Plague Final

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TOTO

MINOR CREDIT SEMINARMINOR CREDIT SEMINAR


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A SEMINARA SEMINAR

ONON

PLAGUEPLAGUE(Epidemiology and control)(Epidemiology and control)

BYBY--

Dr. RAJESH KUMARDr. RAJESH KUMAR

M.V.Sc. 1M.V.Sc. 1stst YEARYEAR

ROLL NoROLL No--47864786


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INTRODUCTIONINTRODUCTION

Plague is anacute, highly infectious, zoonotic disease causedPlague is anacute, highly infectious, zoonotic disease causedbybyYersinia pestis.Yersinia pestis.

Plaguealso knownas the black death, thegreat pestilence,andPlaguealso knownas the black death, thegreat pestilence,andthe bubonic plague.the bubonic plague.

Disease transmitted to humans and animals by the bite ofratDisease transmitted to humans and animals by the bite ofratflea.flea.

Yersinia pestisYersinia pestis was first isolated by Alexandre Yersinwas first isolated by Alexandre Yersin in 1894in 1894in Hong Kong.in Hong Kong.

Between 1987 and 2001,Between 1987 and 2001, 36876 cases ofplague with 284736876 cases ofplague with 2847deaths were reported todeaths were reported to WHO.WHO.


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HISTORYHISTORY

Plague has produced at least threegreat pandemics andPlague has produced at least threegreat pandemics andmultipleepidemics throughout history.multipleepidemics throughout history.

Threegreat PandemicsThreegreat Pandemics

1.1. 542542--556 B.C.556 B.C. -- Plague ofJustinianPlague ofJustinian

2.2. 13461346--13501350 -- Black DeathBlack Death

3.3. 18941894 -- ModernPandemicModernPandemic

TheThefirst pandemicfirst pandemic knownas theknownas the Justinian plagueJustinian plague inin543543--542 B.C. was believed to have started in Egypt542 B.C. was believed to have started in Egypt

spreading into the Middle East and Mediterranean.spreading into the Middle East and Mediterranean.

killing 100 million people over 60 years.killing 100 million people over 60 years.


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ContCont TheThe second pandemicsecond pandemic knownas theknownas the Black DeathBlack Death began in 1347,began in 1347,

The Black Death had killed approximatelyThe Black Death had killed approximately

OneOne--forth ofEurope populationandforth ofEurope populationand

One thirds ofthe worlds populationsOne thirds ofthe worlds populations

About 30 million people death.About 30 million people death.

TheThe third pandemicthird pandemic began in China in 1860s spreading to Hongbegan in China in 1860s spreading to Hong

Kong in 1890s. Plague was spread by rats transported on ship toKong in 1890s. Plague was spread by rats transported on ship to

Africa, Asia, California,and South AmericaAfrica, Asia, California,and South America

Foci ofinfectionestablished in wild rodents in ruralareas.Foci ofinfectionestablished in wild rodents in ruralareas.

About 20 million dead in Indiaalone between 1889 andAbout 20 million dead in Indiaalone between 1889 and

19501950


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Major plague outbreaksMajor plague outbreaks

YearsYears CountryCountry DeathsDeaths

740740--744744 TurkeyTurkey 200,000200,000

16721672 ItalyItaly 400,000400,000

17111711 Germany, AustriaGermany, Austria 500,000500,000

17921792 EgyptEgypt 800,000800,000

18981898--19081908 China, IndiaChina, India 3 million3 million

19091909--19181918 China, IndiaChina, India 1,335,0001,335,00019201920 IndiaIndia 2 million2 million

19941994 India (Surat)India (Surat) 5656 (WHO)(WHO)

20022002 Shimla ( H.P.)Shimla ( H.P.) 44 (WHO)(WHO)


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Human Plague India (Surat) 1994Human Plague India (Surat) 1994

InIn19941994, total 693 suspected bubonic or pneumonic plague, total 693 suspected bubonic or pneumonic plaguecases were reported tocases were reported to WHO by Government ofIndiaWHO by Government ofIndia..

The outbreak ofsuspected plague diseaselasted fromThe outbreak ofsuspected plague diseaselasted from AugustAugust

26, 1994 to October 18, 1994,26, 1994 to October 18, 1994, that resulted inthat resulted in56 deaths56 deaths..

