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Plague Makes a Comeback

by Khandaker Tanvir Ahmed and S A Khan Mailish
FROM time immemorial plague has dogged man's journey towards advan-eement and at various periods in history it has taken a heavy ’oil on human Ilves. The • urrent incidence of plague in India Is. in fact, an indication if the epidemics of plague in its natural foci which are wid-Hy scattered in all countries. Plague becomes active perio-dically in cycles of 3-5 or 8-10
The causative organism I vsinia pestis is a small bacteria which spread among rats by • hen fleas. If domestic rats be-
■me infected then their fleas may bile man and man may also fall victim to plague. There may be interhuman spread by < aughing. Plague may occur in 'hree different forms. The Bubonic plague is the commonest the onset is sudden with rigour, high fever, dry skin and severe headache with characteristic painful swollen lymphnodes — buboes' in the groin There is also a chance of toxaemia with rapid pulse, hypotension and mental confu-sior at the advance stage In
Bubonic plague interhuman spread is quite rare. In Pneumonic plague the onset is also sudden with breathlessness and copious frothy blood stained expectoration. It Is highly infectious and spread from man to man by caughing. The Septicaemic plague is yet another a rare phenomenon except for accidental laboratory infections.
Early diagnosis in case of plague is urgent. Microscopic examination of blood, sputum and aspirate from a bubo can reveal the organism in humans. "Rat falls'" (dead rats) provide a useful warning of a possible outbreak.
Isolation — it is recommended in all cases of human plague.
Treatment — should start instantly without waiting for the diagnostic report to come. The drug of choice is streptomycin administered intramus-
cularly In two divided doses at 30 mg/kg body weight per day for 10 days. Tetracycline can be given orally as an alternative drug.
Prevention — the most effective method is to break the chain of transmission (Rat-flea-man). Insecticides like DDT. Malathion should be given into rat-holes and also in the fields. Insecticidal spraying upto a radius of 5 miles around each infected locality is thought to bi’ adequate. Rodenticides are of equal importance.
Vaccination as per WHO recommendation the vaccine is given subcutaneously in two doses of .5 and 1.0 ml at an interval of 7 to 14 days. Booster dose is recommended after 6 months.
Surveillance and quarantine measures should be strictly implemented for effective control of plague. Emphasis must
also be given on the need for the prompt reporting of dead rats and suspected human cases for prevention. Medical practloners should keep the thought of plague in. mind in differential diagnosis of any case of fever with TtW phadenopatny or when multiple cases of Pneumonia occurs. Attendants of the suspected patients must wear gowns, masks and gloves for protect ing themselves and those around them.
The government and its various municipal corporations must take appropriate measure to improve the overall urban and rural environment situation through proper disposal of daily wastes. Special emphasis should be given on rat control and effective reporting of dead rats from all the surrounding habitats. Media should also work In cooperation with health and social workers to create public awareness on this matter.
The writers are. Final Yr students of Sir Salimullah Medical College. Dhaka.