JIMMMA UNIVERSITY

COLLEGE OF HEALTH SCIENCE

FACULTY OF PUBLIC HEALTH
DEPARTMENT OF ENVIRONMENTAL HEALTH SCIENCE
AND TECHNOLOGY
Communicable disease control course individual
assignment
Title of assignment:plague disease
Name:Kenbon Alemayehu Sarbessa
ID No.:RU1217/15

Submitted to:Dr./pro. Sahilu Assegid(Associate professor)

Submission date:8,Nov,2024
 Table of Content
Introduction………………………………………………………………….…2

Overview………………………………………………………………………..2

1.Plague disease…………………………………………………………….......3

2.Etiology of plague……………………………………………………………5

3.Epidemology of plague………………………………………………………5

4.Sign and symptoms of plague…………………………………………….….6

4.1 Bubonic plague……………………………………………………………7

4.2 Septicemic plague………………………………………………………...7

5.Transmission………………………………………………………………….9

6.Diagnosis………………………………………………………………………10

7.Management…………………………………………………………………..10

7.1 Risk factors………………………………………………………............11

7.2 Complications…………………………………………………………....11

8.Treatment…………………………………………………………………….11

9.Prevention……………………………………………………………………12

10.Surveillance and Control………………………………………………….13

Summary…………………………………………………………………….....14

References……………………………………………………………………...15

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Introduction
 This introduction sets the stage for a deeper exploration of the plague
disease, its historical impact, clinical manifestations, and ongoing relevance
in contemporary society.
 Plague, a highly infectious and often lethal disease, has shaped human
history through its devastating outbreaks.
 Caused by the bacterium *Yersinia pestis*, which is primarily transmitted
through the bites of infected fleas, contact with contaminated materials, or
respiratory droplets from infected individuals, plague has manifested in
various forms, including bubonic, septicemic, and pneumonic plague.
 The most infamous of these outbreaks occurred during the Black Death in
the 14th century, which claimed millions of lives across Europe and
fundamentally altered societal structures.
 Understanding the ecology of *Yersinia pestis*, its transmission dynamics,
and the socio-economic factors that contribute to its spread is crucial for
effective prevention and control measures.

Overview
What historic pandemics were caused by the plague?

There were three infamous plague pandemics in history:

 The Plague of Justinian started around 541 and had several waves of
illness.
 It’s hard to get an accurate number, but it’s thought that tens of
millions of people died during this pandemic.
 The Black Death started in 1348. About 25 million people died in
Europe during the Black Death.

The third plague pandemic spread to every continent except Antarctica.

It killed around 12 million people in India and China alone.

Plague is considered a potential bioweapon.

The U.S. government has plans and treatments in place if the disease is used
as a weapon.

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 1. Plague Disease
Plague is an illness you get from Yersinia pestis bacterium.
You usually get the most common form (bubonic plague) from flea bites,
but you can get pneumonic plague from someone who’s infected.
Plague caused deadly pandemics in the past and still exists in many
countries today.
You can survive plague if you’re treated with antibiotics quickly.
Plague is an infectious disease caused by the bacteria Yersinia pestis, a
zoonotic bacteria, usually found in small mammals and their fleas.
It is transmitted between animals through fleas. Humans can be infected
through:

 the bite of infected vector fleas

 unprotected contact with infectious bodily fluids or contaminated materials
 the inhalation of respiratory droplets/small particles from a patient with
pneumonic plague.

Yersinia pestis seen at 200× magnification with a fluorescent label.

Specialty Infectious disease

Symptoms Fever, weakness, headache

Usual onset 1–7 days after exposure

Types Bubonic plague, septicemic plague, pneumonic plague

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Causes Yersinia pestis

Diagnostic method Finding the bacterium in a lymph node, blood, sputum

Prevention Plague vaccine[2]

Treatment Antibiotics and supportive care[2]

Medication Gentamicin and a fluoroquinolone

Prognosis(outlook) ≈10% risk of death (with treatment)

Frequency ≈600 cases a year

In the western United States, these animals include:

 Rats, mice and voles.

 Squirrels.
 Rabbits.
 Prairie dogs.
 Ground squirrels and chipmunks.
Other animals can get plague by eating small animals with the disease or
picking up their fleas. These may include:

 Pet cats and dogs.

 Coyotes.
 Wild cats

2. Etiology(causative agents)
o The bacterium Yersinia pestis (Y. pestis) causes plague.

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o Rats and other animals carry Y. pestis, but humans usually get infected by being
bitten by fleas or lice carrying the bacteria.
o Y. pestis gets into your lymph nodes, bloodstream or lungs and makes you sick.

3. Epidemiology
 Without treatment, plague is nearly always fatal.
 With treatment, there’s a 5 to 15% mortality (death) rate for bubonic
plague and around a 50% mortality rate for pneumonic and septicemic
plague.
 A 21st-century study of a 1665 outbreak of plague in the village of Eyam in
England's Derbyshire Dales
 which isolated itself during the outbreak, facilitating modern study – found that
three-quarters of cases are likely to have been due to human-to-human
transmission, especially within families, a much larger proportion than
previously thought.

