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CDCFAQPlague

FrequentlyAskedQuestions
OnthisPage
Whatisplague?(#what)
Howdopeoplebecomeinfectedwithplague?(#how)
Whataredifferentformsofplague(#different)
Howisplaguetransmitted?(#transmission)
Couldonepersongetplaguefromanotherperson?(#person)
Whatistheincubationperiodforplague?(#period)
Howisplaguediagnosed?(#diagnosed)
HowmanycasesofplagueoccurintheUnitedStates?Globally?(#cases)
Whatisthedeathrateofplague?(#mortality)
Howisplaguetreated?(#treated)
Isthediseaseseasonalinitsoccurrence?(#occurrence)
WhereisplaguemostcommonintheUnitedStates?(#common)
WhoisatriskforgettingplagueintheUnitedStates?(#risk)
Isavaccineavailabletopreventplague?(#vaccine)

Whatisplague?
Plagueisaninfectiousdiseasethataffectsrodents,certainotheranimalsandhumans.Itiscaused
bytheYersiniapestisbacteria.Thesebacteriaarefoundinmanyareasoftheworld,includingthe
UnitedStates.

Howdopeoplebecomeinfectedwithplague?
Peoplemostcommonlyacquireplaguewhentheyarebittenbyafleathatisinfectedwiththe
plaguebacteria.Peoplecanalsobecomeinfectedfromdirectcontactwithinfectedtissuesorfluids
whilehandlingananimalthatissickwithorthathasdiedfromplague.Finally,peoplecan
becomeinfectedfrominhalingrespiratorydropletsafterclosecontactwithcatsandhumanswith
pneumonicplague.

Whatarethedifferentformsofplague?
Therearethreeformsofplague:
Bubonicplague:Patientsdevelopsuddenonsetoffever,headache,chills,andweakness
andoneormoreswollen,tenderandpainfullymphnodes(calledbuboes).Thisformis
usuallytheresultofaninfectedfleabite.Thebacteriamultiplyinthelymphnodeclosestto
wherethebacteriaenteredthehumanbody.Ifthepatientisnottreatedwithappropriate
antibiotics,thebacteriacanspreadtootherpartsofthebody.
Septicemicplague:Patientsdevelopfever,chills,extremeweakness,abdominalpain,
shock,andpossiblybleedingintotheskinandotherorgans.Skinandothertissuesmayturn
blackanddie,especiallyonfingers,toes,andthenose.Septicemicplaguecanoccurasthe
firstsymptomsofplague,ormaydevelopfromuntreatedbubonicplague.Thisformresults
frombitesofinfectedfleasorfromhandlinganinfectedanimal.
Pneumonicplague:Patientsdevelopfever,headache,weakness,andarapidlydeveloping
pneumoniawithshortnessofbreath,chestpain,cough,andsometimesbloodyorwatery
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mucous.Pneumonicplaguemaydevelopfrominhalinginfectiousdropletsorfromuntreated
bubonicorsepticemicplaguethatspreadstothelungs.Thepneumoniamaycause
respiratoryfailureandshock.Pneumonicplagueisthemostseriousformofthediseaseand
istheonlyformofplaguethatcanbespreadfrompersontoperson(byinfectiousdroplets).

Formsofplague.

Whatisthebasictransmissioncycleofplague?
Fleasbecomeinfectedbyfeedingonrodents,suchaschipmunks,prairiedogs,groundsquirrels,
mice,andothermammalsthatareinfectedwiththebacteriumYersiniapestis.Fleastransmitthe
plaguebacteriatohumansandothermammalsduringasubsequentfeeding.Theplaguebacteria
survivebriefly(afewdays)inthebloodofrodentsandforlongerperiodsinthefleas.An
illustrationofplagueecologyintheUnitedStates(/plague/transmission/index.html)isavailable.

Couldonepersongetplaguefromanotherperson?
Yes,whenapersonhasplaguepneumoniatheymaycoughdropletscontainingtheplaguebacteria
intoair.Ifthesebacteriacontainingdropletsarebreathedinbyanotherpersontheycancause
pneumonicplague.Humantohumantransmissionisrareandtypicallyrequiresdirectandclose
contactwiththepersonwithpneumonicplague.

Whatistheincubationperiodforplague?
Apersonusuallybecomesillwithbubonicplague2to6daysafterbeinginfected.Someone
exposedtoYersiniapestisthroughtheairwouldbecomeillwithin1to3days.
Whenbubonicplagueisleftuntreated,plaguebacteriacaninvadethebloodstream.Whenplague
bacteriamultiplyinthebloodstream,theyspreadrapidlythroughoutthebodyandcauseasevere
andoftenfatalconditioncalledsepticemicplague.Untreatedbubonicplaguecanalsoprogress
intoaninfectionofthelungs,causingpneumonicplague.Ifplaguepatientsarenotgivenspecific
antibiotictherapy,allformsofplaguecanprogressrapidlytodeath.

