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‘Black Death’ is not that deadly
South Africa has been declared at risk for plague importation, by the World Health Organisation, one of nine countries in this category, on account of trade and travel between the country and the Indian Ocean island. The first thing Professor Lucille Blumberg points out is that “Black Death”, a term used to describe the plague that has broken out in Madagascar, is a misnomer.Jews have a history with the plague. In the mid-fourteenth century, they were accused of having deliberately poisoned the wells – possibly because they were less affected than others through being isolated in ghettos and due to a general sense of anti-Semitism at that time – and were blamed for the outbreak of the Black Death in Europe which resulted in a third of its population perishing.
MOIRA SCHNEIDER
The violent attacks against Jewish communities that followed, came to be known as the Black Death persecutions and massacres.
The first massacre saw the Jewish quarter in Toulon, France, sacked and 40 Jews murdered in their homes, followed by similar actions in Barcelona in Spain. Hundreds of Jewish communities were destroyed during the period 1348 – 1350, with some individuals killing themselves to avoid persecution.
Blumberg, who is medical consultant at the National Institute for Communicable Diseases (NICD), explains that the plague used to be called the Black Death because a large number of people were affected, many died and because of the blood-borne phase of the disease.
“Their tissues appeared black, because they had damage to tissues and they also had haemorrhage into tissues. And I guess black also referred to the high number of cases and huge number of deaths.
“But that was then,” she says. “It’s a different disease now, it’s treatable.
“We have antibiotics that are highly effective – it’s not a bacterium that has developed resistance, so it is treatable with some antibiotics that are quite readily available.”
The key focus should be on early diagnosis and treatment with the correct antibiotics, she stresses, adding that the severe form of the illness, pneumonic plague, is quite rapidly progressive and has a high mortality rate.
There are three forms of the disease: bubonic plague is the common one that usually results from the bites of fleas that have been infected by rodents and carry the bacteria. Painful, swollen lymph nodes in the groin, armpit or neck are symptoms. If not treated at this stage, it can progress to either a blood infection (septicaemic plague) or severe pneumonia (pneumonic plague).
“What happened now (in Madagascar) is that there were a lot more cases of pneumonic plague – that is spread person-to-person (through coughing and sneezing) and it’s highly infectious.”
The deaths that have occurred, she surmises, could be due to the fact that people have presented late for treatment.
“You have to bring treatment to the people – you have to make it accessible and teach them about symptoms and what to do.”
There are, however, no travel restrictions to Madagascar in place and Blumberg thinks that the risk there is “quite low” unless one is living in a rural environment where fleas are more common. “They have an annual seasonal increase from plague – it’s not unusual,” she adds.
The current outbreak is, however, unusual in that it has affected urban areas, increasing the risk of transmission.
So, how can people protect themselves? “I think it’s avoiding crowded places – I don’t think tourists are at great risk,” she says.
“I think it’s about protecting yourself against flea bites if you’re in the more rural areas.” The NICD website advises the liberal application of DEET-containing insect repellent to prevent flea bites. Prophylactic antibiotics are not advised.
“All travellers returning from Madagascar must monitor their health for 15 days and seek medical care immediately at their nearest health facility, if they develop fever, chills, head and body aches, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum.
“They should tell the doctor about their recent travel and their symptoms. Persons with fever should also be tested for malaria,” it states.
While we are a country at risk of plague, the last cases were in 1982. “We do have a monitoring programme for plague,” says Blumberg.
Blumberg is confident the country is prepared for any eventuality in this regard. “There are a lot of things in place.
“Your risk of getting malaria in Madagascar is probably higher than plague and I think it’s important to remind people to protect themselves against malaria and not come back with a fever and cause confusion.”