Fig: Distribution of plague-infected animals 1998

o Globally about 600 cases are reported a year.

o In 2017, the countries with the most cases include the Democratic Republic of
the Congo, Madagascar and Peru.
o In Madagascar cases of bubonic plague are reported nearly every year, during
the epidemic season (between September and April).

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o It has historically occurred in large outbreaks, with the best known being
the Black Death in the 14th century which resulted in more than 50 million
dead.
o In recent years, cases have been distributed between small seasonal outbreaks
which occur primarily in Madagascar, and sporadic outbreaks or isolated cases
in endemic areas.

Where is plague found?

o As an animal disease, plague is found in all continents, except Oceania.

o There is a risk of human plague wherever the presence of plague natural foci
(the bacteria, an animal reservoir and a vector) and human population co-exist.

4. Signs and Symptoms(Clinical manifestation)

People infected with plague usually develop acute febrile disease with other
non-specific systemic symptoms after an incubation period of one to seven
days, such as sudden onset of fever, chills, head and body aches, and weakness,
vomiting and nausea.
 Plague symptoms depend on how the patient was infected.
 The most common forms of plague are bubonic, pneumonic, and septicemic.
There are three most common forms of plague.The symptoms vary for each
type.

4.1 Bubonic plague

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o This form usually results from the bite of an infected flea, with an incubation
period of 2 to 8 days.
o The bacteria multiply in a lymph node near where the bacteria entered the
human body.
o If the patient is not treated with the appropriate antibiotics, the bacteria can
spread to other parts of the body.
o Bubonic plague causes swelling of lymph nodes.
o These are small, bean-shaped filters in the body's immune system.
o A swollen lymph node is called a bubo. The word "bubonic" is describing this
feature of the disease.
o If a person has bubonic plague, buboes appear in the armpits, groin or neck.
Buboes are tender or painful.
o They vary in size from about less than half an inch (1 centimeter) to about 4
inches (10 centimeters).
 Other symptoms of bubonic plague may include:

 Sudden high fever and chills.

 Headache.
 Tiredness.
 Not feeling well in general.
 Weakness.
 Muscle aches.
 Rarely, skin sores.
4.2 Septicemic plague

o Septicemic plague can occur as the first symptom of plague or may develop
from untreated bubonic plague.
o This form results from bites of infected fleas or from handling an infected
animal.
o The incubation period of septicemic plague is poorly defined but likely occurs
within days of exposure.
o Septicemic plague occurs when plague bacteria multiply in the bloodstream.
Buboes may not be present.
o Early symptoms are very general and include:

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  Sudden high fever and chills.
 Extreme weakness.
 Stomach pain, diarrhea and vomiting.
o More-serious symptoms may develop with advanced disease and organ failure.
These include:

 Bleeding from the mouth, nose or rectum, or under the skin.

 Signs of shock, such as seizure, rash and low blood pressure.
 Blackening and death of tissue, called gangrene, most commonly on the
fingers, toes, ears and nose.

4.3 Pneumonic plague

 Pneumonic plague affects the lungs. The disease may begin in the lungs, or it
may spread from infected lymph nodes to the lungs.
 Symptoms can begin within a few hours after exposure and worsen rapidly.
 Symptoms may include:

 Sudden high fever and chills.

 Cough, with bloody mucus.
 Difficulty or irregular breathing.
 Chest pain.
 Upset stomach and vomiting.
 Headache.
 Weakness.

 If treatment is not begun the first day, the disease progresses rapidly to failure
of the lungs, shock and death.

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 5. Transimission
The Oriental rat flea (Xenopsylla cheopis) engorged with blood after a blood
meal.
This species of flea is the primary vector for the transmission of Yersinia
pestis,
The organism responsible for bubonic plague in most plague epidemics in
Asia, Africa, and South America.
Both male and female fleas feed on blood and can transmit the infection.
A child bitten by a flea infected with the bacterium Yersinia pestis.
Y. pestis, a member of the family Yersiniaceae, has caused the bite to
become ulcerated.

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 Transmission of Y. pestis to an uninfected individual is possible by any of the
following means:
 droplet contact – coughing or sneezing on another person

 direct physical contact – touching an infected person, including sexual

contact
 indirect contact – usually by touching soil contamination or a
contaminated surface
 airborne transmission – if the microorganism can remain in the air for
long periods
 fecal-oral transmission – usually from contaminated food or water
sources
 vector borne transmission – carried by insects or other animals.
6. Diagnosis
 Confirmation of plague requires lab testing. The best practice is to identify Y.
pestis from a sample of pus from a bubo, blood or sputum.
 A specific Y. pestis antigen can be detected by different techniques.
 Symptoms of plague are usually non-specific and to definitively diagnose
plague, laboratory testing is required.
 Y. pestis can be identified through both a microscope and by culturing a sample
 The sample can be obtained from the blood, mucus (sputum), or aspirate
extracted from inflamed lymph nodes (buboes).
 Polymerase chain reaction (PCR) may also be used to diagnose plague,
 by detecting the presence of bacterial genes such as the pla gene (plasmogen
activator) and caf1 gene, (F1 capsule antigen).

