Everything YOU need to know about pneumonic plague as Russia launches quarantines: How it spreads, the first warning signs and lifesaving treatment

A feared plague outbreak in Russia has set off alarms around the world, including in the White House.

A lab technician in the country is suspected to have died from the disease after allegedly breaking a test tube containing Yersinia pestis, the bacteria behind the most severe form of plague that colonizes the lungs and leaves patients struggling to breathe.

Two-hundred people and five hospitals in Russia, including one for children and another for new mothers, have now been quarantined.

Authorities in the country suggest the situation is under control, but other capitals are sounding the alarm. 

Three countries in Asia have already brought in restrictions, while the White House said it was ‘monitoring the situation closely.’

The suspected disease, known as the pneumonic plague, is extremely rare but also almost always fatal if not treated within 24 hours of symptoms starting. 

‘It’s the most severe and lethal form, and timing is everything,’ Dr Uzma Syed, chief of infectious diseases at Good Samaritan University Hospital in New York, told the Daily Mail.

Below, experts have revealed everything you need to know about pneumonic plague, and how to stay safe.  

How plague could be spread through the air 

Plague is caused by the bacteria Yersinia pestis, a fast-multiplying organism that can cause a severe infection.

Most cases are caused when fleas infected with the bacteria bite humans, transmitting the bacteria to their bloodstream.

But, if the infection spreads to the lungs, it can also be spread from human-to-human when a patient coughs or sneezes and another breathes in the droplets.

Person-to-person spread is rare, however. If plague spreads to the lungs, patients are bedbound within a day or two of symptoms developing, which gives them little chance to mix with and infect others.

It can also be spread via direct contact with flesh from infected animals, such as when a hunter skins a rabbit.

There are three forms of plague, but the most common is bubonic plague, which is caused by flea bites, and is when the bacteria infect lymph nodes – a network of vessels responsible for draining fluid in the body.

Pneumonic plague, or plague in the lungs, is when the bacteria spread to the lungs and septicemic plague, linked to blood vessels, is when the plague spreads to blood vessels. 

In bubonic plague, the bacteria can spread and cause either of the other forms of plague.

About 30 to 60 percent of patients who have bubonic plague die without early treatment, according to the World Health Organization. 

But among those who have either of the other forms, without early treatment, the fatality rate is nearly 100 percent. 

Plague can be triggered wherever in the world Yersinia pestis is present. 

Experts fear, however, that because of air travel, the disease could quickly spread to other areas.

Warning signs to watch out for  

In bubonic plague, patients develop symptoms within one to seven days of being bitten by a flea. 

Warning signs include fever, chills, head and body aches, weakness, vomiting and nausea.

Patients may also have painful and inflamed lymph nodes, part of a circulatory system in the body for draining fluids, typically in the armpits or groin.

In the pneumonic form, patients develop symptoms within 24 hours of infection which include shortness of breath and coughing, often coughing up blood-tainted mucus.

This form leaves patients struggling to breathe and is almost always fatal without rapid early treatment.

In septicemic plague, symptoms include bleeding under the skin, a bluish discoloration of the skin and tissue death. 

Without treatment, this version leads to multiple organ failure and severe bleeding difficulties, which are fatal.

America reports seven plague cases every year 

Plague epidemics have occurred in Africa, Asia and South America, the World Health Organization says.

Since the 1990s, however, most human cases have been reported in Africa, particularly the Democratic Republic of the Congo and Madagascar, which reports cases of the plague nearly every year.

In the US, the CDC says that the country records about seven cases of the disease every year, typically in northern New Mexico and Arizona. 

More than 80 percent of these cases are the bubonic form, meaning they are caused by flea bites. There’s no evidence of recent human-to-human transmission in the US.

In Russia, its last publicly reported plague cases were in 2016, when a case of the bubonic form was reported in the Altai Republic, which borders Mongolia.

Researchers linked this case, and two others reported in 2014 and 2015, to catching, butchering and eating marmots in the area.

The latest case has been reported in the Irkutsk region, also in Russia’s far eastern area, and, according to local media, was diagnosed in Darya Shipilova, an employee at the Irkutsk Anti-Plague Research Institute of Siberia and the Far East.

The bacteria that causes plague is endemic to Siberia, the location of the first known prehistoric human outbreak, as the bacteria that causes it is present among the small wild mammals in its vast wilderness and their fleas.

It is rare for Russians to fall ill with the plague, however.

Globally, there are about 1,000 to 2,000 cases of plague each year. Of those, pneumonic plague accounts for about 10 to 14 percent. 

Lab-acquired cases of plague are even more rare. The last known lab-acquired case in the US was in 2009 in an unnamed 60-year-old diabetic researcher who contracted and died from septicemic plague after working with a weakened strain of Yersinia pestis.

Syed said that lab-acquired cases can arise from multiple scenarios, such as not following strict protocols correctly or materials breaking.

‘It’s certainly not a very common scenario,’ she added. 

People who are in direct and close contact with an infected individual or animal, as well as people in endemic rural areas, are the most at risk of the disease.  

Are there any treatments? 

Doctors say that plague must be treated within a day or two of symptoms emerging to boost a patient’s survival chances. 

It’s such a threat that doctors normally start treatment when the infection is just suspected, rather than confirmed. 

Physicians can treat the infection using antibiotics, which quickly clear the infection.

Syed said: ‘You don’t want to waste any time. If there is any suspicion, we want to start treatment immediately.’ 

First-line treatments in the US include the antibiotics fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) and aminoglycosides (gentamicin, streptomycin).

Doxycycline can also be an alternative if none of these treatments are available.

‘The good news is plague is highly treatable,’ Dr Rays Jiang, associate professor in the Department of Global, Environmental and Genomic Health Sciences at the University of South Florida, told the Daily Mail. 

‘If we act early, there are very effective antibiotics that can be used.’ 

A typical course of treatment ranges from seven to 14 days, Syed estimates, depending on the exact case.  

Do Americans need to be worried?  

Though pneumonic plague has not been confirmed, the suspected case has prompted outbreak fears in Russia and the US. 

Jiang urges, however, that panic is not necessary.

‘I’m not worried,’ she told the Daily Mail. ‘The risk right now is mostly precautionary. I think the right measures have been taken. We have to treat it as if there is a local outbreak, and that’s what [Russia] did.

‘The risk is very low for the American population.’

She also said that unlike when bubonic plague spread across Europe, there are medications that can stop the disease in its tracks before it becomes an outbreak. 

Additionally, Jiang notes that plague, while extremely rare, has been in the US for hundreds of years, carried by rodents in western states. 

‘It’s always been with us and will continue,’ she said. ‘As population and urbanization increase, the chance might increase that we come into contact with it more frequently. 

‘We have a risk here, but we can contain it.’ 

Syed cautions people living in areas that might be at higher risk of plague, such as the southwest US, to avoid touching dead animals or leaving food out for them to encourage them to stay close. 

‘There are always precautions you can take,’ she said.