Plague

Plague is a bacterial infection transmitted by the bite of an infected flea or sometimes, through exposure to plague infected animals or their tissue. Plague can be spread from person to person. Epidemic plague is generally associated with domestic rats. Almost all of cases reported occur in rural areas and among people living in small towns, villages, or agricultural areas rather than in larger, more developed towns and cities. The bacterium may be introduced through flea bites or a cut or break in the skin during exposure to rodents or rabbits.

Wild rodent plague poses a real, though limited, risk to humans. When infection spreads to domestic or peridomestic rodents in urban or populated areas, humans are at markedly increased risk of exposure. Wild rodent plague exists in the western third of the United States, in widely scattered areas of South America, in north, central, eastern and southern Africa, Madagascar, Iranian Kurdistan, along the frontier between Yemen and Saudi Arabia, central and southeast Asia (Myanmar, China, India, Indonesia, Mongolia, Vietnam, Kazakhstan), and portions of the Russian Federation.

In recent years, human plague has been reported from Angola, India, Kenya, Lesotho, Madagascar, Mozambique, Namibia, South Africa, Botswana, Tanzania, Uganda, Zimbabwe, Zaire, Myanmar, China, Mongolia, Vietnam, United States, former Soviet Union, Brazil, Bolivia, Ecuador and Peru. Risk to travelers in any of these areas is small.

Symptoms

Classic plague symptoms include a very painful, usually swollen, and often hot to the touch lymph node in the armpit, groin, or neck. Other symptoms include high fever, headache, chills, extreme exhaustion, and sometimes delirium. Untreated, about 40% of patients die.

Treatment

Treatment with tetracycline, chloramphenicol, and streptomycin is usually rapidly effective.

Prevention

Prevent plague by avoiding fleas and rodents such as rats, rabbits, squirrels, and chipmunks. If you are living in a plague area, spray a rodenticide around all dwellings and use flea powders on all domestic pets. Insect repellents will ward off fleas.

Vaccination

A vaccine for prevention and treatment is available. The efficacy of plague vaccine in humans has not been demonstrated in a controlled trial. Only limited indirect data are available that suggest the vaccine may offer protection against acquiring plague. Vaccination against plague is not required by any country as a condition for entry.

There are few indications to vaccinate persons other than those who are at particularly high risk of exposure because of research activities or certain field activities in epizootic areas. In most of the countries of Africa, Asia, and Americas where plague is reported, the risk of infection exists primarily in rural mountainous or upland areas. Vaccination is rarely indicated for travelers to countries reporting cases, particularly if their travel is limited to urban areas with modern hotel accommodations.

Travelers who genuinely may be at risk for acquiring plague should consider antibiotic chemoprophylaxis with tetracycline 500 mg. four-times-a-day during periods of exposure in an active epizootic or epidemic area. The recommendation for tetracycline chemoprophylaxis is inferred from experience with the drug in treating plague. Controlled trials that demonstrate the efficacy of tetracycline chemoprophylaxis in preventing plague have not been reported.

Diseases