Chapter 3Infectious Diseases Related To Travel
Plague (Bubonic, Pneumonic, Septicemic)
Kevin S. Griffith, Paul S. Mead
Plague is caused by the gram-negative bacterium Yersinia pestis.
MODE OF TRANSMISSION
Zoonotic disease is usually transmitted to humans by the bites of infected rodent fleas. Less common exposures include handling infected animal tissues (hunters, wildlife personnel), inhalation of infectious droplets from cats or dogs with plague, and rarely, contact with a pneumonic plague patient.
Each year, 1,000–2,500 cases occur globally. Plague is endemic in rural areas in central and southern Africa, central Asia and the Indian subcontinent, the northeastern part of South America, and parts of the southwestern United States. Although rare, urban outbreaks of plague have been reported in Mahajanga, Madagascar. All ages are at risk for infection; however, risk to travelers is largely restricted to rural endemic areas. Only 1 case associated with international travel has been reported in the United States in the past 2 decades.
The incubation period is typically 1–6 days. History is suggestive of exposure to rodents, rodent fleas, wild rabbits, sick or dead carnivores, or patients with pneumonic plague. Symptoms and signs of the 3 clinical presentations of plague illness are as follows:
- Bubonic (more than 80%)—rapid onset of fever; painful, swollen, and tender lymph nodes, usually inguinal, axillary, or cervical
- Pneumonic—high fever, overwhelming pneumonia, cough, bloody sputum, chills
- Septicemic—fever, prostration, hemorrhagic or thrombotic phenomena, progressing to acral gangrene
Y. pestis can be isolated from bubo aspirates, blood cultures, or sputum culture if pneumonic. Diagnosis can be confirmed through culture rapid assays, available through public health laboratories, or serologic tests that show a 4-fold change in antibody titer to F1 antigen between acute- and convalescent-phase sera.
Physicians should report all suspected plague cases to state or local health departments and consult with CDC to obtain information and access diagnostic services. Parenteral antibiotic therapy with streptomycin is the recommended first-line therapy; alternatively, gentamicin or, where treatment is limited to oral therapy, doxycycline can be used. Additional information can be found on the Division of Vector-Borne Diseases website at www.cdc.gov/ncidod/dvbid/plague/index.htm.
PREVENTIVE MEASURES FOR TRAVELERS
No vaccine is currently available in the United States. Preventive measures are aimed at reducing contact with fleas and potentially infected rodents and other wildlife. Prophylactic antibiotic treatment is given only in the event of exposure to bites of wild rodent fleas during an outbreak, exposure to tissues of a plague-infected animal, or close exposure to another person or animal with suspected plague pneumonia. People working in health care settings should follow droplet precautions while working with suspected plague patients, especially if patient is coughing.
- Boisier P, Rahalison L, Rasolomaharo M, Ratsitorahina M, Mahafaly M, Razafimahefa M, et al. Epidemiologic features of four successive annual outbreaks of bubonic plague in Mahajanga, Madagascar. Emerg Infect Dis. 2002 Mar;8(3):311–6.
- Boulanger LL, Ettestad P, Fogarty JD, Dennis DT, Romig D, Mertz G. Gentamicin and tetracyclines for the treatment of human plague: review of 75 cases in new Mexico, 1985–1999. Clin Infect Dis. 2004 Mar 1;38(5):663–9.
- CDC. Human plague—India, 1994. MMWR Morb Mortal Wkly Rep. 1994 Sep 30;43(38):689–91.
- CDC. Prevention of plague: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1996 Dec 13;45(RR-14):1–15.
- Dennis DT, Mead P. Yersinia species, including plague. In: Mandell GS, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010. p. 2943–53.
- Gage KL. Plague. In: Collier L, editor. Microbiology and Microbial Infections. 9th ed. New York: Arnold; 1998.
- Inglesby TV, Dennis DT, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, et al. Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA. 2000 May 3;283(17):2281–90.
- Kool JL. Risk of person-to-person transmission of pneumonic plague. Clin Infect Dis. 2005 Apr 15;40(8):1166–72.
- Neerinckx S, Bertherat E, Leirs H. Human plague occurrences in Africa: an overview from 1877 to 2008. Trans R Soc Trop Med Hyg. 2010 Feb;104(2):97–103.
- Perry RD, Fetherston JD. Yersinia pestis—etiologic agent of plague. Clin Microbiol Rev. 1997 Jan;10(1):35–66.
- World Health Organization. Human plague: review of regional morbidity and mortality, 2004–2009. Wkly Epidemiol Rec. 2009 Feb 5;85(6):40–5.
- Travel Notices
- Find a Clinic
- Disease Directory
- Information Centers
- Traveler Information Center
- Common Travel Health Topics
- Adventure Travel
- Bug Bites
- Business Travel
- Counterfeit Drugs
- Cruise Ship Travel
- Cold Climates
- Deep Vein Thrombosis
- Food and Water
- Health Care Abroad
- High Altitudes
- Hot Climates
- Humanitarian Aid Workers
- Jet Lag
- Last-Minute Travel
- Long-Term Travel
- Mass Gatherings
- Medical Tourism
- Mental Health
- Motion Sickness
- Natural Disasters
- Pregnant Travelers
- Road Safety
- Senior Citizens
- Sex Tourism
- Sick After Travel
- Study Abroad
- Sun Exposure
- Swimming and Diving
- Travelers' Diarrhea
- Travelers with Chronic Illnesses
- Travelers with Weakened Immune Systems
- Traveling with a Disability
- Traveling with Your Pet
- Visiting Friends or Relatives
- Water Disinfection
- Traveler Survival Guide
- CDC-TV Videos
- Common Travel Health Topics
- Clinician Information Center
- Travel Industry Information Center
- Traveler Information Center
- Yellow Book
- RSS Feeds
Before you travel make sure you speak with your doctor.