Uncle Nigel's Fireside Pestilence Chat

[M. Nigel Salt]

Inspired by Kai, by the recent post about the case of plague recently identified in Oregon, and by today's glorious release of the CDC's June newsletters, I thought I would start a thread for the subject I love most; the shit what makes you sick.

In my inbox today:

http://wwwnc.cdc.gov/eid/article/18/7/12-0121_article.htm

Our results suggested temporal changes in socioeconomic factors associated with location of human plague cases. In the 1980s, plague tended to occur in CBGs with poor housing conditions (e.g., old homes with incomplete plumbing) and high proportions of the population living near or below the poverty line, but this second association was confounded by presence of ecotone habitat (Table 2; Figure). Beginning in the 1990s, plague cases began to be associated with CBGs with higher median incomes and home values, and by the 2000s, wealthier CBGs with higher proportions of newer homes were positively associated with plague cases (Table 1, Table 2). High proportions of homes using wood fuel were consistently associated with positive CBGs for each time frame (Table 1, Table 2), which supported suggestions from previous studies that availability of harborage for rodents (e.g., wood piles) in and around domestic environments may increase human plague risk (2,5–8).

A general change in the distribution of plague cases during the study period was also observed. In the 1980s, plague cases were more widely distributed across New Mexico and were particularly common in the northwestern region of McKinley and Cibola Counties (Figure). However, by the 1990s, plague cases became less common there and more focused in the north-central region of the state (Santa Fe–Albuquerque and surrounding counties; Figure). We implemented the Kulldorff spatial scan statistic (9) by using SaTScan (10) to identify clusters of CBGs with high incidence rates of plague cases per 1,000 persons for each of the time frames to quantify these changes. Significant clusters were detected only in the Santa Fe–Albuquerque region for each time frame (Figure). Changes consistent with the overall analysis in which plague occurrence shifted from poorer to wealthier CBGs and occurred in more new homes were observed when this region was considered alone.

Our analysis also suggested that migration of middle to upper–class families into suitable plague habitat throughout the high-risk areas of the state was associated with locations of plague cases. For example, in the 1990s, 28 (96.6%) of 29 plague-positive CBGs experienced population growth between the 1980 and 1990 censuses, in contrast to 337 (78.4%) of 430 nonplague CBGs that experienced growth. Likewise, 17 (85%) of 20 plague-positive CBGs in the 2000s occurred where there was growth between the 1990 and 2000 censuses versus growth in only 327 (75%) of 434 nonplague CBGs. Moreover, for the census 2000 period, population growth was more likely to have occurred in CBGs that had ecotone habitat than CBGs without ecotone habitat (p = 0.004, by Fisher exact test). Migration of persons into suitable plague habitat would potentially increase the likelihood of human exposure to infected rodents and their fleas (7).

Roughly, what this is getting at is that there is a (relatively) significant plague cluster in the Albuquerque/Santa Fe area, and that plague isn't just for poor people anymore.

[Juana Go?]

Interesting!

[stelz]

Ugh, I'm one state away from that and there's lots of rats around. Every winter they try to move inside.
OMFG TGRR's HOROSCOPE IS RIGHT 

Seriously, though, I didin't even know plague was back. Good info.

Funny how I have to go to a forum to get news like this. 

[M. Nigel Salt]

Oh, it's always been around. It just doesn't usually break out in an epidemic, and it's unlikely to do so unless there's some cataclysmic series of events that leads up to it.

Bottom line, though, is that if you live in a risky area (desert), do everything you can to minimize exposure to wild rodents.

[stelz]

I think that Hanta virus outbreak in the 90's was in NM too...

[M. Nigel Salt]

I think that Hanta virus outbreak in the 90's was in NM too...

I think that was at Four Corners, so it involved New Mexico.

Yep! Here's a story and risk map from 2002: http://earthobservatory.nasa.gov/Features/Hanta/

[stelz]

Ugh.
Maybe a dumb question, but why do these outbreaks always seem to happen in NM? Lots of places are just as dry...

[M. Nigel Salt]

Ugh.
Maybe a dumb question, but why do these outbreaks always seem to happen in NM? Lots of places are just as dry...

Because God hates Navajos.

[stelz]

Ugh.
Maybe a dumb question, but why do these outbreaks always seem to happen in NM? Lots of places are just as dry...

Because God hates Navajos.

If I was a little more conspiracy-inclined, I'd be speculating who "God" might actually be.
Because not much would surprise me after the uranium mines.

[El Twid]

Oh, it's always been around. It just doesn't usually break out in an epidemic, and it's unlikely to do so unless there's some cataclysmic series of events that leads up to it.

Bottom line, though, is that if you live in a risky area (desert), do everything you can to minimize exposure to wild rodents.

Yep. There's usually about 1-3 deaths per year from it, which considering that it wiped out a full third of everyone from China to Iceland, is acceptable.

