The Egyptian authorities have been taking measures over the past couple of weeks to prevent a plague outbreak in neighbouring Libya from reaching Egypt.
One person has died and five more were infected with bubonic and septicaemic plague in the eastern Libyan town of Tubruq, some 150km from the Egyptian border, according to the World Health Organization (WHO).
“An international [WHO] expert went there and assessed the situation. On 21 June, there were five suspected cases, according to his report; one septicaemic plague who died and four bubonic who recovered,” Dr John Jabbour, emerging diseases specialist at the WHO office in Cairo, told IRIN on 5 July.
Jabbour said the WHO expert in Libya had made recommendations to the Libyan authorities on how to educate communities about the disease and its modes of transmission and how to improve surveillance systems in infected areas. He said a team of international experts was being assembled to provide a wider assessment of the situation.
“What we can say here is that the situation is under control and being very well monitored by the national authorities and there is active surveillance in the area to discover any suspected case of plague,” Jabbour said.
According to London-based newspaper Al-Quds Al-'Arabi, Algeria has reported 50 cases of bubonic plague and two deaths.
Interactive map showing Tabruq in Libya
The Egyptian government has declared a state of emergency along the Egypt-Libya border and sent two teams of experts to the border town of Sallum, which was already under quarantine for surveillance of the A(H1N1) virus, to set up a field laboratory and isolation facility. Health checks are being conducted on everyone returning from Libya.
“The medical team on the border was supported with more doctors to survey all the cases that come in. No suspected cases have been registered to date and we think the disease was completely controlled on the Libyan side,” Abdel Rahman Shahin, spokesman of the Egyptian Ministry of Health, told IRIN on 6 July.
Shahin said that pest control teams had been sent to the border and were spraying all vehicles coming through Sallum, to kill rodent fleas. “Rodent traps were also put in open areas, while special teams trapped a number of rat fleas and tested them to make sure they are free of the disease. The authorities also got rid of the garbage at Sallum crossing and the exit points of Marsa Matrouh city, which is a very important preventive measure because garbage in open areas can facilitate the reproduction of rodents,” he said.
Bubonic plague epidemiology
According to WHO, infected persons usually start with “flu-like” symptoms after an incubation period of 3-7 days. Patients typically experience the sudden onset of fever, chills, head and body-aches, and weakness, vomiting and nausea.
WHO stresses that rapid diagnosis and treatment is essential to reduce complications. Effective treatment methods enable almost all plague patients to be cured if diagnosed in time.
Clinical plague infection manifests itself in three forms depending on the route of infection: bubonic, septicaemic and pneumonic.
Plague is a bacterial disease caused by Yersinia pestis, which primarily affects wild rodents or rats. It is then spread from rat to rat by fleas. If a human is bitten by an infected flea, he or she would usually develop a bubonic form of plague (a form that enters via the skin), characterized by a swelling of the nearest nymph node to the bite. If diagnosed early, bubonic plague can be successfully treated with antibiotics. It has a case-fatality ratio of 30-60 percent if left untreated.
The septicaemic form of plague occurs when infection spreads directly through the bloodstream without evidence of a "bubo". It may result from flea bites and from direct contact with infective materials through cracks in the skin.
The rare pneumonic form of plague is the most virulent as it can be transmitted from human to human via aerosolized infective droplets without the involvement of fleas or animals.
According to WHO, plague is endemic in many countries in Africa, in the former Soviet Union, the Americas and Asia. In 2003, nine countries reported 2,118 cases and 182 deaths - most in Africa.