These cases werefromThese cases werefromSTATESTATE Cases reportedCases reported

MaharashtraMaharashtra 488488

GujaratGujarat 7777

KarnatakaKarnataka 4646

UttarPradeshUttarPradesh 1010

MadhyaPradeshMadhyaPradesh 44

New DelhiNew Delhi 6868

CDC. Human plagueCDC. Human plague -- India,India,1994. MMWR 1994;43:6891994. MMWR 1994;43:689--91.91.


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Discovery ofcausativeagentDiscovery ofcausativeagent

1894: Hong Kong pandemic1894: Hong Kong pandemic

Dr. Alexandre YersinDr. Alexandre Yersin firstfirstisolated and described in detail,isolated and described in detail,Pasteurella pestisPasteurella pestis, the old term, the old termused forused forYersinia pestisYersinia pestis..

Gram negativeGram negative

BacillusBacillus

In 1896, Yersin developed anIn 1896, Yersin developed anantiserum that saved thelife ofantiserum that saved thelife of

an 18 year old Chinese student.an 18 year old Chinese student.


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CAUSATIVE AGENTCAUSATIVE AGENT

YersiniaYersinia pestispestis Family EnterobacteriaceaeFamily Enterobacteriaceae

Gram negative, coccobacillus,Gram negative, coccobacillus,

pleomorphic.pleomorphic.

Aerobic,facultativeanaerobic,Aerobic,facultativeanaerobic,

and facultative intracellular.and facultative intracellular.

Several plasmids and virulenceSeveral plasmids and virulencefactorsfactors

F1, murineexotoxin, LPSF1, murineexotoxin, LPSendotoxin, coagulase, pesticin,endotoxin, coagulase, pesticin,

plasminogenactivatorplasminogenactivator

CDC/ Courtesy ofLarry Stauffer,


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Yersinia pestisYersinia pestis

Destroyed byDestroyed by

SunlightSunlight

DesiccationDesiccation

SurvivalSurvival

1 hour inair1 hour inair Briefly in soilBriefly in soil

1 week in soft tissue1 week in soft tissue

Years whenfrozenYears whenfrozen

Source: Centers for Disease Controland

Prevention, Division ofVector-Borne

Infectious Diseases,Fort Collins, CO

Giemsa, Wright, WaysonGiemsa, Wright, Waysonstainsstains bipolar bipolar safety pinsafety pin""

stainingstaining


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EPIDEMIOLOGYEPIDEMIOLOGY

Geographical distributionGeographical distribution

ReservoirReservoir

VectorVector

Incidental hostIncidental host

Epidemiological Cycles ofPlagueEpidemiological Cycles ofPlague

Mode ofTransmissionMode ofTransmission


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Geographic distributionGeographic distribution

Naturalfoci ofinfection persist onnearly onall continents, theyNaturalfoci ofinfection persist onnearly onall continents, theydo not exist in Australia, New Zealand,and Japando not exist in Australia, New Zealand,and Japan (OIE 2004)(OIE 2004)

WorldwideWorldwide

The WHO document between 1000The WHO document between 1000--3000 cases peryear3000 cases peryear

18,739 cases from 198018,739 cases from 198019941994

2,603 cases in 1999 from 14 countries and 181 deaths2,603 cases in 1999 from 14 countries and 181 deaths

2118 cases in 2003from 9 countries and 182 deaths2118 cases in 2003from 9 countries and 182 deaths

More than 76% ofcases and deaths were reported fromMore than 76% ofcases and deaths were reported fromAfrica.Africa.

There have been recent outbreaks ofplague in India in 2002 andThere have been recent outbreaks ofplague in India in 2002 andAlgeria in 2003.Algeria in 2003.


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Human plague cases : countries having notified to WHO 2004


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AsiaMost cases ofplague worldwide were reported from Asiafrom 1954-80s.

There were outbreaks in Tanzaniaand Madagascar in the 1990s.

Outbreaks occurred in India in 1954, 1963,and thenagain30 years later in 1994.

The plague outbreak in India in 1994 is a result oftheearthquake in September

1993 that disturbed theequilibrium density ofdomestic rodents and theirfleas.


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Maharashtra

Karnataka

H.P

Gujarat

A.P.

T.N.