7.Management
 Find and stop the source of infection. Identify the most likely source of
infection in the area where the human case(s) was exposed, typically looking
for clustered areas with large numbers of small animal deaths.
 Protect health workers. Inform and train them on infection prevention and
control.
 Ensure correct treatment: Verify that patients are being given appropriate
antibiotic treatment and that local supplies of antibiotics are adequate.
 Isolate patients with pneumonic plague. Patients should be isolated so as not
to infect others via air droplets.

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 Surveillance: identify and monitor close contacts of pneumonic plague patients
and give them a seven-day chemoprophylaxis.
 Obtain specimens which should be carefully collected using appropriate
infection, prevention and control procedures and sent to labs for testing.

 Disinfection. Routine hand-washing is recommended with soap and water or

use of alcohol hand rub.
 Ensure safe burial practices. Spraying of face/chest area of suspected
pneumonic plague deaths should be discouraged.

7.1 Risk factors

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.

7.2 Complications

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.

8. Treatment
o Plague needs to be treated with antibiotics right away.
o Healthcare provider will give medication to you either through your veins (IV)
or in a pill to take.
o Depending on your symptoms and risk, you may start antibiotics even before
your provider has your test results.

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o Untreated pneumonic plague can be rapidly fatal, so early diagnosis and
treatment is essential for survival and reduction of complications.
o Antibiotics and supportive therapy are effective against plague if patients are
diagnosed in time.
o Pneumonic plague can be fatal within 18 to 24 hours of disease onset if left
untreated,
o But common antibiotics for enterobacteria (gram negative rods) can effectively
cure the disease if they are delivered early.

What medications are used to treat plague?

o antibiotics taken by mouth or through your veins to treat plague. Your
healthcare provider might prescribe one or more of these antibiotics:
 Ciprofloxacin.
 Levofloxacin.
 Moxifloxacin.
 Gentamicin and so on

9. Prevention
 You can reduce your risk of plague by avoiding flea bites and being careful
around animals that could be infected.
 No vaccine is available, but scientists are working to develop one.
 Preventive measures include informing people when zoonotic plague is present
in their environment and advising them to take precautions against flea bites
and not to handle animal carcasses.
 We can prevent plague by taking below measures:
 Wear bug spray with DEET.
 Ask your pet’s veterinarian how to prevent fleas. Pet dogs and cats can
spread plague.
 Wear gloves if you have to handle animals that could be infected. This
includes living and dead animals.
 If you live in an area with plague, don’t let your pets roam free outside.
 If you think something exposed you to plague, ask your healthcare provider
whether you should take antibiotics to prevent getting sick.
 People with pneumonic plague are isolated during treatment to prevent the
spread of disease.

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 Health care workers must wear protective masks, gowns, gloves and
eyewear when they treat someone with pneumonic plague.

10. Surveillance and control

o Surveillance and control requires investigating animal and
o flea species implicated in the plague cycle in the region and
o developing environmental management programmes to understand the
natural zoonosis of the disease cycle and to limit spread.
o Active long-term surveillance of animal foci, coupled with a rapid response
during animal outbreaks has successfully reduced numbers of human plague
outbreaks.
o In order to effectively and efficiently manage plague outbreaks it is crucial
to have an informed and
o vigilant health care work force (and community) to quickly diagnose and
manage patients with infection, to identify risk factors, to conduct ongoing
surveillance, to control vectors and hosts, to confirm diagnosis with
laboratory tests, and to communicate findings with appropriate authorities.

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SUMMARY

 Plague is caused by the bacteria Yersinia pestis, a zoonotic bacteria usually

found in small mammals and their fleas.
 People infected with Y. pestis often develop symptoms after an incubation
period of one to seven days.
 There are two main clinical forms of plague infection: bubonic and pneumonic.
Bubonic plague is the most common form and is characterized by painful
swollen lymph nodes or 'buboes'.
 Plague is transmitted between animals and humans by the bite of infected fleas,
direct contact with infected tissues, and inhalation of infected respiratory
droplets.
 Antibiotic treatment is effective against plague bacteria, so early diagnosis and
early treatment can save lives.
 Currently, the three most endemic countries are the Democratic Republic of the
Congo, Madagascar, and Peru.

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References
1) "Symptoms Plague". CDC. September 2015. Retrieved 8 November 2017.
2) "Plague". World Health Organization. October 2017. Retrieved 8
November 2017.
3) "Resources for Clinicians Plague". CDC. October 2015. Retrieved 8
November 2017.
4) "Transmission Plague". CDC. September 2015. Retrieved 8 November 2017.
5) Chung LK, Bliska JB. Yersinia versus host immunity: how a pathogen evades
or triggersprotectiveresponse.
6) Clinical Key. Clinical Overview:
7) Glatter KA, Finkelman P. History of the Plague: An Ancient Pandemic for the
COVID-19.
8) Prentice MB. Plague and Other Yersinia Infections. In: Loscalzo J, Fauci A,
Kasper D, et al. eds.
9) Harrison’s Principles of Internal Medicine 21e. McGraw Hill; 2022.
10) Sun W, Singh AK. Plague vaccine: recent progress and prospects

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