Containing the Plague


With the growing risks of CBRN hazardous materials being illegally smuggled over borders it is essential that security personnel have the correct high specification PPE for safely handling and neutralizing the threats. Specially designed suits and apparatus are required to allow operatives to carry out these dangerous tasks whilst also providing detergents and decontaminants to eradicate biological and chemical hazards.

It is not only hazardous CBRN materials that can cross borders, but as has been graphically illustrated in recent weeks, potentially deadly diseases can migrate from one country to another. An epidemic of the deadliest form of plague, pneumonic, has hit major cities and towns in Madagascar and is spreading fast. As of 27 October, the Madagascar Health Ministry reported that 1,153 people had been infected and 124 died, and numbers were rising rapidly. More than 70 per cent of the cases are pneumonic plague, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated. At the same time authorities in Seychelles said a man was diagnosed with pneumonic plague after returning from Madagascar.

A massive response is underway and the World Health Organization (WHO) has been on high alert, and reacting to criticism of its slow response to the 2014 Ebola epidemic in West Africa, released US$1.5 million and sent plague specialists and epidemiologists.

The poor island nation of Madagascar has been regularly hit by plague outbreaks, but they are typically the relatively less dangerous bubonic form, transmitted from rats to humans by fleas, and occur largely in remote areas. Bubonic plague has an incubation period of two to seven days, when the bacterium is actively replicating. What has proved particularly alarming in the current outbreak is that pneumonic plague is easily transmitted from person to person by coughing, and the outbreak has reached relatively densely populated urban areas, including the capital, Antananarivo. Left untreated with antibiotics, pneumonic plague is 100 percent fatal. Plague is endemic in many countries.

Both forms of the disease are caused by the bacterium Yersinia pestis. Pneumonic plague develops when a person with bubonic plague is not treated, and the infection spreads to the lungs. WHO has assessed the risk of national spread in Madagascar to be high, regional spread moderate, and international spread low, but those rankings are continually being reassessed.

Lessons learned from the Ebola outbreak means that response needs to be extremely fast in these types of situations, in order to bring an outbreak under control as quickly as possible. The International Federation of Red Cross and Red Crescent (IFRC) has sent its first-ever plague treatment centre to Madagascar. The plague treatment centre includes 50 beds and a medical team with the capacity to isolate patients to significantly bolster the outbreak response. The IFRC has also introduced the same ‘safe and dignified’ burial methods used in West Africa during the 2014 Ebola epidemic. This helps cut the chain of transmission, preventing further infections through direct contact with corpses.

The IFRC is launching an emergency appeal for additional funds to support further expansion of Red Cross efforts in community surveillance and engagement, water and sanitation and vector control. The medical team at the Red Cross treatment centre will include an infectious disease specialist and community health experts, and will operate 24/7.

Operatives and medical staff dealing with and working around highly infectious patients – such as Ebola or plague patients are particularly at high risk from contracting diseases. They require a range of both PPE and respiratory protection products suitable for the threat level being encountered. WHO has supplied more than 150,000 sets of PPE to Madagascar and UNICEF is sending 100 000 masks.

If the outbreak persists or increases, NGOs are likely to establish treatment centres similar to those set up by Médecins Sans Frontières to respond to the cholera outbreak in Yemen. These include a disinfection area where new patients are assessed by medical staff before treatment. Medical staff have to go through multiple decontaminations when moving from one area to another in the centre. Separate latrines are provided to ensure that any human waste is contained to help the disease from spreading.

Decontaminates can be a very convenient way of quickly neutralizing biological hazards such as Ebola, blood borne HIV, MRSA, TB or bodily fluids. Fluid bags have to be fitted with strops so that a fork-lift can then remove the waste. By using decontaminants and detergents in the fluid bags before removal, any accidental spillages during the removal process will be non-hazardous and non-toxic preventing further contamination of the surrounding population and environment.

Contaminated waste such as cloth and plastics as well as needles and glass and organic waste is either incinerated or buried in a pit. It is also important to disinfect patients’ houses and public places such as schools and workshops to limit the spread of the disease.

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A defence photo-journalist for more than 30 years, and member of the Independent Defence Media Association (IDMA) and the European Security and Defence Press Association (ESDPA). David is the author of 18 defence-related books, and is former IHS Jane’s consultant editor and a regular correspondent for defence publications in the UK, USA, France, Poland, Brazil and Thailand.