Useful to teach MBBS students

1. Dr. R. Sowmya Pallavi MD.,

2. Plague of Justinian

3. Plague Pandemic
1st : Plague of Justinian (542 A.D.)
 10,000 deaths/ day in Constantinople
 Half of Europe's population — almost 100 million
deaths
2nd : Black death (14th - 19th century)
 1/3 of people were killed in Europe.
3rd : From China and reached India by means of ship.

4. Mass burial

6. Global level
2010 - 15
 3,248 cases
 584 deaths

7. Outbreak in Madagascar - 2017

8. Famadihana
"The turning of
the bones" or
"body turning.“
Exhuming bones
Rewrapping
Dancing with the
wrapped corpses

9. India
12.5 million deaths
-- 3rd pandemic
1959
Eliminated
1967
Plague free
India
2004
Localized outbreak
of bubonic plague
(8 cases ; 3 deaths)
in Dangud village,
Uttarkashi

10. Epidemiological determinants

11. Agent factors
• Yersinia pestis
• Gram negative, non
motile cocco-bacillus
• Bipolar appearance
• Reservoir : Wild rodents
• India -- Tatera indica
Alexander Yersin

12. Tatera indica
Rattus rattus

13. Host factors
• Age & Sex
• Human Activities
• Movement of people
• Immunity

14. Environmental factors
• Season: September - May
• Temp : 20 to 25 deg. C
• Relative humidity: 60 %
• Rainfall
• Urban and rural
• Human dwellings

15. Vectors
 X. Cheopis
 X. astia
 X. brasiliensis
 Pulex irritans

16. Blocked flea
Block the proventriculus

17. Flea indices
• To measure the density of fleas
• To evaluate effectiveness of spraying programmes
 Total flea index
 Cheopis index: >1 - plague outbreak
 Specific percentage of fleas
 Burrow index

18. Modes of transmission

19. Natural foci
• Latent infection in rodents,
• Dev.t of resistance to plague infection by some
rodents
• Survival of rat fleas for as long as 4 years in rat
burrows - most likely mechanism
• Variations in the pathogenecity of Y. pestis
• Survival ; multiplication of plague bacilli in the soil of
rodent burrows.

20. SILENT PERIODS
Silences of long durations f/b sudden explosive attacks
• Reintroduction
• Bacilli -- multiply in soil of rodent burrows; healthy
rodents reoccupy ; infected.

21. Incubation period
• Bubonic plague -- 2 to 7 days
• Septicemic plague -- 2 to 7 days
• Pneumonic plague -- 1 to 3 days

22. Clinical forms

23. Pneumonic plague

24. Lab Investigations
• Staining: Giemsa's or Wayson's
• Culture
• Serology
• Other methods

25. Prevention and Control

26. 1. Control of cases
• Early diagnosis
• Notification
• Isolation
• Treatment
• Disinfection
"Rat Falls"

27. Treatment
 30 mg/kg /daily
 IM
 2 divided doses
 7 to 10 days

28. Treatment
30-40 mg / kg

29. Treatment
 2 mg/kg LD
 then 1. 7 mg/kg
 every 8 hours
 IV

30. 2. Control of fleas

31. 2. Control of fleas

32. 2. Control of fleas

33. 3. Control of rodents
• Continuous mass destruction
• Long-term policy

34. 4. Vaccination
• Haffkine
• Subcutaneous
• 2 doses
• 0.5 and 1.0 ml
• Interval - 7 to 14 days
• Booster doses – every 6 months

35. 5. Chemoprophylaxis
500 mg
6-hourly
 for 5 days

36. 6. Surveillance
7. Health education
• Prompt reporting of dead rats and suspected
human cases