University at Albany Prevention Research Center

PLAGUE

Infectious Agent

A Gram negative bacillus Yersinia Pestis (Y. Pestis)
More Information On Infectious Agent at CIDRAP, NYSDOH & CDC
Image at CDC

Clinical Symptoms

The different clinical syndromes caused by Y. Pestis are
Bubonic Plague - enlarged, tender lymph nodes, fever, chills and prostration
Pneumonic Plague - fever, chills, cough and difficulty breathing; rapid shock and death if not treated early
Septicemic Plague - fever, chills, prostration, abdominal pain, shock and bleeding into skin & other organs
(To View Syndrome Specific Information at CIDRAP, Click on the Syndrome Names)
More Information On Clinical Symptoms at CIDRAP, NYSDOH & CDC
Images at CDC

Epidemiology

Reservoir - Many different animal species (mostly wild rodents) are natural reservoirs for Y. Pestis e.g. Urban/Domestic Rats, Squirrels, Prairie Dogs, Mice, Guinea Pigs, Kangaroo Rats, etc. Humans are incidental hosts for Y. Pestis and are not part of the natural life cycle of the organisms. Disease occurrence in humans is dependent on the frequency of infection in local rodent populations and the degree of contact between rodents and humans. Like humans, mammalian species other than rodents generally are incidental hosts for Y. Pestis. However, such animals also can serve as sources of human exposure (either through direct contact or through flea vectors). Examples include dogs, cats, camels, goats, deer etc.

Vectors - Infected Fleas. Examples of major flea vectors include the following: Xenopsylla cheopis (the oriental rat flea; nearly worldwide in moderate climates), Oropsylla montanus (United States) & Others.
See Image at CDC

Modes of Transmission -
Bubonic Plague: via
- flea vector bites
- bites/scratches from infected animals e.g. cats
- direct contact with infected animal carcasses e.g. of rodents
Pneumonic Plague: via inhalation of respiratory droplets from infected animals (e.g. cats) or another person with either primary or secondary pneumonic plague.
More Information On Epidemiology at CIDRAP & CDC

Plague as a Bioterrorism Agent

Plague is a suitable pathogen for use as a biological weapon because:
- The organisms can be delivered in an aerosol form.
- Pneumonic plague causes a serious illness with a high case-fatality rate.
- Pneumonic plague is communicable, and large outbreaks have occurred in the past.
- A bioterrorist attack involving pneumonic plague would cause widespread fear and panic that would be difficult to contain, partly because of the communicable nature of the disease.

Plague used as a bioterrorist weapon would be expected to have the following features:
- Previously healthy patients would present with a severe and rapidly progressive pneumonia.
- An acute multilobar pneumonia accompanied by hemoptysis, associated gastrointestinal symptoms, and a fulminant clinical course would be very suspicious for pneumonic plague.
- Many similar cases would present over several days.
- Illness onsets would generally occur 2 to 4 days after release, but could occur as soon as 1 day and up to 6 days later.
- Buboes characteristic of bubonic plague would not be present.
- Illness would likely occur in an urban area and patient would not have a history of recent travel to a plague-endemic region (i.e. southwestern United States).
- Patients would not necessarily have risk factors for plague exposure (e.g. outdoor field work, veterinary work, recent outdoor recreational activity).
- There would be no indication of a prior recent plague epizootic with rodent deaths in the affected community
More Information on Plague as a Bioterrorism Agent at CIDRAP

Prevention & Control

Standard Precautions - include handwashing, protecting exposed body parts (gloves, masks, gowns, eye protection and face shields) and patient care equipment to avoid infection from blood, secretions, fluids, excretions and contaminated items.
Droplet Precautions & Eye Protection
More Information On Prevention & Control at CIDRAP, NYSDOH & CDC

Click here for Information on

Naturally Occurring Plague at CIDRAP & CDC

Laboratory Diagnosis at CIDRAP, NYSDOH & CDC
Treatment Information at CIDRAP, NYSDOH & CDC

Additional Sources of Information

- Visit the Centers for Disease Control & Prevention (CDC) Plague Home Page
- Visit Infectious Disease Society of America (IDSA) for Plague Information