NICD DELHI

INDIA PLAGUE FOCI

PLAGUE ENDEMIC STATES 6


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RESERVOIRRESERVOIR

Wild and domestic ratsWild and domestic rats Ground squirrelsGround squirrels

Rock squirrelsRock squirrels

Prairie dogsPrairie dogs

Deer miceDeer mice

Field miceField mice

GerbilsGerbils VolesVoles

ChipmunksChipmunks

MarmotsMarmots

Guinea pigsGuinea pigs

Kangaroo ratsKangaroo rats

over 200 identified reservoirs speciesover 200 identified reservoirs species


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VECTORVECTOR

XenopsyllaXenopsylla cheopischeopis The oriental rat flea; nearly worldwideThe oriental rat flea; nearly worldwide

in moderate climatesin moderate climates

OropsyllaOropsylla montanusmontanus United StatesUnited States

NosopsyllusNosopsyllus fasciatusfasciatus Nearly worldwide in temperate climatesNearly worldwide in temperate climates

XenopsyllaXenopsylla brasiliensisbrasiliensis Africa, India, South AmericaAfrica, India, South America

XenopsyllaXenopsylla astiaastia Indonesiaand Southeast AsiaIndonesiaand Southeast Asia

XenopsyllaXenopsylla vexabilisvexabilis Pacific IslandsPacific Islands

~~30 identified fleavectors30 identified fleavectors


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INCIDENTAL HOSTINCIDENTAL HOST

HumansHumans

Domestic and feralDomestic and feral

catscats

DogsDogs Lagomorphs (rabbitsLagomorphs (rabbits

and hares)and hares)

CoyotesCoyotes

CamelsCamels

GoatsGoats

DeerDeer

AntelopeAntelope


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Epidemiological Cycles of PlagueEpidemiological Cycles of Plague

Sylvatic (wild) Cycle ofPlague:Sylvatic (wild) Cycle ofPlague:-- Reservoir (foci) = wild rodents (prairie dogs, rabbits, mice,Reservoir (foci) = wild rodents (prairie dogs, rabbits, mice,dogs)dogs)

Vector = wild rodent fleaVector = wild rodent flea

Urban (domestic) Cycle ofPlague:Urban (domestic) Cycle ofPlague:-- Reservoir = domestic (urban) black ratReservoir = domestic (urban) black rat

Vector = oriental rat flea (Vector = oriental rat flea (Xenopsylla cheopisXenopsylla cheopis))

Human Cycle ofPlague:Human Cycle ofPlague:--

Bubonic plagueacquired from contact with either sylvaticBubonic plagueacquired from contact with either sylvatic

orurban reservoirs orarthropod vector biteand furtherorurban reservoirs orarthropod vector biteand further

transmitted in human population by spread ofpneumonictransmitted in human population by spread ofpneumonic

plague.plague.


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TRANSMISSIONTRANSMISSION

Bites from fleavectors (78%)Bites from fleavectors (78%)

Direct animal contact (20%)Direct animal contact (20%)

With infectious bodyfluids, tissues, scratches, bites whileWith infectious bodyfluids, tissues, scratches, bites while

handlingan infected animal (which can be dead oralive)handlingan infected animal (which can be dead oralive)

Enters through break in skinEnters through break in skin

Ingestion ofraw oruncooked meat from an infectedIngestion ofraw oruncooked meat from an infectedanimal (marmots, prairie dogs,goats, camel)animal (marmots, prairie dogs,goats, camel)

Inhalation ofinfectious droplets,aerosol (2%)Inhalation ofinfectious droplets,aerosol (2%)


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Mode of TransmissionMode of Transmission

Thereareat least 6 potential modes oftransmission:Thereareat least 6 potential modes oftransmission:

1.1. Wild rodentWild rodent FleaFlea Peridomestic rodentsPeridomestic rodents

FleaFlea Domestic rodentDomestic rodent FleaFlea HumansHumans

2.2. Human with pneumonic plagueHuman with pneumonic plague dropletdroplet

infectioninfection HumansHumans

3.3. Wild rodentsWild rodents FleaFlea Humans (whenHumans (when

humans enter theforests etc where thehumans enter theforests etc where thesylvaticsylvatic

cyclecycle is maintained)is maintained)


