Frequently Asked Questions
- What is plague?
- How do people become infected with plague?
- What are the different forms of plague?
- What is the basic transmission cycle of plague?
- Could one person get plague from another person?
- What is the incubation period for plague?
- How is plague diagnosed?
- How many cases of plague occur in the United States? Globally?
- What is the death rate of plague?
- How is plague treated?
- Is the disease seasonal in its occurrence?
- Where is plague most common in the United States?
- Who is at risk for getting plague in the United States?
- Is a vaccine available to prevent plague?
Plague is an infectious disease that affects rodents, certain other animals, and humans. It is caused by the Yersinia pestis bacteria. These bacteria are found in many areas of the world, including the United States.
People most commonly acquire plague when they are bitten by a flea that is infected with the plague bacteria. People can also become infected from direct contact with infected tissues or fluids while handling an animal that is sick with or that has died from plague. Finally, people can become infected from inhaling respiratory droplets after close contact with cats and humans with pneumonic plague.
There are three forms of plague:
- Bubonic plague: Patients develop fever, headache, chills, and weakness and one or more swollen, painful lymph nodes (called buboes). This form is usually the result of an infected flea bite. The bacteria multiply in a lymph node near where the bacteria entered the human body. If the patient is not treated with appropriate antibiotics, the bacteria can spread to other parts of the body.
- Septicemic plague: Patients develop fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic plague can occur as the first symptoms of plague or may develop from untreated bubonic plague. This form results from bites of infected fleas or from handling an infected animal.
- Pneumonic plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous. Pneumonic plague may develop from inhaling infectious droplets or from untreated bubonic or septicemic plague that spreads to the lungs. The pneumonia may cause respiratory failure and shock. Pneumonic plague is the most serious form of the disease and is the only form of plague that can be spread from person to person (by infectious droplets).
Fleas become infected by feeding on rodents, such as chipmunks, prairie dogs, ground squirrels, mice, and other mammals that are infected with the bacterium Yersinia pestis. Fleas transmit the plague bacteria to humans and other mammals during a subsequent feeding. The plague bacteria survive briefly (a few days) in the blood of rodents and for longer periods in the fleas. An illustration of plague ecology in the United States is available.
Yes, when a person has plague pneumonia they may cough droplets containing the plague bacteria into air. If these bacteria-containing droplets are breathed in by another person they can cause pneumonic plague. Human-to-human transmission is rare and typically requires direct and close contact with the person with pneumonic plague.
A person usually becomes ill with bubonic plague 2 to 8 days after being infected. The incubation period of septicemic plague is poorly defined but likely occurs within days of exposure. A person exposed to Yersinia pestis through the air would usually become ill in just 1 to 3 days.
When bubonic plague is left untreated, plague bacteria can invade the bloodstream. When plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition called septicemic plague. Untreated bubonic plague can also progress into an infection of the lungs, causing pneumonic plague. If plague patients are not given specific antibiotic therapy, all forms of plague can progress rapidly to death.
The first step in plague diagnosis is evaluation by a health worker. If the health worker suspects plague, samples of the patient’s blood, sputum, or lymph node aspirate are sent to a laboratory for testing. Once the laboratory receives the sample, preliminary results can be ready in less than two hours. Laboratory confirmation will take longer, usually 24 to 48 hours. Often, presumptive treatment with antibiotics will start as soon as samples are taken, if plague is suspected.
Plague was first introduced into the United States in 1900. Between 1900 and 2012, 1006 confirmed or probable human plague cases occurred in the United States. Over 80% of United States plague cases have been the bubonic form. In recent decades, an average of 7 human plague cases are reported each year (range: 1-17 cases per year). Plague has occurred in people of all ages (infants up to age 96), though 50% of cases occur in people ages 12–45. Worldwide, between 1,000 and 2,000 cases each year are reported to the World Health Organizationexternal icon (WHO), though the true number is likely much higher.
In the pre-antibiotic era (1900 through 1941), mortality among those infected with plague in the United States was 66%. Antibiotics greatly reduced mortality, and by 1990-2010 overall mortality had decreased to 11%. Plague can still be fatal despite effective antibiotics, though it is lower for bubonic plague cases than for septicemic or pneumonic plague cases. It is hard to assess the mortality rate of plague in developing countries, as relatively few cases are reliably diagnosed and reported to health authorities. WHO cites mortality rates of 8–10%, however some studies (WHO, 2004) suggest that mortality may be much higher in some plague endemic areas.
Plague can be successfully treated with antibiotics. Once a patient is diagnosed with suspected plague they should be hospitalized and, in the case of pneumonic plague, medically isolated. Laboratory tests should be done, including blood cultures for plague bacteria and microscopic examination of lymph node, blood, and sputum samples. Antibiotic treatment should begin as soon as possible after laboratory specimens are taken. To prevent a high risk of death in patients with pneumonic plague, antibiotics should be given as soon as possible, preferably within 24 hours of the first symptoms.
Yes. Although cases can occur any time of the year, most cases in the United States are acquired from late spring to early fall.
Plague occurs in rural and semi-rural areas of the western United States. Plague is most common in the southwestern states, particularly New Mexico, Arizona, and Colorado.
Human plague occurs in areas where the bacteria are present in wild rodent populations. The risks are generally highest in rural and semi-rural areas, including homes that provide food and shelter for various ground squirrels, chipmunks and wood rats, or other areas where you may encounter rodents.
A plague vaccine is not available. New plague vaccines are in development but are not expected to be commercially available in the immediate future.