A 28-year-old lab technician in Russia has reportedly died after an accident at an anti-plague research laboratory. Darya Shipilova, an employee at the anti-plague institute in the city of Irkutsk, is believed to have died on October 2, two days after becoming unwell at work.
Ms Shipilova died from “pneumonia of unknown aetiology”, according to Rospotrebnadzor, Russia’s health watchdog. However, the Russian authorities have told the World Health Organisation (WHO) that: “No case of this dangerous disease has been recorded in the city of Irkutsk, Russian Federation.”
It has been alleged that Ms Shipilova became infected after breaking a test tube in the laboratory, but Rospotrebnadzor has denied that any such accidents have occurred at the institute. Following the reports, a number of experts based in London have given their reaction.
What is pneumonic plague?
Pneumonic plague is an exceptionally serious lung infection, which is often described as the most virulent form of plague. It is not to be confused with the bubonic plague, which affects the lymph nodes; and septicaemic plague, which affects the blood.
Symptoms of pneumonic plague include shortness of breath, chest pain, and often coughing up blood. There are between 1,000 and 3,000 total cases of plague around the world each year, most of which are bubonic plague, and many of them occurring in central Africa. Cases have also developed in Russia, India, China, and the United States.
Pneumonic plague has a higher mortality rate of the three, and can be spread between people. Dr Malick Gibani, Clinical Associate Professor in Bacterial Vaccinology at Imperial College London, said: “Pneumonic plague is a very severe manifestation of plague disease. He added: “Pneumonic plague is of particular concern because it can be transmitted from person to person unlike bubonic plague. “It is recognised as a potentially serious public health threat if not rapidly identified and controlled.”
How does pneumonic plague spread, and can it be treated?
Plague can be caught by getting bitten by an infected flea or handling an infected animal, but human-to-human transmission of pneumonic plague is also possible through coughing infected droplets into the air. According to the World Health Organization, pneumonic plague has a very short incubation period, and is commonly fatal if not diagnosed and then treated quickly.
Dr Gibani said: “Some textbooks will say it has 100% mortality if left untreated, and it's difficult to have accurate figures in the modern age. “It is treatable with antibiotics, particularly if started early. That's why anyone with high-risk potential exposure might be offered post-exposure prophylaxis with antibiotics and/or quarantine.”
Prof Brendan Wren, Professor of Microbial Pathogenesis, London School of Hygiene & Tropical Medicine (LSHTM), said: “There are still around 2000 cases of plague each year that are treatable with standard antibiotics. “But there are multi-antibiotic-resistant strains emerging, and if the laboratory is working on such a strain, then treatment options may be limited.”
What is the wider risk to the public following the reported death?
Dr Gibani said: “Based on the information we know, it seems as though this is a precautionary measure albeit one with high consequences. “If a researcher has come into is working in the laboratory that handles plague, and has developed an illness that could be compatible with plague, then it appears that measures are being implemented to quarantine any potential contacts and prevent any onward transmission. “Plague is something we all know about, but it isn't just of historical interest. There are a few hundred cases of plague reported each year globally. “Whilst the crude overall number of cases is low, there is a large zoonotic animal reservoir and there is therefore always a theoretical risk of zoonotic spillover.”
Prof Wren added: “Potentially this lab acquired case of pneumonic plague could be transmitted by the respiratory route. Yersinia pestis, the causative bacterium of plague, is fairly transmissible, but not as transmissible as SARS2/COVID.”
Should we be concerned about what’s happening in Russia?
The UN health agency’s spokesperson Christian Lindmeier has said that the risk to others is low. He said: “The WHO initial risk assessment from the information available estimates the risk to be moderate to low for Irkutsk, a low risk for the Russian Federation as a whole, and very low for the WHO European region.”
Dr Gibani said: “Based on reports, there appears to be a suspected index case and contacts have been quarantined. “If there is an exposure in a laboratory to a potentially dangerous pathogen, the usual procedure would be to undertake a risk assessment of who may have been exposed and the nature of their contact. “People considered at risk can then be monitored and, where appropriate, screening, quarantine, or post-exposure prophylaxis with antibiotics may be offered.”
“I think this emphasises the need to be aware of ongoing outbreaks of serious bacterial pathogens and highlights the need for investment in biosecurity, particularly for preventing biological risks. This could include developing medical countermeasures like better diagnostics or vaccines.”
According to Prof Wren: “Plague is still endemic in many parts of the world, including western parts of the US, so there shouldn’t be too much concern as the transmission of Yersinia pestis between humans is generally poor.”
