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Human Plague -- United States, 1983

Between April 21 and June 17, 1983, 16 human plague cases, resulting from exposure to wild-rodent plague, were reported in the western United States (Table 2). The plague season began with two cases reported in late April, two in the first 2 weeks of May, four in the last 2 weeks of May, and eight in the first 2 weeks of June.

Four patients (25%) have died, two (13%) have contracted secondary plague pneumonia, and at least two (13%) have become septicemic. Disease has not spread to contacts of patients with plague pneumonia, and no cases of primary pneumonic plague have occurred. Nine patients were American Indians, three (33%) of whom died; seven were Caucasians, accounting for one (14%) fatality. Eight patients were under 20 years old (three fatalities), four were 21-50 years old, and plague pneumonia, and at least two (13%) have become septicemic. Disease has not spread to contacts of patients with plague pneumonia, and no cases of primary pneumonic plague have occurred. Nine patients were American Indians, three (33%) of whom died; seven were Caucasians, accounting for one (14%) fatality. Eight patients were under 20 years old (three fatalities), four were 21-50 years old, and four were over 50 years old (one fatality). Thirteen patients were male.

Seven patients each were exposed to wild-rodent plague in Arizona and New Mexico, and one each, in Utah and Oregon. Although most patients were exposed in areas reporting plague in previous years, three acquired infection in locations where human plague has not previously been reported--the southwestern quadrant of New Mexico (one case) and north central Arizona near Lake Powell (two cases).

Surveillance for evidence of wild-rodent plague indicates increased levels of activity in many areas of Arizona, New Mexico, Nevada, Utah, California, and Oregon. Animal plague also has been detected in Colorado, Wyoming, western Texas, and Washington. Wyoming is currently experiencing a widespread plague epizootic among ground squirrels in and near Cheyenne. Reported by Respective state health depts; Plague Br, Div of Vector-Borne Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: The large number of plague cases this season appears to reflect widespread epizootic plague in 10 western states. Unseasonably cool, moist weather in the western United States early in 1983 appears to have resulted in longer survival for infective fleas, thus extending the plague season in areas where it normally would have subsided earlier.

Human plague infections occur most frequently in the southwestern states, particularly northern New Mexico, northeastern Arizona, southern California, Colorado, and southen Utah because of sociocultural factors that increase human exposure to the rodent/flea environment and the propensity for fleas of certain wild rodents to bite humans. Clinicians in the other western states should maintain a high degree of suspicion when a compatible clinical/ epidemiologic syndrome is seen, despite the apparent paucity of cases in these states. Physicians in nonendemic areas in the eastern two-thirds of the United States should consider plague in the differential diagnosis for febrile patients who have recently traveled to the western states. If plague is reasonably included in the differential diagnosis, acute-phase serum and blood and other appropriate specimens for culture should be obtained. Oral tetracycline is effective early in the course of illness and in relatively uncomplicated bubonic plague cases. Streptomycin is the drug of choice for inpatient therapy. If intravenous antibiotics are indicated, as for hypotensive patients, gentamicin or chloramphenicol are preferred. When outpatient treatment is given, the patient should be followed actively for 1-3 days to ensure he has responded satisfactorily and to mount an appropriate public health response if laboratory tests support the diagnosis of plague.

In response to the current increase in plague in wild rodents and humans, public health authorities are initiating a number of preventive measures. These include: 1) educating the public to avoid sick or dead rodents and rabbits, to avoid burrows, to deflea household pets (cats and dogs) that can transport fleas of wild rodents to humans, and to eliminate trash, which can harbor rodents, near living areas; 2) conducting surveillance for evidence of wild-rodent plague; 3) dusting with insecticides to eliminate wild-rodent fleas in populated, residential, or recreational areas where plague is found or appears active. Suspected cases of human or animal plague should be reported to CDC through state and local health departments.

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