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Plague in the Four Corners Region; Symptoms, Causes, and Prevention

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Mercy Regional Medical Center
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Dr. Jennifer Rupp

As the community grieves the recent loss of a child due to the plague, KSUT's Sarah Flower spoke with Dr. Jennifer Rupp, Infectious Disease Specialist with Mercy Regional Medical Center about symptoms, causes and prevention.

Story Transcript:

Sarah Flower 00:00
Hi, I'm Sarah Flower with KSUT News. Today we are joined by Dr. Jennifer Rupp, the Infectious Disease Specialist at Mercy Regional Medical Center for the Centura Group. Dr. Rupp, thanks so much for joining us today.

Dr. Jennifer Rupp 00:14
Thank you for having me.

Sarah Flower 00:15
It's such a critical time. We had you on last year talking about COVID-19, but if you can believe there's another infectious disease that we need to be discussing, and highlighting here with the recent tragedy of the death of a child due to the plague. What I thought we could cover here is kind of a general synopsis of the plague and how prevalent it is in Southwest Colorado.

Dr. Jennifer Rupp 00:41
Right, I think it is a good time of year to think about plague, because we often see these cases, more prominently in the summer and more months. So, plague just quickly, is a bacterial infection. And it's caused by a bacteria called Yersinia, but we call the illness, the plague. And as a bacterial infection, we can become quite sick from this illness. And that does affect humans,

Sarah Flower 01:06
As the confirmation came back on Friday that this was in fact, the cause of death of the child was the plague, is this something common that we see here?

Dr. Jennifer Rupp 01:17
That that's a very good question. It's common enough that we should be very much aware of this. As far as cases per year, it's probably anywhere from zero to a handful of cases. It does occur enough that we need to be aware of the signs and the symptoms, because this is a very treatable condition. A lot of people will be sick, but the main symptoms are a fever, chills, feeling extremely tired, weakness, and sometimes you can have a sore throat actually, and including some G.I. symptoms, such as nausea and diarrhea, as well as tender lymph nodes. So a lot of those symptoms can be confused as some sort of a specific viral illness or some other illness. But if these symptoms persist with a high fever, it's important that you seek attention with anybody in the healthcare field and get this evaluated.

Sarah Flower 02:03
So this is treatable, from what I understand from the CDC, that if you do become infected with the plague and experience some of these symptoms, that it doesn't have to lead to what happened to the child.

Dr. Jennifer Rupp 02:15
Yeah, that is exactly right. Oftentimes, if these symptoms persist for about 42 hours, whoever you see for your symptoms will think that it might be time to start an antibiotic. And this is what is critical, because the simple antibiotics that we often use for illnesses such as doxycycline, cipro or keflex, when those are started for other infections, oftentimes those will actually also treat the plague organism.

Sarah Flower 02:40
it's fascinating to see how the reaction time for this is also important too. And I think we're learning now in the middle, maybe at the tail end of a global pandemic at this point to go in, and if you're sick, to either stay at home, or get tested, because a lot of what you're mentioning Dr. Rupp for these symptoms, it checks all the boxes for COVID. In my head, too.

Dr. Jennifer Rupp 03:02
it really does. And also you have to go in thinking of COVID too. The good rule of thumb is if you are sick enough to go to the ER, or even if you're thinking of going to the ER calling your doctor, you should go ahead and do that. It's always good to err on the side of being a little more cautious than trying to tough out these symptoms at home.

Sarah Flower 03:20
What does this protocol look like? I think people hearing "oh my God, the plague, the plague is here", I think of what the community might be thinking and how what they can do to protect themselves to be on top of it.