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ContCont

4. Handling infected rodent tissue (wild / domestic)4. Handling infected rodent tissue (wild / domestic)orany other infected materiale.g. pus fromorany other infected materiale.g. pus from

buboesbuboes

5. Domestic cats eat infected rodents develop5. Domestic cats eat infected rodents develop

pneumonic plaguepneumonic plague Droplet infectionDroplet infection

HumansHumans

6. Plague bacilli6. Plague bacilli BioterrorismBioterrorism HumansHumans


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BUBONIC TANSMISSIONBUBONIC TANSMISSION

Bites from fleavectorsBites from fleavectors

Bites or scratches from infected animals, such asBites or scratches from infected animals, such as

catscats

Direct contact with infected animal carcasses, suchDirect contact with infected animal carcasses, such

as rodents (especially marmots), rabbits, hares,as rodents (especially marmots), rabbits, hares,

carnivores (eg, wild cats, coyotes),and goatscarnivores (eg, wild cats, coyotes),and goats


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SEPTICEMIC TRANSMISSIONSEPTICEMIC TRANSMISSION

Bites from fleavectors whereBites from fleavectors whereY pestisY pestis is insertedis inserted

directly into bloodstreamdirectly into bloodstream

no discernible bubo presentno discernible bubo present

Develops as a complication ofbubonic or 1Develops as a complication ofbubonic or 1

pneumonic plaguepneumonic plague

WhenWhenY pestisY pestis enters the bloodstreamenters the bloodstream

Neither bubonic plaguenor septicemic plagueNeither bubonic plaguenor septicemic plague

spreads directlyfrom person to personspreads directlyfrom person to person


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PNEUMONIC TRANSMISSIONPNEUMONIC TRANSMISSION

Inhalation ofrespiratory droplets from infected animals suchInhalation ofrespiratory droplets from infected animals suchas cats.as cats.

Inhalation ofrespiratory droplets from a person with primaryInhalation ofrespiratory droplets from a person with primary

or secondary pneumonic plague.or secondary pneumonic plague.

HandlingHandlingY pestisY pestis cultures in thelaboratory.cultures in thelaboratory.

Bubonic and 1Bubonic and 1 septicemic spread plague bacillisepticemic spread plague bacilli

hematogenously to thelungs.hematogenously to thelungs.

Theability to cause infection byaerosoland the seriousTheability to cause infection byaerosoland the serious

nature ofpneumonic plague makenature ofpneumonic plague make Y pestisY pestis aapotentialpotential

biological weapon.biological weapon.


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Manner in which fleas transmit plagueManner in which fleas transmit plague

Flea feeds on Y. pestisFlea feeds on Y. pestis--infected bloodinfected blood

Y. Pestis enters fleas midgut & multiplies logarithmicallyY. Pestis enters fleas midgut & multiplies logarithmically

Clump of Y. pestis forms in the midgut, blocking fleasClump of Y. pestis forms in the midgut, blocking fleasforegutforegut

During next meal, blood cannot enter the midgut & fleaDuring next meal, blood cannot enter the midgut & flea

gets very hungrygets very hungry

Flea bites vigorously & regurgitates the contents of itsFlea bites vigorously & regurgitates the contents of itsmidgut into the next woundmidgut into the next wound


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Disease in humanDisease in human

3Forms ofthe disease3Forms ofthe disease

1. Bubonic Plague.1. Bubonic Plague. 8080--95%95%

Painfullymph node swellings,Painfullymph node swellings, buboesbuboes

2. Septicemic Plague.2. Septicemic Plague. 1010--20%20%

Also called Also called blood poisoningblood poisoning,attacked the,attacked the

blood systemblood system

3. Pneumonic Plague.3. Pneumonic Plague. rarestrarest

Attacked the respiratory systemAttacked the respiratory system


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Bubonic PlagueBubonic Plague

Incubation: 2Incubation: 2--6 days6 days Clinical signsClinical signs

Fever, chills, malaise, muscleaches, headacheFever, chills, malaise, muscleaches, headache

Regionallymphadenitis (buboes)Regionallymphadenitis (buboes)

1.1. Swollen,very painfullymph nodesSwollen,very painfullymph nodes

2.2. Typically inguinal (most common),Typically inguinal (most common),

femoral,axillary, or cervicalfemoral,axillary, or cervical

3.3. Swellings expandinguntil they burstSwellings expandinguntil they burst death followingdeath following

soonaftersoonafter

-- ss vomiting,abdominal pain,nausea, petechiaevomiting,abdominal pain,nausea, petechiae

Mortality (untreated):30Mortality (untreated):30 --75 %75 %


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Painfullymph nodePainfullymph node

swelling, called buboesswelling, called buboes

Dark blotches = acralDark blotches = acralnecrosisnecrosis Black Death!Black Death!

