Seminar presentation on epidemiology ,control and management of plague

1. EPIDEMIOLOGY,
CONTROL &
MANAGEMENT OF
PLAGUE.

2. • INTRODUCTION

3. Cont
Plague is a zoonotic diseases caused by yersinia
pestis, found in a small mammals. It is
transmitted between animal by their fleas. The
bacteria, the animal reservoir and the vector in a
given area collectively called a “plague natural
focus”.

4. HISTORY OF PLAGUE
Plague has been responsible for wide spread pandemic
throughout history including the so called a black death that
caused over 50 M death in Europe during 15th century.
In 1994 plague in India was an outbreak of bubonic and
pneumonic plague in South central and western india from 26th
August to 18th October 1994.
693 suspected cases and 56 deaths were reported from the five
affcted indian states as well as the Union territory of delhi.

5. DEFINITION
Plague is a diseases that affects humans and
other mammals. It is caused by the
bacterium,yersinia pestis.

6. EPIDEMIOLOGICAL DETERMINANTS
AGENT FACTORS
AGENT : causative agent – yersinia pestis.
Bacilli occur in great abundance in buboes, blood,
splen, liver and other viscera of infected person
and in sputum of pneumonia plague.
Plague bacilli can survive and multiply in soil of
rodent burrows, where micro – climate and other
conditions are favourable.

7. Cont
RESERVOIRS OF INFECTION:
Wild rodents are the natural reservoir Or plague.
E.g ; field mice, skunks, gerbills, and other small animals.
These are found in mountain, desert, cultivated area and
forest in temperature and tropical region.
In india, the wild rodent, TATERA indica has been
incriminated as the main reservoir.

8. Cont -
Sources of infection:
1. Infected rodents
2. Fleas
3. Cases of pneumonic
plagues.

9. HOST FACTOR-
1. Age and sex :
2. Human activities:
3. Movement of people:
4. Immunity
5. Race
6. Ethnicity

10. ENVIRONMENTAL FACTORS-
1. Season
2. Temperature and
humidity
3. Rainfal
4. Urban and rural areas.
5. Human dwelling

11. PATHOPHYSIOLOGY
It consists of two components:-
1. The transmission of bacteria from fleas
2. The host response to the bacteria

12. 1. The transmission of bacteria from fleas.

13. Cont
The host resonse to the bacteria

14. HUMAN PLAGUE
Mode of transmission-
1. Bite of infected flea
2. Direct contact with tissues of infected
animal.
3. Droplet injection from cases of
pneumonic plague.

15. Cont

16. INCUBATION PERIOD
1. Bubonic plaque :2 to 7 days.
2. Septicaemic plague: 2 to 7 days.
3. Pneumonic plague : 1 to 3 days.

17. Types of plague diseases in man
1. Bubonic plague :- most common
The infected rat fleas usually bite on the
lower extremities and inoculate the bacilli.
The bacilli are intercrepted by the regional
lymphatics glands where they proliferate.

19. Typical feature of bubonic plague
Sudden fever, chills, headache, prostration.
Painfull lymphadenities
It can’t be spread from person to person.
Enlarged lymph nodes develop in the groin, and
less often in the axilla or neck, depending upon
the site of bite by flea.

20. Pneumonic plague
Primary pneumonic plague is rare.
It follows complication of bubonic septicaemic plague.
The incidence of bubonic plague is usually 190.
Its highly infectious nad spread from man to man by
droplet infection.
The plague bacilli are present in the sputum.
It is also known as black death

21. Septicemic plague
Primary septicaemic plague is rare except for
accidental laboratory infections.
Untreated septicemic plague is almost always fatal.
Early treatment with antibiotics reduces the mortality
rate to b/w 4 and 15 percent.
It may cause death before anything symptoms occur.
If the bacteria enter the blood stream rather then the
lymph or lungs, they multilply and causing bqcterium
and severe sepsis.

22. Clinical manifestation

23. Laboratory investigation
1. STAINING
2. CULTURE
3. SEROLOGY
4. OTHER METHODS.

24. Complication
Complications of plague may include
1. Death
2. Gangrene
3. Meningitis

25. Prevention and control
Control of cases
Early diagnosis during epdemic situations
diagnosis can be made on clinical grounds.
E.g acute fever.
In other situation “rat flea /dead rat provide
a useful warning a possible outbreak.
Plagur suspected of a human and rodents
must be examined bacteriologically to
confirm the presence of plague.

26. Cont
Notification- If a human or rodent case is diagnosed
health authorities must be notify.
Case notification is required by international health
regulation.
ISOLATION- Although most bubonic plague patients are
non-infectious , isolation is recommonded whenever
possible.

27. Cont

• Treatment -must be started without waiting for
confirmation of the diagnosis.
• The drug choice is – streptomycin (30mg per kg
of body weight daily) 1m in 2 divided doses for 7 to 10
days
Tetracycline,orally (30-40mg per kg of body
weight daily and sometime given in combination with
streptomycin,
Gentamycin, 2mg 1kg of body weight loading

28. Cont
Dose, then 1-7 kg body weight every 8 hours
intravenously.
Sulphonamides may be used , if other drugs not
available
DISINFECTION - Disinfection of sputum ,disincharges
and articles soiled by the patients should be carried
out.
Dead bodied shoudh be handled with aseptic
precautions.

