient’s 4-year-old daughter. She was taken to a clinic in Uganda, where she died. A private health clinic in the DRC alerted the Ugandan government about suspected plague circulating in the village where the patient lived.

“Plague is a deadly disease that can cause epidemics if not recognized early,” Kugeler told Contagion^®. “A 2019 response to pneumonic plague in Uganda highlighted how swift action by local health officials, trained in epidemiology and plague laboratory testing by CDC, likely prevented a larger outbreak. Ugandan health officials traced the contacts of 2 individuals—a woman who had traveled from the DRC to Uganda shortly prior to death and the sister who cared for her and who had fallen gravely ill. Officials treated the sick woman and provided antibiotics to over 100 contacts. Proximity to the DRC, with its ongoing Ebola outbreak, initially complicated the diagnosis, but Ugandan health officials were familiar with pneumonic plague and quickly ruled out Ebola as a cause for concern.”

Officials identified 129 people who had close contacts with the patient or her sister and administered prophylactic treatment of doxycycline, co-trimoxazole, or ciprofloxacin. None of the contacts developed symptoms of plague, suggesting the disease is not as transmissible as often feared. Rapid diagnostic test (RDT), real-time polymerase chain reaction (PCR), and paired serology testing of the patient’s sister were positive for plague, and she was treated with gentamicin and doxycycline.

The study supported collection of multiple clinical samples, use of multiple tests, and cross-border collaboration, along with engagement with community leaders, members, health workers, and traditional healers to curtail the spread of plague.

“Continuing to invest in global health security is vital to stop outbreaks quickly at their source,” Kugeler told Contagion^®.

Cases of pneumonic plague in China last year generated headlines globally and raised concerns about the disease, which devastated the world in the 14^th century.

Caused by Yersinia pestis, the disease is commonly spread through the bites of rodent fleas as bubonic plague, through human-to-human respiratory droplets as pneumonic plague or in the blood as septicemic plague. Commonly attributed to rodents, more recent research has attributed the spread of Europe’s Second Pandemic to human fleas and body lice.