ContCont

Source:CDC NVBID


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Septicemic PlagueSepticemic Plague

Systemic spread (BloodSystemic spread (Blood-- Poisoning)Poisoning)

Clinical signsClinical signs::

1.1. Similar to bubonic, plus Prostration, circulatory collapse,Similar to bubonic, plus Prostration, circulatory collapse,

septic shock, organfailure, hemorrhage,septic shock, organfailure, hemorrhage,

2.2. Skin turns dark purple,almost black =Skin turns dark purple,almost black = The Black DeathThe Black Death..

due to DIC (disseminated intravascular coagulation)due to DIC (disseminated intravascular coagulation)

3.3. Necrosis ofextremitiesNecrosis ofextremities

4.4. Microthrombi blocking capillariesMicrothrombi blocking capillaries

5.5. Victims died the same day symptoms appeared.Victims died the same day symptoms appeared.


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ContCont

Only pneumonic form ofplague is spread personOnly pneumonic form ofplague is spread person--toto--personperson

Mortality Rate (untreated) : 90Mortality Rate (untreated) : 90--95%95%

RadiographyRadiography usually patchyusually patchy

bilateral infiltrates, consolidationbilateral infiltrates, consolidation

Photograph by Ken Gage,Ph.D., Centers ofDisease Controland Prevention,Fort Collins, CO.


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Disease in animalsDisease in animals

Manyfound serologically positiveManyfound serologically positive

Bears, bobcats, badgers,fox, ringtails, skunks, deer,Bears, bobcats, badgers,fox, ringtails, skunks, deer,

Mountainlion, Africanelephant, African buffalo, camel,Mountainlion, Africanelephant, African buffalo, camel,

coyote, more coyote, more

RodentsRodents

Most rodent die readilyfrom infectionMost rodent die readilyfrom infection

Farm animals and dogsFarm animals and dogs

Very resistant to diseaseVery resistant to disease

May be incubatingat time ofslaughterMay be incubatingat time ofslaughter

Human riskHuman risk


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Cats and PlagueCats and Plague

No human cases from cats prior to 1977No human cases from cats prior to 1977

In 1998, 23 cases reported amongIn 1998, 23 cases reported among -- 5 fatal5 fatal

Cats develop severe illnessCats develop severe illness

Signs mimic human illnessSigns mimic human illness

Bubonic, septicemic, pneumonic and dieBubonic, septicemic, pneumonic and die

Can transfer disease to humansCan transfer disease to humans

Owners,veterinarians or staffOwners,veterinarians or staff

Pneumonic,fleas, bite, scratchPneumonic,fleas, bite, scratch

Hundreds ofcases ofdomestic cats reported with plague.Hundreds ofcases ofdomestic cats reported with plague.

In U.S cats have been sours ofinfectionforabout 5% case ofIn U.S cats have been sours ofinfectionforabout 5% case ofplague in manplague in man


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Dogs and PlagueDogs and Plague

Rarely show signsRarely show signsFever,lethargy, orallesions,Fever,lethargy, orallesions,

lymph nodelesionslymph nodelesions

May seroconvertMay seroconvert

May carry infected fleasMay carry infected fleas

Cats and dogs arenow recognized as sources ofCats and dogs arenow recognized as sources of

infectionfor humans.infectionfor humans.


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Laboratory diagnosisLaboratory diagnosis

Theappropriate specimens for diagnosis ofbubonic, pneumonic,Theappropriate specimens for diagnosis ofbubonic, pneumonic,and septicaemic plagueare,and septicaemic plagueare,bubo aspiratebubo aspirate,,sputumsputum,and,andbloodblood

respectively.respectively.

