Saturday, March 9, 2002

Going by the rule book to contain the disease
Chitleen K Sethi

THE first incidence of plague in the world in this century can safely be considered contained. Five deaths and health authorities of three states on high alert is what it took to combat the disease. Despite the national health authorities taking credit for the efficient snuffing out of a deadly and highly virulent disease that could have easily spread its tentacles beyond Hathkoti and Kansal, the fact remains that we are very lucky to have a premier health institute like the PGI catering to this region. Any comparison with the abysmal failure of the health authorities during the Surat plague might not be very fair since, by all accounts, the extent of the spread of the disease in North India was much lower than that in Maharashtra and Gujarat in 1994. According to one report, before pneumonic plague spread in Surat in September, more than 10 per cent of the population of Mamla village in Maharashtra was already suffering from bubonic plague till August end. Compare this to the figures we have here.

Basically, there were two families involved in this plague. The first person to catch the infection and die of the disease was Randhir Sahota of Hathkoti village in Rohru district of Himachal. He is the only one who died of bubonic plague and since he remained untreated, he spread it to his family members as pneumonic plague. Krishan Singh of Kansal village in Punjab had an unfortunate interaction with the Hathkoti family and caught the infection. He also died of plague but only after passing the infection to his wife and daughter.


Uncontrolled pneumonic plague spreads like wild fire from one person to another, through breath. One untreated pneumonic or bubonic plague patient can potentially infect the complete population of the area he lives in. And to think that we had more than 20 people suffering from the disease at some hospital or the other in the region, be it the Rohru Civil hospital, the PGI, the Sirsa Civil hospital, it really was a job well done that the disease has been contained. A success story but not without some uncomfortable pauses.

Randhir Sahota’s visited the hospital in Jubbal, two days before he died of plague. He was sent back home saying that he was suffering from cough and cold. Despite similar outbreaks of plague in the region in the early eighties, the local doctors working there had probably forgotten that diseases have regional tones and the symptoms have to be read in a geographical context. Not that the city doctors did any better. Krishan Singh was X-rayed on his first visit to the General Hospital, Sector 16, Chandigarh, two days before he died of plague. He was told that he was suffering from tuberculosis — at a time when newspapers were shrieking that there were six plague patients in the PGI.

The worst is still to come — the role played by the Mohali-based multi-specialty hospital called Silver Oaks. This hospital admitted a plague patient, had him for 16 hours but could not diagnose the disease. When the patient was about to die, the hospital authorities sent him away in an extremely virulent state to the PGI’s crowded emergency without any qualms whatsoever. Then when they realised that one of their own nurses who had treated the dying man had also caught the infection, they sent her too to the PGI against the institute’s advice that she should be given treatment in Silver Oaks itself. If there are any rules to be followed for the control of diseases like plague, this hospital violated them all.

And those who followed the protocol were the ones who contributed the maximum towards the containment of the disease. When the first set of patients arrived from Himachal to the PGI, they were kept in the PGI emergency. Since their referral hospital had no specific diagnosis of what Randhir’s wife Sulochana was suffering from, it was a good 30 hours before the "P" word started being used and the whole family was immediately isolated. Once it was clear what one was dealing with, the health authorities were quick to respond. The battle to combat this highly contagious disease had to be won. The treatment of the patients began under the charge of the Department of Internal Medicine, PGI, and after the first two deaths — that of Sulochana and Randhir’s sister Anu — all others from the family in Himachal are improving, three of them have been discharged. Krishan Singh’s wife Karamjit and their daughter Jasbir too are improving and so is the nurse from Silver Oaks.

To control the disease from spreading, the Department of Community Medicine was given the charge of tracing the people these patients had come in contact with during their journey to Chandigarh from Rohru. Every contact was found and given medicines so that the disease did not spread.

The fact that Krishan Singh, the young man from Kansal, had interacted with the Himachal family during their stay in the PGI emergency where the former was taking care of his ailing brother, had gone unnoticed by these doctors turned detectives. They traced this link after Krishan Singh died at the PGI emergency of pneumonic sepsis and his wife started showing similar symptoms soon after his cremation at Mansa, the family’s hometown. The Sirsa civil hospital promptly referred Karamjit and then her three- year-old daughter to the PGI. Now there were three states and a UT involved. An alert was sounded. The state health authorities with the PGI’s help prepared a list of more than 150 people spread over three states who could have come in contact with Krishan Singh and his family and thus caught the disease. All these people were given medicines. With no more contacts reporting any pneumonic plague-like symptoms, the doctors and nurses taking care of these patients and those manning the PGI plague helpline can now hope to take it easy.

The killer fleas

These are killer-fleas with flying legs! Kids have enjoyed the ‘flea circuses’, wherein they pull miniature carts and perform other such feats. But one must watch out for them in homes and office-buildings infected with rats as these can create conditions for human plague. They are the deadly ancestors of the scorpion flies and carry sylvatic plague from rodents to human beings. Flea experts have documented over 100 species of fleas that transmit plague, including 10 species that are carriers of urban plague. They are believed to carry typhus, a rickettsial disease of men, mice and rats.

The sexual development of fleas incidentally depend on the sexual development of the rabbits as the fleas feed on blood. The nest-building holes favour fleas larval stages. Rodents like rats, mice and squirrels are parasitised mammals for fleas.

The oriental rat flea is the most successful carrier of the plague. Pets like dogs and cats host the cat flea, while monkeys, apes and horses do not harbour fleas. Watch out for these fleas in your ‘pens’ and haunts of the affected animals. Apply organic phosphorous and other recommended toxicants to the affected animals. The rabbit fleas can live without feeding at freezing temperatures for over 9 months! They can jump 200 times their size.—KC