skip the i-GuideIllinois State UniversityAdmissions at ISUAcademics at ISUEvents at ISUMap of ISUISU A to Z ListingISU AccessibilityISU 150th Anniversary
Environmental Health and Safety

PLAGUE

If you're going to be working with wild caught rodents, special precautions are indicated. Wild caught rodents should be dusted with an appropriate insecticide before being brought into any campus animal facility. If you're going to be working with wild rodents, you must consult with Employee Health Services about the appropriateness of plague vaccination for your staff.

General

Plague, caused by a bacterium called Yersinia pestis, is transmitted from rodent to rodent by infected fleas.

Plague is characterized by periodic disease outbreaks in rodent populations, some of which have a high death rate. During these outbreaks, hungry infected fleas that have lost their normal hosts seek other sources of blood, thus increasing the increased risk to humans and other animals frequenting the area.

All human plague cases in the U.S. have been sporadic cases acquired from wild rodents or their fleas or from direct contact with plague-infected animals.

Rock squirrels and their fleas are the most frequent sources of human infection in the southwestern states. For the Pacific states, the California ground squirrel and its fleas are the most common source. Many other rodent species, for instance, prairie dogs, wood rats, chipmunks, and other ground squirrels and their fleas, suffer plague outbreaks and some of these occasionally serve as sources of human infection. Deer mice and voles are thought to maintain the disease in animal populations but are less important as sources of human infection. Other less frequent sources of infection include wild rabbits, and wild carnivores that pick up their infections from wild rodent outbreaks. Domestic cats (and sometimes dogs) are readily infected by fleas or from eating infected wild rodents. Cats may serve as a source of infection to persons exposed to them. Pets may also bring plague-infected fleas into the home.

Between outbreaks, the plague bacterium is believed to circulate within populations of certain species of rodents without causing excessive mortality. Such groups of infected animals serve as silent, long-term reservoirs of infection.

How Is Plague Transmitted?

Plague is transmitted from animal to animal and from animal to human by the bites of infective fleas. Less frequently, the organism enters through a break in the skin by direct contact with tissue or body fluids of a plague-infected animal, for instance, in the process of skinning a rabbit or other animal. Plague is also transmitted by inhaling infected droplets expelled by coughing, by a person or animal, especially domestic cats, with pneumonic plague. Transmission of plague from person to person is uncommon and has not been observed in the United States since 1924 but does occur as an important factor in plague epidemics in some developing countries.

Diagnosis

The pathognomic sign of plague is a very painful, usually swollen, and often hot-to-the touch lymph node, called a bubo. This finding, accompanied with fever, extreme exhaustion, and a history of possible exposure to rodents, rodent fleas, wild rabbits, or sick or dead carnivores should lead to suspicion of plague.

Onset of bubonic plague is usually 2 to 6 days after a person is exposed. Initial manifestations include fever, headache, and general illness, followed by the development of painful, swollen regional lymph nodes. Occasionally, buboes cannot be detected for a day or so after the onset of other symptoms. The disease progresses rapidly and the bacteria can invade the bloodstream, producing severe illness, called plague septicemia.

Once a human is infected, a progressive and potentially fatal illness generally results unless specific antibiotic therapy is given. Progression leads to blood infection and, finally, to lung infection. The infection of the lung is termed plague pneumonia, and it can be transmitted to others through the expulsion of infective respiratory droplets by coughing.

The incubation period of primary pneumonic plague is 1 to 3 days and is characterized by development of an overwhelming pneumonia with high fever, cough, bloody sputum, and chills. For plague pneumonia patients, the death rate is over 50%.

Treatment Information

As soon as a diagnosis of suspected plague is made, the patient should be isolated, and local and state health departments should be notified. Confirmatory laboratory work should be initiated, including blood cultures and examination of lymph node specimens if possible. Drug therapy should begin as soon as possible after the laboratory specimens are taken. The drugs of choice are streptomycin or gentamycin, but a number of other antibiotics are also effective.

Those individuals closely associated with the patient, particularly in cases with pneumonia, should be traced, identified, and evaluated. Contacts of pneumonic plague patients should be placed under observation or given preventive antibiotic therapy, depending on the degree and timing of contact.

It is a U.S. Public Health Service requirement that all suspected plague cases be reported to local and state health departments and the diagnosis confirmed by the CDC. As required by the International Health Regulations, CDC reports all U.S. plague cases to the World Health Organization.

CLINICAL FEATURES

  • Bubonic plague: enlarged, tender lymph nodes, fever, chills and prostration
  • Septicemic plague: fever, chills, prostration, abdominal pain, shock and bleeding into skin and other organs
  • Pneumonic plague: fever, chills, cough and difficulty breathing; rapid shock and death if not treated early

TRANSMISSION

  • Flea-borne, from infected rodents to humans
  • Direct contact with infected tissues or fluids from handling sick or dead animals
  • Respiratory droplets from cats and humans with pneumonic plague

RESERVOIRS

  • Primarily wild rodents in U.S. (especially rock squirrels, ground squirrels, prairie dogs, other burrowing rodents)
  • Commensal rats may be important elsewhere

RISK GROUPS

  • In the U.S., persons exposed to rodent fleas, wild rodents, or other susceptible animals in enzootic areas of western states
  • Most cases occur in southwestern states of NM, AZ, CO, and in CA
  • Highest rates in Native Americans, especially Navajos; other risk groups: hunters; veterinarians and pet owners handling infected cats; campers or hikers entering areas with outbreaks of animal plague