Howisplaguediagnosed?
Thefirststepinplaguediagnosisisevaluationbyahealthworker.Ifthehealthworkersuspects
plague,samplesofthepatientsblood,sputum,orlymphnodeaspiratearesenttoalaboratoryfor
testing.Oncethelaboratoryreceivesthesample,preliminaryresultscanbereadyinlessthantwo
hours.Laboratoryconfirmationwilltakelonger,usually24to48hours.Often,presumptive
treatmentwithantibioticswillstartassoonassamplesaretaken,ifplagueissuspected.

HowmanycasesofplagueoccurintheUnitedStates?Globally?
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PlaguewasfirstintroducedintotheUnitedStatesin1900.Between1900and2010,999
confirmedorprobablehumanplaguecasesoccurredintheUnitedStates.Over80%ofUnited
Statesplaguecaseshavebeenthebubonicform.Inrecentdecades,anaverageof7humanplague
casesarereportedeachyear(range:117casesperyear).Plaguehasoccurredinpeopleofallages
(infantsuptoage96),though50%ofcasesoccurinpeopleages1245.Worldwide,between
1,000and2,000caseseachyeararereportedtotheWorldHealthOrganization
(http://www.who.int/ith/diseases/plague/en/) (http://www.cdc.gov/Other/disclaimer.html)(WHO),
thoughthetruenumberislikelymuchhigher.

Whatisthedeathrateofplague?
Inthepreantibioticera(1900through1941),mortalityamongthoseinfectedwithplagueinthe
UnitedStateswas66%.Antibioticsgreatlyreducedmortality,andby19902010overallmortality
haddecreasedto11%.Plaguecanstillbefataldespiteeffectiveantibiotics,thoughitislowerfor
bubonicplaguecasesthanforsepticemicorpneumonicplaguecases.Itishardtoassessthe
mortalityrateofplagueindevelopingcountries,asrelativelyfewcasesarereliablydiagnosedand
reportedtohealthauthorities.WHOcitesmortalityratesof810%,howeversomestudies(WHO,
2004)suggestthatmortalitymaybemuchhigherinsomeplagueendemicareas.

Howisplaguetreated?
Plaguecanbesuccessfullytreatedwithantibiotics.Onceapatientisdiagnosedwithsuspected
plaguetheyshouldbehospitalizedand,inthecaseofpneumonicplague,medicallyisolated.
Laboratorytestsshouldbedone,includingbloodculturesforplaguebacteriaandmicroscopic
examinationoflymphnode,blood,andsputumsamples.Antibiotictreatmentshouldbeginas
soonaspossibleafterlaboratoryspecimensaretaken.Topreventahighriskofdeathinpatients
withpneumonicplague,antibioticsshouldbegivenassoonaspossible,preferablywithin24
hoursofthefirstsymptoms.

Isthediseaseseasonalinitsoccurrence?
Yes.Althoughcasescanoccuranytimeoftheyear,mostcasesintheUnitedStatesareacquired
fromlatespringtoearlyfall.

WhereisplaguemostcommonintheUnitedStates?
PlagueoccursinruralandsemiruralareasofthewesternUnitedStates.Plagueismostcommon
inthesouthwesternstates,particularlyNewMexico,Arizona,andColorado.

WhoisatriskforgettingplagueintheUnitedStates?
Humanplagueoccursinareaswherethebacteriaarepresentinwildrodentpopulations.The
risksaregenerallyhighestinruralandsemiruralareas,includinghomesthatprovidefoodand
shelterforvariousgroundsquirrels,chipmunksandwoodrats,orotherareaswhereyoumay
encounterrodents.

Isavaccineavailabletopreventplague?
Aplaguevaccineisnotavailable.Newplaguevaccinesareindevelopmentbutarenotexpectedto
becommerciallyavailableintheimmediatefuture.
Pagelastreviewed:June13,2012
Pagelastupdated:July25,2012
Contentsource:CentersforDiseaseControlandPrevention
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NationalCenterforEmergingandZoonoticInfectiousDiseases(NCEZID)
DivisionofVectorBorneDiseases(DVBD)

CentersforDiseaseControlandPrevention1600CliftonRoadAtlanta,GA30329
4027,USA
800CDCINFO(8002324636)TTY:(888)2326348ContactCDCINFO

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