Egypt takes precautionary measures as plague fears grow along its western border, reports Reem Leila Health officials are on full alert after a suspected outbreak of bubonic plague in Libya. The disease appeared almost two weeks ago in a Libyan village 50km from the border with Egypt. Twelve cases have been reported, together with one death. It is thought the disease is a result of rising numbers of rats attracted by livestock being reared near homes. A state of emergency has been declared along the Egyptian-Libyan border. Health Minister Hatem El-Gabali toured the area on 17 June, inspecting measures to keep plague from Egypt. "Egypt is free of plague and we are taking precautionary measures to prevent it from entering. We are working with officials in Marsa Matrouh to sterilise the area," El-Gabali said. Strict measures are now in force along the border, and the army has been drafted in to help control rodents. "The armed forces are currently helping spray a wide area along the border. A preventive medicine committee from the Health Ministry has been sent to the border to strengthen surveillance activities," added El-Gabali. Cabinet spokesman Magdi Radi said in a press conference last week that Prime Minister Ahmed Nazif was monitoring the situation. Plague primarily affects rodents, and is spread between them by fleas. Humans who contract the plague through flea bites normally develop a bubonic form -- in other words, a form that enters via the skin. When a person is infected with the bacteria that cause bubonic plague, the bacteria begins to multiply within the lymph system. After two to six days symptoms of plague appear. If they are not treated quickly these symptoms can rapidly worsen and result in death. Early bubonic plague symptoms can include buboes, which are tender, enlarged lymph nodes under the armpits, in the neck, or in the groin, ranging in size from one to 10cm. Plague patients usually suffer fever, headache, chills, nausea, vomiting, abdominal pain, diarrhoea which may be bloody, decreased appetite and tiny broken blood vessels. Later symptoms are coma, stiff neck, fever and confusion. John Jabbour, of the Communicable Disease Surveillance Department at the World Health Organisation (WHO), warns that people can be infected by flea bites from insects hosted by infected rodents, inhaling infected droplets, or by direct contact with infected tissues or bodily fluids. "The WHO is sending an expert to Libya to look into the reported outbreak of bubonic plague," said Jabbour. The WHO recorded outbreaks of plague in Libya in the 1970s and 1980s. Plague is a very severe disease in people, with fatality rates of 50 to 60 per cent after three to seven days if left untreated. A press release issued by the WHO stresses that rapid diagnosis and treatment is essential to reduce complications. Effective treatment methods enable almost all plague patients to be cured if diagnosed on time. "These methods include the administration of antibiotics and supportive therapy," explains Jabbour. He stresses the importance of informing people of any areas where plague is active so they can take precautions against flea bites and in handling corpses in plague- endemic areas where direct contact with infected tissues must be avoided. Vaccines are not recommended for immediate protection in outbreak situations. "Vaccination is only recommended as a prophylactic measure for high-risk groups such as laboratory personnel who are constantly exposed to the risk of communication," says Jabbour. Hamed Samaha, head of General Authority for Veterinary Services (GAVS), is unwilling to put an estimate on the number of rats in Egypt. "Definitely they exceed 100 million. A female rat can produce up to 30 babies a year. They transfer more than 20 viral and bacterial diseases to humans," he says. Mohamed Tawfiq, head of the Central Administration for Pest Control at the Ministry of Agriculture and Land Reclamation, says that in addition to the ministry's operational plan to combat the rats throughout the year, control committees along the border with Libya, in Marsa Matrouh and the Al-Wadi Al-Gadid governorates, have been strengthened. "Rats must be totally eliminated not only out of fear of potential infection with plague but because they cost the government millions of pounds in treating patients infected with the other diseases they carry."
