The terrain of the plague-endemic region of Uganda
CDC scientists are developing better ways of detecting the world’s most deadly diseases. In this guest blog post, Dr. Paul Mead, a medical epidemiologist with the Division of Vector-Borne Diseases (DVBD) at CDC, explains how he and a team of scientists are using a quick and affordable handheld test to detect plague in patients in a matter of minutes – critical for such a rapidly fatal disease.
This tool – developed by Dr. Marty Schriefer and his team at DVBD – is being used in collaboration with the Ministry of Health and village leaders to save lives in rural Uganda, where laboratories for diagnosing diseases like plague are rare. In addition to improving the diagnosis and treatment of plague in communities still ravaged by the disease, DVBD is evaluating ways to prevent human plague altogether by reducing exposure to rats and their disease-causing fleas.
The Words of Dr. Mead:
Plague is a rapidly fatal flea-transmitted disease with a storied past. Beginning in 1347, the so-called “Black Death” swept through Europe, killing an estimated 25 million people in five years. The disease reached the U.S. in 1900, aided by the newly invented steamship, and during World War II Japanese planes dropped clay pots with plague-infected fleas over China, reportedly triggering outbreaks.
Plague is not the scourge it once was, but it continues to cause death and disability in rural Africa, including the West Nile region of northern Uganda. CDC’s Division of Vector-Borne Diseases (DVBD) runs a program in the region, working to build local health infrastructure and control this devastating but treatable disease. This multidisciplinary work can be illustrated through the recent case of a Ugandan farmer and the team who saved his life.
On October 12, a 27-year-old Ugandan farmer in the Arua District experienced the sudden onset of a very high fever and a painful swelling in his left groin. He consulted a nearby traditional healer, who ordinarily would have treated the man with herbal or perhaps spiritual therapies. Fortunately, this particular healer had been trained to recognize plague as part of a CDC study in the area.
The plague patient (in blue shirt) and his wife
He immediately referred the man to the local clinic where a sample was taken for testing. Many places in rural Uganda have no testing capacity, and plague patients deteriorate so quickly that results from a central laboratory could come too late to administer lifesaving treatment. However, in this clinic and others, CDC has provided inexpensive, rapid test strips – called plague dipsticks and pictured below – developed by DVBD scientists in Fort Collins, Colorado, using the same technology as an at-home pregnancy kit.
Within 15 minutes, the Ugandan farmer’s test yielded a positive result. The patient was promptly enrolled in a CDC-sponsored trial evaluating the effectiveness of ciprofloxacin for treatment of plague. He received the study drug, and within a single day his fever had resolved. Within three days, he was back working in his field, growing food to support his wife and young children.
This man’s infection was ultimately confirmed by standard culture techniques, but without such prompt recognition and treatment, his chances of dying were about 50:50. Furthermore, there is the chance that the pathogen would have spread to his lungs, into his sputum, and from there to his family and caregivers, triggering an outbreak of pneumonic plague that could have devastated his village.