PAN AMERICAN HEALTH SECOND MEETING ORGANIZATION 17-21 June 1963 Washington, D.C. ADVISORY COMMITTEE ON MEDICAL RESEARCH PLAGUE IN THE AMERICAS Ref: RES 2/12 23 April 1963 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION WASHINGTON, D.C. RES 2/12 PLAGUE IN THE AMERICAS Table of Contents Section Page A Introduction 1 B General Remarks 2 C Present Status of Plague in Argentina 12 D Present Status of Plague in Bolivia 22 E Present Status of Plague in Brazil 42 F Present Status of Plague in Ecuador 67 G Present Status of Plague in Peru 89 H Plague in the United States 109 I Present Status of Plague in Venezuela 121 J List of Research Needs 132 K Research Plan Outline for Plague Studies in the Peru-Ecuador Focus 136 L Research Plan Outline for Plague Studies in Venezuela 143 i RES 2/12 PLAGUE IN THE AMERICAS * SECTION A INTRODUCTION Since the birth of the Pan American Health Organization plague has been an important albeit diminishing problem of the member countries. The initial meeting of the Organization, then known as the International Sanitary Bureau, was the First Inter- national Sanitary Convention held in Washington D.C. from 2 to 4 December, 1902. One of the main concerns of the founders was: "The adoption of measures for the disposal of garbage and wastes to prevent the spread of bubonic plague and other diseases". In the years following, the application of classical meth- ods has driven plague into the endemic foci of today. While current control and containment measures have been more or less successful, it has become obvious that before further progress can be made against plague it will be necessary to undertake a thorough study of the nature of the disease in its present cir- cumstances. As a first step in a program to include the needed ecol- ogical studies, a thorough study and evaluation was begun of all information on plague in the Americas contained in the technical literature, official reports and other sources. Based on these data and observations to be made in the plague foci, there will be designed a series of ecological research studies. This document contains a summation of the basic informa- tion available on plague in Argentina, Bolivia, Brazil, Ecuador, Peru, United States, and Venezuela. The data contained were obtained from the technical literature and official reports. Included also in this document are a listing of research needas, and preliminary outlines of two field research projects, i.e. Peru and Venezuela. In undertaking the exhaustive studies nec- essary and in the preparation of this document the Organization. has had the capable services of Dr. Robert Pollitzer on assign- ment from Fordham University, and Dr. K. F. Meyer, Director Emeritus of the George Williams Hooper Foundation, University of California Medical Center, together with the secretariat services of Dr. A. N. Bica and Dr. E. C. Chamberlayne. * Prepared for the second meeting of the PAHO Advisory Committee on Medical Research, 17-21 June 1963. The present document revises and completes RES 1/13 presented at the first meeting of the PAHO/ACMR. - 2 - RES 2/12 SECTION B GERERAL REMARKS As can be gathered from the adjoined tabulations, plague is at present manifest in the western part of the United States as well as in five South American countries, namely Bolivia, Brazil, Ecuador, Peru and Venezuela. Generally speaking, the ecology of the disease is of a uniform pattern, characteristic also of other countries with a vast hinterland like for instance, South Africa, which had become plague infected during the present pandemic: entering through sea-ports, the infection involved first the rat-populations in these urban areas and soon also in more or less distant cities and towns, the rat epizootics invar- iably leading to considerable epidemics; however, though often slowly, the infection inexorably spread to rural areas of the hinterland where owing to the presence of susceptible wild rodent species, it found conditions for its persistance compa- rable in principle to those in the ancient plague foci of Central Asia, Though in some of the affected South American countries or parts thereof the common rats are still involved in the man- ifestations of plague, in other foci these rodents have ceased to play a role or have been relegated to a secondary role, be- coming but temporarily affected when the disease is rampant among the wild rodents and thus, like the house