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Making Sense of ... Plague




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

If this article hasn't answered your question, email me at the address below, and I'll try to get the information you seek. I regret I cannot assist with individual cases or essays and school projects, but if it's something I've missed, I'll be happy to try and help.

Article written by Andrew Heenan BA (Hons), RGN, RMN

First Published: 23 January 2006
Last updated: 11 March 2012
© Andrew Heenan 2006 et seq


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