29. Cont
CONTROL OF FLEAS
 Most effective method to break the chain of transmission is
distruction of rat fleas by insecticides.
 DDT 10% and BHC 3% should be used as dust.• In areas of
resistance to one or both of these, oust of carbaryl 2%or
malathion 5% is used.
The organochlorine insecticides remain effective for 2 to 4
months. Before sprying remove all foodstuffs and eating
cooking vessels from the house.
Insecticidal spraying upto,the radius of 5 miles around each
infected locality is consideraded adequate.

30. Cont
3.) CONTROL OF FLEAS - continuous destruction or
rodent is important plague preventive measure
4.) VACCINATION- immunization with plague vaccine is a
valuable preventive measure.
Vaccination should be carried out at least week before
an antipated outbreak and the vaccine should be given
in 2 doses.

31. Dosage of plague vaccine
Age and sex Ist dose 2nd dose Six monthly
Adult male
Adult
females
Children
1-4 yearrs
5-10 years
11-16 years
Infants under 6
months are not
immunized
0.1 ml
0.75 ml
0.2 ml
0.3ml
0.4 ml
1.5 ml
1.0 ml
DoubLe the f
First dose
1.0 ml
0.75 ml
Same as
the dose

32. NURSING MANAGEMENT
1. DIAGNOSIS: chest pain related to resouartory
system.
Goal: To maintain respiratory problem.
Assess vital sign
Auscultate breath sound
Give comfort position to patient
Encourage breathing exercise to patient

33. C
Diagnosis :- Altered body Temperature related to
infection as evidenced by hyperthermia.
Goal:- To maintain normal body temperature
Intervention :- provide assessment to patient and take
vital sign for baseline data
Provide cool and calm environment to the patient
- Windows and doors are open and air ventilation by
fan are provided
- Provide asepsis care to patient
. Provide anti- pyretics meditation as prescribed by
physician

34. 3.) Diagnosis :- Deficient fluid volume r/t
vomiting.
Goal:- To maintain fluid volume
Intervention :- Monitor for possible sources of fluid loss
 Monitor the clients intake and output
monitor coagulation studies – administer anti-diarrheal
medication as
prescribed, in addition to IV fluids. -.
 Prepare IV fluids and electrolyte balance

35. 4.) Diagnosis :- Anxiety related to change
in health status
Goal :- To improve health status
Intervention :- Assess the client level of anxiety
 Acknowledge and awareness of client anxiety
 reduce unnecessary external stimuli by maintaining a
quiet environment
maintain a confident assured manner while interacting
with the client

36. 5.) Diagnosis :- Risk of infection
related to unhygienic activity of
patient
Goal :- To provide healthy and hygiene routine to patient
Intervention :- Monitor the patient daily care routine and activities
- find out the unhygienic activities of the patient
- provide healthy education about healthy hygiene and its importance to
patient
- provide support and assistance in day to day care to patient
- provide a family health education to patient
-. Remove excessive and tight clothing

37. 6.) Diagnosis :- decreased cardiac output
due time alteration in hear rate.
Goal: To maintain the hear rate
Intervention:
Assess client’s heart rate and bp Including peripheral
pulses like direct intra arterial monitoring as order.
Monitor oxygen as order.
Assessed for any change in level of consciousness.
Provide electrolytes replacement as prescribed.
Administer fluid and blood replacement therapy as
prescribed

38. HEALTH EDUCATION
Health education is an essential part of any plague
control programme.
EmPhasis Must be placed On the need for the
prompt reporting of dead rats and suspected human
so that preventing measures can be taken.
Medical practitioners should keep plague in mind for
differential diagnosis of any cases of fever with
lymphadenopathy, or when multiple cases of
pneumonia occur.
Fill holes and gaps in home to stop mice, rats and
the squirrel from getting in.

39. Cont
Wear gloves while touch wild animal alive
or dead.
Use flea control spray or other treatment
on pet.

40. RESEARCH ARTICLE
Published 10th April 2020
Research done by – Catherine killer.
Title : soil salinity and aridity specify plague
foci in the United status of America.

41. Cont
Abstract : plague is a deadly ZOONOSIS that periodically
remerges as small outbreaks in geographically limited foci
where the causative agent YERSINIA PESTIS may reside in soil.
We analyzed a data set of 1.005 carefully documented plague
cases that were geo referenced over 113 years in peer. –
reviewed literature in the contiguos United status. Plotting
outbreaks by countries defined as plague foci on
geographical maps. We observed a significant co localization
of plague outbreaks with high soil salinity measured by an
electric conductivity of >4ds /m and aridity measured by an
atidity index <0.5

42. Summary
Today we learned about the definition of plague,
their cause, host factor and environmental factor and
how to diseases can transmit from animals to men
and their incubation timr to know the sign and
symptoms of plague. Then we learned about
different types of plague, their laboratory
investigation, and their prevention and control of
plague, their management, vaccination treatment.

43. Conclusion
Plague is infectious disease that can easily transmitted
from men to men. In some cases not reated Earlier it is
100%fatal.rodents are the reservoir of plague. All age
group and both sexes are susceptible to disease. Plague
is responsible for widespread throughout the history.
Now a days, vaccine are available globally 600 cases are
report in year but now treatment has lowered mortality
rate to approx 11%.

44. BIBLIOGRAPHY
Park’s textbook of preventive and social
medicine, 23rd medicine.
Robert D. And Jacqueline D. Fathets on.
Yersinia pestis – etiology agent of plague,
clinical mucrobiology reviews jan, 1997.pg -
35 to 66 volume -10(1)
Internet sources.. www. En.M.Wikipedia.
Org/wiki/Plague diseases