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Turkmenistan: Hidden Resurgence Of Plague Threatens

Say the word "plague" and what immediately comes to many minds are three dreadful scourges of Black Death that killed nearly 200 million people in Europe and China in the fifth and sixth centuries, between the eighth and 14th centuries, and in the mid-19th century. Modern antibiotics have stripped the plague of much of its virulence, but it retains its dread.

Prague, 30 June 2004 (RFE/RL) -- The World Health Organization has received what one WHO medical officer calls "unofficial" reports of 10 new cases of bubonic plague in Turkmenistan, but at last word has been unable to verify them.

Although this is the same terrible disease that twice wiped out almost half the population of Europe, the plague no longer is the fearsome threat of ancient times. Antibiotics and public health strategies have taken care of that.

WHO medical officer Eric Bertherat said that what severe threat the plague still retains comes from a tendency of some officials to cover up its outbreaks.

"We got unofficial information about some cases of plague having occurred in Turkmenistan," Bertherat said. "In fact there would be around 10 cases, 10 cases of bubonic plague in this country. And we are trying to check this information."

A human rights organization known as the THI, for Turkmenistan Helsinki Initiative, reported last week that 10 cases had been identified and that the victims had been quarantined in a hospital of the Akhalsky velayat, a district near the capital Ashgabat. THI said at the time that the hospital lacked the means to treat the disease.
"This occurrence of cases of plague is not a surprise, since this area -- Central Asia -- is the cradle, the birthplace of plague."

If true, this could create conditions for the development of the most dangerous form of the plague.

Bubonic plague is primarily a disease of rodents. It is most commonly spread to humans by insect bites. A flea, tick, or other parasite acquires the plague bacillus from biting a rodent and subsequently transmits the bacillus to a human being by biting the person. Plague transmitted this way typically attacks the human lymphatic system, causing one or more lymph nodes to swell into painful inflamed knots known as buboes. Hence the name bubonic plague.

Once a human contracts the disease, however, it can if untreated develop into pneumonic plague, a highly contagious form that bypasses the lymphatic system and is transmitted by airborne droplets directly from human to human.

Bertherat said this form of the disease is very dangerous.

"Yes, it is exactly the same disease but the bubonic plague is transmitted by flea bites and, secondarily, [the] human infected can develop pneumonic plague," Bertherat said. "And when he's got pneumonic plague he can transmit the virus by respiratory droplets to other humans. And in that case the risk of spread is very, very important."

Medical authorities say that 90 percent or more patients, properly treated, survive bubonic plague. Untreated, about half the victims die. Untreated, pneumonic plague is nearly always fatal within 48 hours of infection.

There is no reason, Bertherat said, that a Central Asian country should feel shamed at an occasional incidence of bubonic plague. He said that one or even a few cases are common in the spring there.

"This occurrence of cases of plague is not a surprise, since this area -- Central Asia -- is the cradle, the birthplace of plague, and sporadic cases of plague are not uncommon in these countries, including Turkmenistan," Bertherat said.

The disease also shows up in a handful of cases a year in Africa and North America.

In recent years, Central Asian states have controlled bubonic plague by setting up scientific detection teams to learn what rodents or other carrier animals are involved in an outbreak and what insects are the transmitters. They then deploy plague stations to reduce or isolate the threatening populations. Numerous antibiotics are useful in treating the actual victims.

That's what Kazakh health official Baurzhan Baiserkin said his country did with notable success this year.

"Last year there was a case involving a camel in which six people were made sick," Baiserkin said. "This year, starting in February, we took precautions to prevent the plague. So far [this year] there are no reports on Kazakh territory of any kind of plague."

But Turkmenistan Helsinki Initiative charges that the Turkmen government of President Saparmurat Niyazov has abandoned controls that minimized outbreaks in the country. THI said Turkmen authorities have severely cut funds and employment in the health sector.

Reached last week by an RFE/RL correspondent, Turkmen health authorities denied any knowledge of bubonic plague cases there. THI has said that local officials reached by the organization neither confirmed nor denied the outbreak.

(Almaty bureau chief Kenzhebek Nurkasen of the RFE/RL Kazakh Service contributed to this report.)

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