Plague

The risk of getting plague is very low. Worldwide, only a few thousand people get plague each year. In the United States, seven people on average get plague each year.

Location

Plague has been reported in nearly all parts of the world. The most common locations are Madagascar, the Democratic Republic of Congo and Peru. In Madagascar there is usually an outbreak of plague every year.

Plague has been reported in the western United States, most often in Arizona, California, Colorado and New Mexico.

The disease mostly survives in populations of rodents and their fleas in rural and semirural areas. It also has occurred in cities with overcrowding, poor sanitation or large rat populations.

Jobs

People are at risk of getting plague if they work outdoors in areas where plague-carrying animals are common. People who work in animal clinics in these regions also have a risk of coming into contact with pet cats and dogs with the disease.

Hobbies

Camping, hunting or hiking in areas where plague-carrying animals reside can increase the risk of being bitten by an infected flea.

Bioweapons

The U.S. government considers plague a possible biological weapon. Evidence exists of it being used or developed as a weapon in the past. The U.S. government has guidelines for treatment and prevention of plague used as a weapon.

Complications of plague may include:

• Gangrene. Blood clots can form in the tiny blood vessels of the fingers, toes, nose and ears. This can cause the tissues to die. The dead tissue needs to be removed.
• Meningitis. Rarely, plague may cause swelling and disease of the protective tissues surrounding the brain and spinal cord. This condition is called meningitis.
• Pharyngeal plague. Rarely, the disease can be present in the tissues behind the nasal cavity and mouth, called the pharynx. This is called pharyngeal plague.

Death

The risk of death in people with all types of plague in the United States is around 11%.

Most people with bubonic plague survive with prompt diagnosis and treatment. Death is more likely with septicemic plague because it is difficult to diagnose and worsens rapidly. Treatment may unintentionally be delayed.

Pneumonic plague is severe and worsens rapidly. Risk of death is high if treatment doesn’t begin within 24 hours after symptoms start.

No vaccine is available, but scientists are working to develop one. Antibiotics can help prevent infection if you were likely exposed to plague.

People with pneumonic plague are isolated during treatment to prevent the spread of disease. Health care workers must wear protective masks, gowns, gloves and eyewear when they treat someone with pneumonic plague.

Reducing the risk of exposure

If you live or spend time outdoors where plague occurs:

• Rodent-proof your home. Remove nesting areas for rodents, such as piles of brush, rock, firewood and junk. Don’t leave pet food in areas that rodents can easily access. If you become aware of rodents living in your home, take steps to remove them.
• Protect your pets. Use flea-control medicines for your pets. Talk to your vet about the best options. If your pet is sick, get prompt treatment. Don’t let pets sleep with you if they are outside in areas where plague occurs.
• Protection from animals. When handling dead animals, wear gloves to prevent contact between your skin and the animal. Call your local health department if you have concerns about the removal of a dead animal.
• Use insect repellent on skin and clothing. When outdoors, use insect repellents registered with the U.S. Environmental Protection Agency. These include products that contain DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), para-menthane-3,8-diol or 2-undecanone. Do not use a spray directly on your face. Do not use products with OLE or PMD on children under age 3. Do not use insect repellent on a child under 2 months old.