Historically, what we think caused the epidemic was an odd combination of coincidences. A population boom and spread of rats from the Gobi desert, followed by a die off, causing massive flea migration to human hosts (rapid decline in rodent populations have also been linked with other waves of plague). During the Mongol siege of Caffa, a Genoese merchant colony, the Mongol army began to be decimated by the plague. In a early version of biological warfare, they catapulted the infected corpses over the city walls, thus spreading it into the city. When the Genoese abandoned the city, they took the plague with them. Considering that the Italian city-states were major economic powers in Europe at the time, the plague then swept through Europe through predictable trade routes, and from those trading centers outward into the rest of the country.

The last major plague outbreak was global, due to the British Empire owning a huge chunk of the planet, and continued into the early 20th century.

The Japanese army used it as biological warfare during World War II, by bombarding cities with fleas carrying the plague. This resulted in localized outbreaks of epidemic proportions.

Now I feel wicked itchy.

It should also be worth noting that some scientists think that starting with the Black Death and continuing with repeated outbreaks, that Europeans have a certain degree of immunity to it. I think, if I remember, there is some sort of gene, and if you don't have it, you get the plague and die, removing you from the genepool. If one of your parents had it, you get sick but survive. If both parents have it, you don't get the plague. You're resistant to it. And even though the plague is a bacterial infection, some researchers think that immunity to it has also extended a degree of immunity to HIV infection, which is, of course, viral. I can't comment on this though, and it's been several years since I've heard about it.

[El Twid]

Oh! And Yersinia pestis, the bacteria that causes the plague, is actually pretty interesting.

In an infected flea, it lives harmlessly in the stomach. By harmless, I mean that the flea is not at risk. When a flea feeds, it regurgitates blood back into the blood stream, along with the bacteria.

In rare cases, bubonic plague can progress into septicemic plague, which can be spread by touch, and pneumonic plague, which is airborne.

Bubonic is an infection of the lymphatic system
Septicemic, of the blood stream
and Pneumonic of course, the lungs.

Septicemic must be treated within the first 24 hours or death is inevitable.
Untreated pneumonic is almost always fatal.
Untreated bubonic has a 50%-90% fatality rate.

[navkat: navkat of...navkat!]

This is dismal. Unfortunately, outbreak might be the only goddamned way people in this country begin to see the value again in social programs like public health, food safety, fair work practices and the betterment of squalid conditions. If your neighbor goes to the doctor when he's hacking up particulate of pulmonary Y. Pestis, instead of clocking in and coughing that shit all over everyone, maybe you, your babies and your entire, loyal customer base won't ever have to catch it...and the only way he's going to do that is if he's not going to get dinged a day's work and $150 to go to the doctor which will put him behind on paying the slumlord his $700 rent and shelling out $90 to eat Ramen noodles which offer nothing in the way of proper nutrition to help him beat the goddamned disease.

[El Twid]

This is dismal. Unfortunately, outbreak might be the only goddamned way people in this country begin to see the value again in social programs like public health, food safety, fair work practices and the betterment of squalid conditions. If your neighbor goes to the doctor when he's hacking up particulate of pulmonary Y. Pestis, instead of clocking in and coughing that shit all over everyone, maybe you, your babies and your entire, loyal customer base won't ever have to catch it...and the only way he's going to do that is if he's not going to get dinged a day's work and $150 to go to the doctor which will put him behind on paying the slumlord his $700 rent and shelling out $90 to eat Ramen noodles which offer nothing in the way of proper nutrition to help him beat the goddamned disease.

Even that wouldn't change the culture, I don't think. Not unless it spread out and took the same percentages that the Black Death did, and then only because it would have essentially wiped out the people on top too (oddly, the Plague was a contributing factor to the Renaissance and the end of feudalism). I consider this scenario unlikely in 21st century America. Even a large (by our current standards of it) outbreak of it would get contained fairly quickly.

[El Twid]

This is dismal. Unfortunately, outbreak might be the only goddamned way people in this country begin to see the value again in social programs like public health, food safety, fair work practices and the betterment of squalid conditions. If your neighbor goes to the doctor when he's hacking up particulate of pulmonary Y. Pestis, instead of clocking in and coughing that shit all over everyone, maybe you, your babies and your entire, loyal customer base won't ever have to catch it...and the only way he's going to do that is if he's not going to get dinged a day's work and $150 to go to the doctor which will put him behind on paying the slumlord his $700 rent and shelling out $90 to eat Ramen noodles which offer nothing in the way of proper nutrition to help him beat the goddamned disease.

Even that wouldn't change the culture, I don't think. Not unless it spread out and took the same percentages that the Black Death did, and then only because it would have essentially wiped out the people on top too (oddly, the Plague was a contributing factor to the Renaissance and the end of feudalism). I consider this scenario unlikely in 21st century America. Even a large (by our current standards of it) outbreak of it would get contained fairly quickly.

Another big part of that is our expectations of cleanliness. Most people don't accept being flea-ridden these days.