But after years of testing in Uganda, the CDC is finishing a study of a low-cost dipstick, not unlike a home pregnancy test, which requires just a drop of blood or urine to reveal within minutes if a person has plague. Jeff Borchert, the CDC scientist who oversees the project in Uganda, says that having such a test would be critical in the event of a biological attack and that the United States could provide free tests to Uganda and other plague-endemic countries.
Meanwhile, the researchers have sought to expand drug options, because some intravenous antibiotics, such as streptomycin, are not widely available and because drug resistance to other antibiotics poses a concern. The go-to pill for an anthrax attack is ciprofloxacin, which is part of the U.S. Strategic National Stockpile established for national emergencies. The researchers hope it will also be approved by the FDA for plague.
As part of the ongoing clinical trials, 14-year-old Isaac Baniyo’s plague was diagnosed with a dipstick; he then became the fifth plague patient — and the first with the pneumonic form of the disease — treated with a 10-day dose of cipro. Fortunately, the drug worked for him. “It’s a very big step forward,” says Ingelsby, who was not involved in the research.
A role for traditional healers
Despite their efforts so far in Uganda, the team has not achieved its goal of reducing plague mortality from about 30 percent to 15 percent. Mead at first suspected that people farthest from clinics were not getting diagnosis and treatment within the two-day window that makes the difference. That hunch proved wrong.
It turned out that cultural traditions were key, and they were working against the CDC. Many people in Baniyo’s village rely on traditional healers, who treat illness with herbs or prayers. During a 2008 outbreak of pneumonic plague, the healer was one of those sickened — and a fully stocked clinic was less than a half-mile away. “Having a diagnostic dipstick and effective antibiotics doesn’t really matter if a person doesn’t get to the clinic,” Mead says.
So in 2010, Titus Apangu of the Ugandan Virus Research Institute, with funding from the CDC, began recruiting 10 of these traditional healers, training them to recognize plague symptoms and providing them with bicycles, cellphones and referral cards to direct patients to a specialist at the local clinic. The number of healers working with the institute has now climbed to 42, and they have made 562 referrals for suspected cases of plague, malaria, tuberculosis and other serious illnesses. Some are even sporting homemade uniforms with a CDC logo.
On a recent morning, Mark Wadribo, a healer in a blue sweater with a wooden cross around his neck, pulled out his book of referrals and told the story of a young farmer who limped into his compound last year. The man was so weak, he could barely speak. “When I examined him, I found high fever,” Wadribo recalled. “I asked if he had swellings.” The man revealed a bubo on the left side of his groin.
In the past, Wadribo treated such patients by making incisions and rubbing herbs in the wound. This time, he grabbed his cellphone and told his brother to ready the motorbike. They had a plague to stop.
Borrell is a freelance writer and a 2013 fellow with the Alicia Patterson Foundation.