What do we know about death of anti-plague institute worker in Russia and is there a wider risk?

After a 28-year-old lab technician died last week reportedly after an accident at an anti-plague research laboratory in Russia, we take a look at what we know about the incident.

What has happened?

The exact details remain unclear but reports from Russia have suggested 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 Rospotrebnadzor, Russia’s health watchdog, Shipilova died from “pneumonia of unknown aetiology”.

However there are other accounts: Alexey Tsydenov, the head of the neighbouring Buryatia region, intially 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.”

If it is the plague, what are we talking about?

We are talking about a disease caused by the bacterium Yersinia pestis, typically found in small mammals and the fleas that feed on them. It is the same organism that was behind the bubonic plague or “black death” that swept Europe in the 14th century.

However, the bubonic form is different from the pneumonic plague that some have suggested caused Shipilova’s death.

The former is more common, results in swellings called buboes and is spread by the bite of infected fleas, whereas the latter is lung-based. Pneumonic plague has a higher mortality rate and can be spread between people.

How might Shipilova have ended up with pneumonic plague?

One report in the media is that Shipilova was admitted with the disease after returning from Thailand, while another is that she became infected after breaking a test tube in the laboratory. Rospotrebnadzor has denied any such accidents have occurred at the institute.

How concerned should we be?

It is worth noting 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,” said Dr Malick Gibani at Imperial College London.

That might not seem reassuring, but we no longer have to rely on medieval medicine.

Dr Simon Clarke at the University of Reading said: “Unlike many viral respiratory diseases, plague is caused by bacteria, and antibiotics such as fluoroquinolones and aminoglycosides work well against this pathogen if administered early enough and are often given prophylactically, post-exposure.”

However, Prof Brendan Wren at the London School of Hygiene & Tropical Medicine said there were multi-antibiotic-resistant strains emerging, “and if the laboratory is working on such a strain, then treatment options may be limited”.

There have also been reports that almost 200 people with whom Shipilova may have had contact are now under medical observation, and that 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 the incubation for pneumonic plague was only one to three days and, as yet no one has shown symptoms.

Prof Ian Jones at the University of Reading also offered reassurance. “This case here seems like a rare lab accident and is unlikely to go much further.”

However, Clarke said there were still unknowns. “Until more details emerge, it is difficult to assess whether this represents an isolated case, an occupational exposure, or evidence of wider transmission,” he said.

The UN health agency’s spokesperson Christian Lindmeier has 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,” he said.

What happens next?

Dr Zania Stamataki, an associate professor of viral immunology and academic lead for containment level 3 laboratories at the University of Birmingham, said the control systems used in the UK for hazardous organisms work, meaning laboratory-acquired infections are rare.

But, she added: “They are not impossible, and this is why an incident warrants a full account of what happened. That account matters beyond Russia.”

Other experts also 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.

“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,” he added. “This could include developing medical countermeasures like better diagnostics or vaccines.”