Specialty infectious disease ICD-9-CM 020.0 MedlinePlus 000596 | ICD-10 A20.0 DiseasesDB 14226 | |
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The 1924 Los Angeles pneumonic plague outbreak began October 30, 1924, and was declared fully contained on November 13, 1924. It represented the first time plague had emerged in Southern California. Previously, plague outbreaks had arisen in San Francisco and nearby Oakland marking the first time plague had emerged in California. The Los Angeles outbreak began on October 30, lasted two weeks, and killed 30 people. Public health officials credited the lessons learned from the San Francisco outbreak coupled with swiftly implemented measures, including hospitalization of the sick and all their contacts, a neighborhood quarantine, and a large-scale rat eradication program, with saving lives.
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Epidemiology
Traceback analysis to identify the index-patient revealed that the outbreak actually began sometime in late September or early October, 1924 when a 51-year-old man named Jesús Lujan, living in the Macy Street district near downtown Los Angeles, fell ill with fever and a painful lump in his groin. Prior to symptoms, Lujan had discovered a decaying rat under his house and picked it up and threw it in the trash. Within that same week, Lujan's fifteen-year-old daughter, Francisca (Concha), also fell ill. She complained of fever and respiratory distress. A physician called to the house diagnosed the daughter with 'double pneumonia' and diagnosed Lujan's enlarged lymph node as being associated with a venereal disease. Investigators believed that Jesús Lujan initially contracted the bubonic form of plague. Left untreated, bubonic plague can move to the lungs and cause a secondary pneumonic infection. As Lujan's end-stage symptoms included bloody sputum, it's believed his had converted to the pneumonic form. And because he fell ill before any of the others, Jesús Lujan was identified as the index-patient.
A week later, Francisca Lujan died. A young pregnant neighbor, Lucena Samarano, who had been caring for Francesca also developed the same respiratory symptoms and died days later. A Catholic priest, Father M. Brualla, who had administered last rites to the victims and said the requiem Mass for Samarano, as well as a dozen or so of the congregants at her funeral, developed the same respiratory symptoms and died days later. Within a week, Lucena Samarano's entire family of eight had died.
On October 30, 1924, the Los Angeles County Hospital pathologist, Dr. George Maner, identified plague as the cause of the illness. Dr. Maner identified it from a serum sample from a patient who had died after attending Lucena Samarano's funeral. He notified the City Health Department as well as state officials. City health officials quarantined an eight-block area Clara Street where the funeral had taken place as well as a six-block area in the Belevdere district after Jesǘs Lajun was identified as the index-patient.
Within the quarantined area, the health department set up a temporary laboratory to quickly identify new cases. At the same time, the city began a citywide rat extermination program. Infected rats were found in downtown, Beverly Hills, and the harbor.
Transmission
Pneumonic plague is the only form of plague that has person-to-person transmission which occurs during droplet-respiration.