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Plague

An infection caused by the organism Yersinia pestis which occurs in wild rodents and is transmitted to humans.

Plague is transmitted among rodents and to humans by flea bite or ingestion of the faeces of fleas. It can also be transmitted human to human when a plague victim develops pneumonia and spreads infected droplets by coughing. An epidemic maybe started this way. Two types of plague, bubonic and pneumonic, can occur. The incubation period is 2 to 10 days but maybe as short as a few hours for pneumonic plague. Plague has occurred in

Africa Angola, Botswana, Kenya, Lesotho, Libya, Madagascar, Mozambique, Nambia, South Africa, Tanzania, Uganda, Zaire, Zimbabwe.
Asia Myanmar, Mongolia, China, Vietnam, India.
North America United States: California, Utah, Arizona, Nevada, and New Mexico.
South America Bolivia, Brazil, Ecuador, and Peru.

Current Plague Infected Areas: www.cdc.gov/travel/blusheet.htm (usually at bottom of yellow fever infected areas)
Also see disease outbreaks: http://www.who.int/emc/outbreak_news/index.html

The risk of exposure is generally confined to rural and highland areas. Persons hunting camping, or backpacking for prolonged periods in these areas are at risk. Breakdown in sanitation as in a natural disaster may lead to an outbreak in urban areas. An outbreak of plague occurred in India in 1994. In recent years, sporadic cases have occured in hunters of wild rodents and in residents of remote Andean villages living in rat infested housing.* Vaccination or tetracycline 500mg q.i.d. during periods of exposure is available.

PREVENTION
Rat control and surveillance of the disease in the wild rodent population are the main measures used to control the risk of epidemics. Use of measures to stop insect bites* (permethrin impregnated bedsheet and clothing) are recommended. A vaccination is available for high-risk workers, but its effectiveness is not clearly established.

SYMPTOMS

BUBONIC PLAGUE
sudden onset of high fever
chills
general discomfort, uneasiness, or ill feeling (malaise)
muscular pains
severe headache
smooth, oval, reddened, painful swellings called buboes in the groin, armpits, neck, or elsewhere in the body
swollen lymph glands
seizures

PNEUMONIC PLAGUE
severe cough
frothy, bloody sputum
difficulty breathing

TREATMENT
Immediate treatment with antibiotics such as streptomycin, chloramphenicol, or tetracycline is indicated. Oxygen, intravenous fluids, and respiratory support are additional treatments. Patients with pneumonic plague are strictly isolated from other patients. People who have had contact with anyone infected by pneumonic plague are observed closely and are given antibiotics as a preventive measure.
Half of bubonic plague victims die if not treated, and almost all victims of pneumonic plague die if not treated. Treatment reduces the death rate to 5%.

Information mostly taken from: "International Travel and Health" (WHO year book - internet only)
Australian Immunisation Handbook, 8th Edition - 9/2003 - Part1 - Part 2 & Part 3 (large pdf files)
Centre for Disease Control, USA -  www.cdc.gov/travel Travel Health Seminar Oct 96, June 97,Feb 98, March 99, May 2000, August 2002 & March 2005 - Victorian Medical Postgraduate Foundation.
Manual of Travel Medicine, Melbourne, Oct 2004. Updated 18/09/2005.  Additional references & disclaimer.