Russia has denied that a 28-year-old lab technician died from plague after becoming ill at work, but experts say questions remain. Darya Shipilova, an employee at the anti-plague institute in the city of Irkutsk, died on 2 October, two days after becoming unwell at work, according to reports from Russia.
Conflicting accounts of death
The exact details remain unclear. Rospotrebnadzor, Russia's health watchdog, said Shipilova died from “pneumonia of unknown aetiology”. However, Alexey Tsydenov, the head of the neighbouring Buryatia region, initially said Shipilova had died of plague, before editing his social media post to say she had “possibly” died of the disease.
Russian authorities have denied this to the World Health Organization (WHO), stating: “No case of this dangerous disease has been recorded in the city of Irkutsk, Russian Federation.”
What is the plague?
The plague is caused by the bacterium Yersinia pestis, typically found in small mammals and the fleas that feed on them. It is the same organism behind the bubonic plague or “black death” that swept Europe in the 14th century. The bubonic form, spread by infected fleas, results in swellings called buboes. Pneumonic plague, which some have suggested caused Shipilova's death, is lung-based, has a higher mortality rate, and can spread between people.
One media report suggested Shipilova was admitted with the disease after returning from Thailand, while another said she became infected after breaking a test tube in the laboratory. Rospotrebnadzor has denied any such accidents occurred at the institute.
Risk assessment
Dr Malick Gibani at Imperial College London noted that the plague is not a disease of the past: “There are a few hundred cases of plague reported each year globally usually in geographically restricted areas, particularly in Madagascar and the Democratic Republic of Congo – although there are a small number of cases in the western United States, central Asia, Mongolia, etc.”
Dr Simon Clarke at the University of Reading said plague is caused by bacteria, and antibiotics such as fluoroquinolones and aminoglycosides work well if administered early enough. However, Prof Brendan Wren at the London School of Hygiene & Tropical Medicine warned of multi-antibiotic-resistant strains emerging, “and if the laboratory is working on such a strain, then treatment options may be limited”.
Reports suggest almost 200 people who may have had contact with Shipilova are under medical observation, and quarantines have been imposed in a number of hospitals. “Isolation and monitoring are sensible strategies,” Wren said. Prof Alice Hughes at the University of Melbourne added that the incubation for pneumonic plague is only one to three days, and as yet no one has shown symptoms.
Prof Ian Jones at the University of Reading said: “This case here seems like a rare lab accident and is unlikely to go much further.” Clarke, however, said: “Until more details emerge, it is difficult to assess whether this represents an isolated case, an occupational exposure, or evidence of wider transmission.”
The WHO's spokesperson Christian Lindmeier said the risk to others is low: “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.”
What happens next?
Dr Zania Stamataki at the University of Birmingham said control systems in the UK for hazardous organisms work, making laboratory-acquired infections rare, but added: “They are not impossible, and this is why an incident warrants a full account of what happened. That account matters beyond Russia.”
Experts stressed a need for transparency. “I think it's important that we see how this pans out, and ideally, there'd be good communication between the public health authorities and the wider global health community,” said Gibani. He added: “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.”
