Zambia plague outbreak yields lessons learned — again

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When the first children with fevers and swollen neck glands arrived at public health clinics in the Nyimba District of Zambia in March 2015, health workers tested them for malaria. And when results showed the children had the mosquito-borne disease, they were given the standard treatment for that illness and sent home. As more patients turned up, though, a  subsequent investigation found they also were sick with bubonic plague, a disease with a death rate of from 66 to 96 percent in the absence of swift antibiotic treatment. In the course of delays in diagnosing the disease during an outbreak in Zambia’s Eastern Province last year, three children died and 21 were sickened, according to a report from the U.S. Centers for Disease Control and Prevention this week. Children in the area were more vulnerable to infection (all patients were between 3 and 18 years old), according to the report, because they were likelier than adults to sleep on reed floor mats, putting them in easy reach of the vector that spreads the disease.

mmwr81116Transmitted by fleas from rats to people, bubonic plague killed at least a quarter of Europe’s population in the 14th century. Outbreaks have occurred with varying degrees of regularity in 15 African countries, including Zambia, where the disease was first reported in 1917, and where a 1997 outbreak in the country’s Southern Province led to 264 cases and 30 deaths. A news account of that outbreak recounted initial misdiagnoses and inappropriate treatment, adding that after laboratory staff from Lusaka, the nation’s capital arrived, the outbreak was controlled, with “lessons learnt.”

Plague commonly causes fever and swollen glands before leading to severe pneumonia, but the outbreak in Nyimba was the first recorded there, giving health workers less reason to recognize it. And even if they had, the report says, they lacked both the experience and resources to collect the specimens needed to diagnose it. And while local clinics’ access to rapid diagnostic tests for malaria sped the diagnoses of that disease, that in turn might have delayed diagnosis and treatment for a disease requiring immediate treatment, according to the authors.

The outbreak highlights needs for improved diagnostic tools, laboratory capacities and health worker training, the report says. For more on the outbreak, see the CDC Morbidity and Mortality Weekly Report, here.

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