Surveillance Summary Human Plague -- United States, 1981
For 1981, 13 cases of human plague, 4 of them fatal, were
reported
from 5 states: Arizona (4), California (1), Colorado (1), Oregon (1
fatal), New Mexico (6, 3 fatal) (Figure 2). Twelve cases were
confirmed at CDC by fluorescent antibody testing and by
bacteriologic
identification and characterization; 1 case was confirmed
serologically. The patients ranged in age from 2 to 72 years with
a
mean age of 38.7 years. Seven patients (54%) were male, 6 were
white,
6 were American Indian (5 Navajo, 1 Hopi), and 1 was Asian. The
clinical manifestations included bubonic plague (5 patients),
septicemic plague (5), septicemic with confirmed secondary
pneumonic
plague (2), and presentation unspecified (1).
The various modes of infection were flea bite (5 cases),
skinning
an infected bobcat (1), rabbit hunting (1), bite of an infected
domestic cat (1), and undetermined (5). The 5 cases acquired by
flea
bite occurred in relation to epizootic plague among prairie dogs
(Cynomys_gunnisoni) and rock squirrels (Spermophilus_variegatus).
Two
patients with unknown source of infection resided in areas where an
epizootic of plague was occurring in prairie dogs.
From 1970 through 1981, enzootic and epizootic plague among
rodents and carnivores was documented in 12 western states:
Arizona,
California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon,
Texas, Utah, Washington, and Wyoming. Human plague cases were
reported from 8 of these states. The geographic distribution of
136
human cases in the period 1970-1981 is shown in Figure 3, and the
totals by state for the same period are shown in Table 2.
Reported by MM Ettenger, MD, Dept of Internal Medicine, Gallup
Indian
Medical Center, J Porvoznik, MD, Indian Health Svcs, MR Skeels,
PhD,
Scientific Laboratories Div, JM Mann, MD, Chief of Communicable
Diseases, Epidemiology, and Control, Health Svcs Div, New Mexico
Health and Environment Dept, New Mexico; J Leedom, MD, P Heseltine,
MD, Los Angeles County USC Medical Center, SL Fannin, MD, Acute
Communicable Disease Control, County of Los Angeles Dept of Health
Svcs, J Chin, MD, State Epidemiologist, Dept of Health Svcs,
California; JK Emerson, DVM, MPH, State Public Health Veterinarian,
RS
Hopkins, MD, State Epidemiologist, State Dept of Health, Colorado;
LP
Williams, Jr, DVM, MPH, State Public Health Veterinarian, Dept of
Human Resources, Oregon; JJ Sacks, MD, State Epidemiologist
(Acting),
State Dept of Health Svcs, Arizona; Field Svcs Div, Epidemiology
Program Office, Vectorborne Diseases Div, Center for Infectious
Diseases, CDC.
Editorial Note
Editorial Note: Plague is a bacterial disease caused by the
organism,
Yersinia_pestis. It is usually contracted from the bite of an
infected wild-rodent flea but can also occur as the result of
direct
contact exposure to infected rodents, rabbits, and carnivores. The
infection can be spread from person to person by patients with
pulmonary involvement with Y._pestis. Although this was most
likely a
major cause of rapid dissemination during great epidemics such as
occurred in China (1), pneumonic plague is seen infrequently in
modern
times. Moreover, today plague pneumonia usually results from
extension of septicemia to involve the lungs (secondary plague
pneumonia) rather than from direct seeding of the lungs by inhaled
organisms (primary plague pneumonia). Of 105 cases of human plague
reported to CDC from 1970 to 1979, 82% were associated with an
antecedent flea bite (2). In this same period, 19 cases (18%) of
pneumonic plague secondary to septicemia were reported. Since
1925,
only 1 case of primary pneumonic plague has been documented in the
United States. This case occurred at Lake Tahoe, California, in
1980,
and resulted from exposure to a kitten with plague pneumonia.
The geographic distribution of cases for 1981 generally
reflects
the same pattern seen since 1970. New Mexico and Arizona continue
to
be important foci for human cases. Possible explanations for this
distribution are the exposure of American Indian populations to
enzootic and epizootic plague foci through hunting and
food-gathering
activities and the growth of non-Indian populations and expansion
of
their residential areas into previously uninhabited areas of
enzootic
plague. Faulty environmental sanitation and premises management
may
also play a role by providing sites for harboring rodents (3).
References
Wu L-T. A treatise on pneumonic plague. Strasburg:
Berger-Levrault, 1926.
Kaufmann AF, Boyce JM, Martone WJ. Trends in human plague in
the
United States. J Infect Dis 1980;141:522-4.
Mann JM, Martone WJ, Boyce JM, Kaufmann, AF, Barnes AM, Weber
NS.
Endemic human plague in New Mexico: risk factors associated
with
infection. J Infect Dis 1979;140:397-401.
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