What
is plague?Plague is an infectious disease caused by the bacillus Yersinia
pestis. Where is plague usually found?Plague
occurs mostly in temperate and sub-tropical areas of Asia, Africa and the Americas;
in epidemic form, it has spread much wider, including most of Europe. Outbreaks
in people occur in areas where housing and sanitation conditions are poor, in
rural communities or in cities. How common is plague?The
World Health Organization reports 1,000 to 3,000 cases of plague annually, while
in the US, an average of 10 to 20 cases are diagnosed each year). How
is plague transmitted?Fleas become infected by feeding mammals that have
been infected with the bacteria Yersinia pestis. Fleas transfer the bacteria
to humans and other mammals during their normal feeding. The bacteria are maintained
in the blood of the rodents. Outbreaks are usually associated with infected
rats and rat fleas that live in the home, though other ground-living rodents have
been implicated, including prairie dogs, wood rats, chipmunks, and ground squirrels. Can
plague be spread from person-to-person?When a person has plague pneumonia
and coughs, droplets containing the plague bacteria are disperesed into the air,
and may then reach a non-infected person. What are
the symptoms of plague?The typical sign of human plague is a swollen and
very painful and tender lymph gland. The swollen gland is called a "bubo",
hence bubonic plague. When plague bacteria reach the bloodstream,
they spread rapidly throughout the body causing a severe and often fatal condition.
Infection of the lungs causes the pneumonic form of plague, a severe respiratory
illness, with the potential to infect others. The infected person may experience
high fever, chills, cough, and breathing difficulty, with bloody sputum. If specific
antibiotic therapy is not given, the disease can progress rapidly to death. How
is plague diagnosed?Bubonic plague ise suspected when a person develops
a swollen gland, fever, chills, headache, and extreme exhaustion, when there is
a history of exposure to rodents or fleas. What
is the incubation period?Usually 2 to 6 days after being infected, an
untreated person becomes ill with bubonic plague, when the bacteria invade the
bloodstream. Is there a treatment for plague?Patients
with suspected plague are hospitalized and isolated. Laboratory tests, including
blood cultures for plague bacteria and microscopic examination of lymph gland,
blood, and sputum samples are arranged with all speed. Antibiotic treatment
begins immediately after laboratory specimens have been taken; some of the results
will not be available for 72 hours, and treatment may be reviewed in the light
of late results. Streptomycin is first line antibiotic; gentamicin may
be used when streptomycin is not available. Tetracyclines and chloramphenicol
are also effective, but are not the drugs of choice. People who have been in close
contact with the index patient are routinely identified and assessed, particularly
in cases of with plague pneumonia. All cases of suspected plague must be
reported to local and national health departments, who will report report to the
World Health Organization. This is a legal requirement in most nations. What
is the mortality rate for plague?About 14% of plague cases in the United
States prove fatal. the death rate for untreated plague is much higher. What
is the plague vaccine?Plague vaccine is an active immunizing agent, which
works by causing the body to produce antibodies against the disease. Who
should get vaccinated against plague?People traveling to plague-infected
areas of Africa, Asia, Latin America, or the western third of the United States
should consider plague vaccine to help prevent infection. Are
there adverse reactions to the plague vaccine?The vaccine may cause flu-like
symptoms, or local inflammation and redness; more serious effects are uncommon.
Can plague be controlled environmentally?Cleanliness
and vermin control. What can be learned from history?Plague
was the cause of Justinian's Plague (6th century) and the Black Death (14th century),
both outbreaks killed millions. A pandemic began in China and spread around the
world causing nearly 30 million cases with over 12 million deaths between 1896-1930.
Bibliography and Further Information Sources
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Article written by Andrew Heenan BA (Hons), RGN, RMN
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