Category A Anthrax Botulism Plague Smallpox Tularemia Viral Hemorrhagic Fevers Category B Brucellosis Glanders Melioidosis Psittacosis Q Fever Typhus Fever Viral Encephalitis Toxins Food Safety Water Safety Category C Nipah Hanta Virus Other Important Zoonotic Diseases Transmissible Spongiform Encephalopathy Rift Valley Fever Virus Handra Virus West Nile Fever	PLAGUE Infectious Agent A Gram negative bacillus Yersinia Pestis (Y. Pestis) More Information On Infectious Agent at CIDRAP, NYSDOH & CDC Image at CDC Clinical Symptoms The different clinical syndromes caused by Y. Pestis are Bubonic Plague - enlarged, tender lymph nodes, fever, chills and prostration Pneumonic Plague - fever, chills, cough and difficulty breathing; rapid shock and death if not treated early Septicemic Plague - fever, chills, prostration, abdominal pain, shock and bleeding into skin & other organs (To View Syndrome Specific Information at CIDRAP, Click on the Syndrome Names) More Information On Clinical Symptoms at CIDRAP, NYSDOH & CDC Images at CDC Epidemiology Reservoir - Many different animal species (mostly wild rodents) are natural reservoirs for Y. Pestis e.g. Urban/Domestic Rats, Squirrels, Prairie Dogs, Mice, Guinea Pigs, Kangaroo Rats, etc. Humans are incidental hosts for Y. Pestis and are not part of the natural life cycle of the organisms. Disease occurrence in humans is dependent on the frequency of infection in local rodent populations and the degree of contact between rodents and humans. Like humans, mammalian species other than rodents generally are incidental hosts for Y. Pestis. However, such animals also can serve as sources of human exposure (either through direct contact or through flea vectors). Examples include dogs, cats, camels, goats, deer etc. Vectors - Infected Fleas. Examples of major flea vectors include the following: Xenopsylla cheopis (the oriental rat flea; nearly worldwide in moderate climates), Oropsylla montanus (United States) & Others. See Image at CDC Modes of Transmission - Bubonic Plague: via - flea vector bites - bites/scratches from infected animals e.g. cats - direct contact with infected animal carcasses e.g. of rodents Pneumonic Plague: via inhalation of respiratory droplets from infected animals (e.g. cats) or another person with either primary or secondary pneumonic plague. More Information On Epidemiology at CIDRAP & CDC Plague as a Bioterrorism Agent Plague is a suitable pathogen for use as a biological weapon because: - The organisms can be delivered in an aerosol form. - Pneumonic plague causes a serious illness with a high case-fatality rate. - Pneumonic plague is communicable, and large outbreaks have occurred in the past. - A bioterrorist attack involving pneumonic plague would cause widespread fear and panic that would be difficult to contain, partly because of the communicable nature of the disease. Plague used as a bioterrorist weapon would be expected to have the following features: - Previously healthy patients would present with a severe and rapidly progressive pneumonia. - An acute multilobar pneumonia accompanied by hemoptysis, associated gastrointestinal symptoms, and a fulminant clinical course would be very suspicious for pneumonic plague. - Many similar cases would present over several days. - Illness onsets would generally occur 2 to 4 days after release, but could occur as soon as 1 day and up to 6 days later. - Buboes characteristic of bubonic plague would not be present. - Illness would likely occur in an urban area and patient would not have a history of recent travel to a plague-endemic region (i.e. southwestern United States). - Patients would not necessarily have risk factors for plague exposure (e.g. outdoor field work, veterinary work, recent outdoor recreational activity). - There would be no indication of a prior recent plague epizootic with rodent deaths in the affected community More Information on Plague as a Bioterrorism Agent at CIDRAP Prevention & Control Standard Precautions - include handwashing, protecting exposed body parts (gloves, masks, gowns, eye protection and face shields) and patient care equipment to avoid infection from blood, secretions, fluids, excretions and contaminated items. Droplet Precautions & Eye Protection More Information On Prevention & Control at CIDRAP, NYSDOH & CDC Click here for Information on Naturally Occurring Plague at CIDRAP & CDC Laboratory Diagnosis at CIDRAP, NYSDOH & CDC Treatment Information at CIDRAP, NYSDOH & CDC Additional Sources of Information - Visit the Centers for Disease Control & Prevention (CDC) Plague Home Page - Visit Infectious Disease Society of America (IDSA) for Plague Information
Created by the School of Public Health University at Albany Updated July 2004