There are scattered reports that the dreaded Bubonic plague has killed 40 Al Qaeda members hiding in rural Algeria.

The new epidemic began in the cave hideouts of AQLIM in Tizi Ouzou province, 150km east of the capital Algiers, the Sun reports…

The group now fears the highly-infectious disease could have spread to other al-Qaeda training camps or Taliban fighters in Afghanistan, the paper said…

Most of the western reaction to the reports are more gleeful than sad: essentially saying: it couldn’t happen to a nicer (sarcasm) group of fellows.

After all, in Algeria, various “Islamicist” groups have killed between 150 and 200 thousand civilians in the 1990’s civil war trying to take over that country; the last thing they need now is a new Al Qaeda trained bunch of guys slitting more civilians throats or bombing UN aid workers.

But as a doctor, the first thing one wonders is: Will the plague spread?

Answer: Probably not.

The article I cited mentioned that some western experts were hoping that the fleeing terrorists would spread it around to their friends in Afghanistan, but the most common “Human to human” spread is the pneumonic type, which has an “incubation period” of one to two days, whereas the infection after flea bites  takes one to six days. So unless they have good airline connections, they won’t spread it to anyone.

There are three types of Bubonic plague: The most common one starts with huge swollen and painful lymph nodes,(AKA “Bubos”) usually in the leg or groin, from a flea bite. Mortality is low if you get diagnosed and treated.

The second type is pneumonic, usually caught from another person who has developed pneumonia as a complication of the plague. This is quickly fatal if not treated.

The third type is “septicemic”, which is usually fatal. This means the lymph node doesn’t slow the plague, and it spread throughout your body, causing “Disseminated intravascular coagulation”  (toxins cause blood to clot, using up all the clotting factor), and as a result you bleed all over: this bruising is one reason it is called the “black” plague.

Nowadays, plague can be treated with common antibiotics, so only the most isolated villages/terror camps would have such a high mortality.

Second question: Was this an example of biological warfare, either by western bad guys against the terrorists, or because the terrorists were trying to cook up a batch of bad germs to kill their enemies?

And again, the answer is: Probably not.

Plague outbreaks are not unknown in Algeria, the most famous one the outbreak in 1943 memorialized by Camus in “The Plague”, and the last outbreak, due to rat fleas, in 2003.

There have been several pandemics of the black plague in human history, the most famous one in medieval Europe. No one is sure why all of a sudden outbreaks spread, but the dirty little secret is that the bacteria is carried by ordinary rodents in quite a few countries.

Usually one thinks: RATS.

But the real danger in the US might be killer prairie dogs.

During the last five years (1994 through December 7, 1998) there were 40 human plague cases in the United States. Of the 17 cases for which a source of infection was identified, 9 were attributed to prairie dogs.

Every year, a couple cases of Plague pops up in the US, usually in the Southwest, but except for a few Infectious disease specialists and docs who work on the Navajo reservation, few of us have ever seen a case.

Prevention of Plague is normal sanitation/pest control.

Treatment is antibiotics, usually Gentamycin or Chloramphenicol, although Streptomycin, chloramphenicol, Ciprofloxin, Doxycycline and TMP/Sulfa have also been used.

And there is a vaccine for plague, but it is rarely given nowadays, partly because it doesn’t always work, because the risk of disease is small, and because antibiotics can stop the spread of the disease. The US Army is working on a new version of the vaccine, because they are worried about bioterrorism.

Bubonic plague has been used in the past as a biological weapon when the Tartars flung the bodies of plague victims into Kaffa, a Crimean city, resulting in an epidemic.

Luckily, ordinary antibiotics and elimination of vectors would probably stop such a plague today; the big worry is if someone developed an aerosolized (spray powder) of plague that could be released in a public area as a bioweapon, especially if the strain used was resistant to ordinary antibiotics.

Luckily, the technique of developing such an aeorsolized bacteria requires sophisticated knowledge and laboratories to develop, but after the Anthrax epidemic proved that there are ways for lay people to produce such a powder, such worries are very real indeed.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog.

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