mice and, more O often, the domesticated guinea-pigs serving merely as linkas in the chain of events leading to a transition of the infection from the wild rodent reservoir to man (which, however, may also be effected through direct contact with wild rodents or through their fleas). Thus, as these brief general statements suffice to show, considerable variances in the plague situations in the individ- ual countries, or even foci involved, are bound to exist, and these variances are further accentuated by the presence of dif- ferent wild-rodent and wild-rodent fleas species in the various affected localities. Therefore, in order to arrive at an ade- quate appreciation of the plague situations in the presently involved American countries, it is necessary to deal individually with each of them. _, O1 %.o 4 a H enCU \ QN I 0 H L0 cn 'kO J O cu ,lo u oi r_ CU 01 i OJ a ,lo : rlcsi l tl ri 0 _i U'\ GQN Hl` 4 cu 0 ! Lo\ -- cu cuc 1 '-4 <i iD, uo cn -t o - U'\ I-1 -Ú j a: c\ C) ! CN QN 4.ri0\ oU S,o1, 1 ,a 0O 0Oo c LrN 01% $ R U UN lo -M en a\ i;v ri r-4 0r-4 0 I 9 ri \i n r N U,\ CO - u-\ 1Ch Nu LA cU 1 (7\ H I CNJ QN r4 51 (N rOcn O e 1-4 CD _% t S?1 Cn rl p zi _.t- CO Hí ( rd 1 ii7 ~1- O cn CU UE \0 1 oi rl ( t id I H <Nl~~~(Y r-? o (C O) cJr4 d rm<a) 1 . 4 4.~~~~~~~ 21~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~C- '.4 1- 4 0 ; 1 .F -a- 1 0 mi- C> IN1 u l .sq i I* - 4 - RES 2/12 TABLE II Plague Incidence in the Americas from 1956-1962 (Figures culled mainly from the WHO weekly Epidemiological Record) II.1 Argentina Year Plague Incidence 1956 1957 1958 One plague case recorded in the Misiones Province (see "Reported cases of notifiable dis- eases in the Americas 1949-1958", PAHO/WHO publication Nº 48 - 1960, p. 70) 1959 1960 1961 1962 II. 2 Bolivia Year. Plague Incidence 1956 Three cases rec- orded in the Santa Cruz Department, Valle Grande Province (see PAHO/WHO publication Nº 48) 1957 - 1958 1959 1960 Small epidemic (12 cases) recorded at Pucar, Santa Cruz Department, Valle Grande Province 1961 20 plague cases with 8 deaths were recorded from 26 March to 1 April in Villa Serrano, Boeto Province, Chuquisaca Department (WHO Weekly Epidemic Record 36, 1961, 16:165) 1962 - 5 - RES 2/12 TABLE II (Cont'ed) III.3 Brazil . Case incidence Year States affected Per State Yearly total 1956 Pernambuco 4 4 1957 Alagoas 5 Bahia 20 37 Pernambuco 12 1958 Bahia 25 25 1959 Bahia - 16 16 1960 Alagoas 13 28 Bahia 13 Rio de Janeiro 2 1961 Alagoas 12 Bahia 15 Ceará 7 Minas Gerais 2 106 Paraiba 31 Pernambuco 39 1962 Alagoas 1 Ceará 16 Paraiba 3 Pernambuco 13 Rio Grande do Norte 3 36 - 6- EI.S 2/12 TABLE TI (Cont'ed) Localities affected Case incidence Yearly Year Provinces Cantons Per Canton Per Province Total 1956 Tungurahua Ambato 18 18 Manabi Jipijapa 12 I2 'Chimboraz 7 LoJa 43 80 1957 Los Rios Vinces 5 5 Chimborazo Guano 12 12 Loja 62 79 1958 Chimborazo Guano 7 . Riobamba 1 8 Loja Celica 9 Calvas 3 Puyango 1 Macará 1 14 22 1959 Chimborazo Guano 11 Riobamba 10 21 Loja Celica 4 Macará 1 Loja 7 Catacocha 1 Paltas 6 19 40 RES 2/12 TABLE II (Cont'ed) II.4 Ecuador (Cont'ed) Localities affected Case incidence Yearly Year Provinces Cantons Per Canton Per Province Total 1960 Chimborazo Riobamba 10 Alausi 10 Guano 15 35 El Oro Piñas 5 5 Loja Celica 1 Paltas 7 Calvas 17 Macará 12 37 77 1961 Tungurahua Ambato 8 8 Chimborazo Riobamba 1 Guano 1 2 Loja Calvas 2 Celica 3 Paltas 2 7 El Oro Pinas 9 Zarumln 8 17 Manabí Manta 36 Portoviejo 23 Rocafuerte 10 69 Pichincha Quito City 2* 2 105 1962 Chimborazo Aluisi 21 Riobamba 6 27 * Infected in Manabi - 8- RES 2/12 TABLE II (Cont ed) II.4 Ecuador (Contted) Localities affected Case incidence Yearly Year Provinces Cantons Per Canton Per Province Total 1962 El Oro Pifas 2 2 Loja Calvas 19 Celica 23 Macará 10 Paltas .1 Puyango 3 56 Manabi Chone 13 Jipijapa 1 Junin 1 Manta 86 Montecristi 9 Portoviejo 26 Rocafuerte 16 Santa Ana 12 Sucre 74 24 de Mayo 3 241 326 I1.5 Peru Localities affected Case incidence Year Department Province Per Province Per Department Total 1956 Piura Ayabaca 8 Huancabamba 16 24 24 1957 Piura Ayabaca 9 Huancabamba 14 23 Ancash Huaraz 11 Recuay 3 14 37 -9- RES 2/12 TABLE II (Cont'ed) II.5 Peru (Cont'ed) Localities affected Case incidence Yearly Year Department Province Per Province Per Department Total 1958 Tumbes C. Villar 3 3 Piura Ayabaca 24 Paita 1 Sullana 6 31 Lambayeque Lambayeque 7 7 Cajamarca Hualgayoc 3 3 Ancash Huaraz 5 .