Dr. Jennifer Rupp 03:35
I think that is a good lead way to talk about, you know, how is this transmitted in the first place. So especially in the storm of COVID that we're in right now, you know, the plague illness is a bacterial infection that we can get from other animals. Well, the reason why we have it mostly in the United States is from our prairie dog population. So it starts with rodents, that includes prairie dogs, squirrels, and possibly chipmunks. And these animals can carry the plague organism within them, and then it's the fleas that these or these animals carry on them, these fleas will then bite the animals, and then they will get plague within the flea, and then the fleet can jump from other animals or to pet dogs, pet cats, or to other humans. And when we have contact with those fleas, then we can also get bit and then the plague will be transmitted to us. This second big way of being infected is not only from the fleas, but if you're in contact with an actually sick animal, an animal that has already died recently or that just doesn't look good, then that animal itself can also transmit plague to us just by being near it or touching it. And so those are dead prairie dogs, dead squirrels and sick appearing cats and dogs.

Sarah Flower 04:47
I think of maybe new doctors or especially here in Southwest Colorado that people coming in, and new doctors and nurses...I think it's a lesson for rural hospitals across the area to be mindful that this is also what it could be.

Dr. Jennifer Rupp 05:06
Exactly. So that's why I think a yearly plague update starting at the beginning of summer is always a good idea. And then the southwest too, I'll just put in a plug, we have to constantly think about hantavirus. So those are two very special infectious diseases that we have, you know, pertintent to our part of the United States is hantavirus and plague.

Sarah Flower 05:24
The Colorado Department of Public Health and Environment says, as reported from 2005 to 2020, that there have been 22 reported human cases of the plague in the state of Colorado. Dr. Rupp, nine of those not including the most recent, is in La Plata County, specifically. Why is that?

Dr. Jennifer Rupp 05:44
That's an impressive number. It basically points again, to probably the reservoir infection that we have in our rodent population. Secondly, squirrels, we did have a case not too long ago of a woman who contracted plague from trying to help baby squirrels that appeared to be ill. Classic scenario, handling the animals about two days later starting to feel very, very sick, came into the hospital, and then we were able to diagnose plague in that individual. So with that, I'll say plague is diagnoseable, and how do we diagnose it, it's by drawing the blood, we send the blood to the microbiology lab, and then that organism can be cultured in our blood. So the microbiology laboratory can pick that up, and then further identify the bacteria as the plague organism.

Sarah Flower 06:30
And then what does that look like because you aren't operating a hospital, a health facility is not operating in and of itself, there's also then a reporting procedure where you've got to walk me through that process of, of what that looks like.

Dr. Jennifer Rupp 06:45
Exactly. So you know, as we see a sick individual in the emergency department or the clinic, and we get the blood work, like we always do when somebody's sick, that will include a culture of the blood. Blood goes down to a microbiology laboratory, they start the blood, they start to incubate it. And as soon as the machine detects growth of any organism, our microbiologist can quickly take a drop of the blood and do a special stain and see what that bacteria might look like. As soon as they identify something that looks at all suspicious for any bacteria, we'll get a phone call about that, and then the process will continue until the identification is complete. And that completed ID is usually about 48 hours later. So we don't get the final ID for a couple of days, but if the first suspicion we'll get it, hopefully within a few hours.

Sarah Flower 07:33
Dr. Rupp, with this tragedy, I think of what are some lessons learned across the region that doctors and health facilities ER rooms, urgent cares around the area should be mindful of right now.

Dr. Jennifer Rupp 07:44
So being mindful that when somebody has the classic symptoms, everybody always thinks of the most common things which could be anywhere from strep throat, to a bacterial blood infection, we just have to remember in the summer months to also think about plague. It's helpful to always ask the patients or maybe the patients can also say, by the way, I live in the country, or I am usually exposed to animals, is that helpful. And so that will help us start thinking about all the other possibilities of infections that we can get in the environment, and from the animals.

Sarah Flower 08:18
Dr. Jennifer Rupp, Infectious Disease Specialist at Mercy Regional Medical Center. I appreciate you taking the time today to speak with us. Is there anything else that you'd like to add for our listeners today,

Dr. Jennifer Rupp 08:28
If this interview generates more questions, the best source in our county is San Juan Basin Public Health and their website. They have a great section on plague. It's a good review on going over all of the symptoms, and who to talk to if you have further questions.

Sarah Flower 08:42
Dr. Jennifer Rupp, thanks so much for joining us today on KSUT.