Plague is a disease caused by infection with the bacterium, Yersinia pestis, which is present widely throughout the world & is carried to humans by bites from infected fleas, contact with body fluids from an infected animal or human or occasionally from inhaling airborne droplets from a case.
The commonest form is bubonic plague, resulting from infected flea bite in which fever, chills headache & prostration follows an incubation period of 2-6 days. Subsequent swelling of the lymph glands in the grain, neck & axilla (buboes) occur & death will ensue in 50-90% of untreated cases. The rarer form of pneumonic plague is spread via inhaling the germ. Shortness of breath shock & rapid death can ensue.
Treatment:Antibiotics are successfully used for treatment, & best results follow early intervention & added supportive care.
Plague is reported in U.S., Canada, widely in South America, Africa, Central & South East Asia. Worldwide annual reports are usually 2-4 thousand cases occurring mostly in poorly developed & remote areas.
The disease is extremely unusual in travellers & travel to urban areas with good accommodation is not considered to place a traveller at risk.
All travellers should avoid exposure to fleas, especially those where plague might be present. Use of repellents & insecticide is encouraged. Close contact with animal or human cases is to be avoided.
Plague vaccine is available in certain countries. The actual effectiveness of the vaccine is not clear, & side effects are common, so it its not recommended as a routine vaccination. The vaccine requires more than one dose so it has limited use in outbreaks. The vaccine may be indicated for those at very high risk e.g. laboratory workers, veterinarians or military personnel.
Preventive antibiotics, particularly the tetracycline group can be used. Doxycycline at 100mg daily, or sulfonamide in children 8yrs or less, will prevent the disease if an exposure is likely.