What is plague?

Plague is a disease that is usually spread through bites from infected fleas. Plague can also be spread by touching infected animals. Rarely, contact with a person with plague can also spread the disease. There are three types of plague: bubonic, pneumonic, and septicemic. The table below describes how these types of plague are spread and what the symptoms are for each.


Type of Plague

How it spreads



Bites from infected fleas and handling infected animals

Fever; headache; chills; weakness; and swollen, painful lymph nodes (called buboes).


Bites from infected fleas and handling infected animals

Fever, chills, extreme weakness, stomach pain, shock, and sometimes bleeding into the skin and other organs. (Skin may turn black and die.)


Contact with humans or animals that have plague pneumonia and cough

Fever, headache, weakness, rapidly developing pneumonia, chest pain, and shortness of breath. Patients may cough up bloody or watery mucous.

Who is at risk?

Each year, 1,000–2,500 people get plague across the world. Plague is seen in certain regions of Africa, central Asia, the Indian subcontinent, the northern part of South America, and parts of the southwestern United States. Although rare, urban outbreaks of plague have been reported in Mahajanga, Madagascar. However, the risk to travelers is low and is usually restricted to rural areas. Only 1 case of plague associated with international travel has been reported in the United States in the past 20 years.

What can travelers do to prevent plague?

There is no vaccine or medicine that prevents plague that is sold in the United States.

Prevent flea bites:

man spraying insect repellent on his arm
  • Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
  • Use an appropriate insect repellent as directed.
  • Higher percentages of active ingredient provide longer protection. Use products with the following active ingredients:
    • DEET (Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon)
    • Picaridin (also known as KBR 3023, Bayrepel, and icaridin products containing picaridin include Cutter Advanced, Skin So Soft Bug Guard Plus, and Autan [outside the US])
    • Oil of lemon eucalyptus (OLE) or PMD (Products containing OLE include Repel and Off! Botanicals)
    • IR3535  (Products containing IR3535 include Skin So Soft Bug Guard Plus Expedition and SkinSmart)
  • Always follow product directions and reapply as directed:
    • If you are also using sunscreen, apply sunscreen first and insect repellent second.
    • Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.
  • Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself:
    woman checking her temperature
    • Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
    • If treating items yourself, follow the product instructions carefully.
    • Do not use permethrin directly on skin.
  • Do not touch dead animals.
    • Fleas can be transferred from a dead animal to you.

If living in the area with plague, you may need to take these additional steps:

  • Keep food tightly sealed and away from rodents.
  • Stay in housing that is free of rodents and has proper sanitation.
  • Protect yourself and pets:
    • Do not allow pets to sleep in your bed.
    • Do not allow pets to roam free in areas where plague is known to occur.
    • Talk to a veterinarian about protecting pets from fleas.
    • Avoid handling sick or dead animals. If you must handle a sick or dead animal, wear gloves, cover your skin, and use additional personal protective equipment if possible.

If you feel sick and think you may have plague:

Traveler Information

Clinician Information