Giemsa smear (Giemsa smear (bipolar staining)bipolar staining) withwithGrams stain (Grams stain (gramgram--negative)negative)

A characteristic growth is seen inA characteristic growth is seen in

nutrient broth such asnutrient broth such asbrainbrain--heartheart--infusioninfusion

Y pestis cultureat 48 h inY pestis cultureat 48 h in

brainbrain--heartheart--infusion broth at 26infusion broth at 26CC


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YersiniaYersinia--specificspecific CIN agarCIN agarcan becan be

usefulfor culture ofcontaminatedusefulfor culture ofcontaminatedspecimens, such as sputumspecimens, such as sputum

Rapid diagnosis is possible by detection ofRapid diagnosis is possible by detection ofY.pestisY.pestis F1 antigenF1 antigenby Immunofluorescenceby Immunofluorescence

PCR testPCR test

4 fold increase inantibody titres against F1 antigen4 fold increase inantibody titres against F1 antigen

(byPHA tests)(byPHA tests)

Isolation ofthe bacteria by cultureand phagelysis.Isolation ofthe bacteria by cultureand phagelysis.

Cont

http://www.cdc.gov/ncidod/dvbid/plague/p4.htm


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PlaguePlague -- TreatmentTreatment

Isolation:Isolation:--

Patients Isolationfor thefirst 48 hours after the initiation ofPatients Isolationfor thefirst 48 hours after the initiation oftreatment.treatment.

Patients with pneumonia must be isolated at least 4 days ofPatients with pneumonia must be isolated at least 4 days ofantibiotic therapy.antibiotic therapy.

Antibiotic Therapy:Antibiotic Therapy:--

Str eptomycinStreptomycin (drug ofchoice)(drug ofchoice)--1515--30 mg/kg IM bid x 10 days30 mg/kg IM bid x 10 days

GentamicinGentamicin-- 2 mg/kg IV then 1.02 mg/kg IV then 1.0--1.5 mg/kg q8h or 5 mg/kg IV1.5 mg/kg q8h or 5 mg/kg IVq24h x 10 daysq24h x 10 days

DoxycyclineDoxycycline -- 200 mg IV then 100 mg bid x 10200 mg IV then 100 mg bid x 10--14 days14 days CiprofloxacinCiprofloxacin -- 400 mg IV q12h x 10 days400 mg IV q12h x 10 days

ChloramphenicolChloramphenicol-- 25 mg/kg IV q6h (Max. 4 Gm/day)25 mg/kg IV q6h (Max. 4 Gm/day)

Avoid in children < 2 year oldAvoid in children < 2 year old

Avoid streptomycin in pregnant womenAvoid streptomycin in pregnant women


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Prevention and ControlPrevention and Control

Two things that could limit the spread ofdisease:Two things that could limit the spread ofdisease:--1. Epidemic plague is best prevented by controlling rat population1. Epidemic plague is best prevented by controlling rat population

in ruraland urbanareas.in ruraland urbanareas.

2. Close surveillance ofhuman plagueassociated with plague in2. Close surveillance ofhuman plagueassociated with plague in

rodents and use ofeffective insecticidefor controlling rodentsrodents and use ofeffective insecticidefor controlling rodentsflea.flea.

Some other measures taken to control plagueare:Some other measures taken to control plagueare:--

1.1. Prophylactic antibiotic therapyas recommended by CDC forProphylactic antibiotic therapyas recommended by CDC forpeople who have beenexposed topeople who have beenexposed to--

Plague outbreak/flea bitesPlague outbreak/flea bites

Handled infected animalHandled infected animal

Close contact with plague caseClose contact with plague case


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Preferred postPreferred post--exposure prophylaxis:exposure prophylaxis:

Doxycycline 100 mgPO BIDDoxycycline 100 mgPO BID

Ciprofloxacin 500 mgPO BIDCiprofloxacin 500 mgPO BID

Duration ofprophylaxis: 7 daysDuration ofprophylaxis: 7 days

2.2. Plague VaccinePlague Vaccine Liveand killed vaccine developedLiveand killed vaccine developed

Killed vaccine preventsKilled vaccine prevents bubonicbubonic plagueplague

Primaryvaccination: 0, 1Primaryvaccination: 0, 1--3, & 53, & 5--6 months6 months

Boosters: 12, 18, & 24 mo., thenevery 1Boosters: 12, 18, & 24 mo., thenevery 1--2 years2 years

ContCont

Vaccination is oflimited useand is ineffectiveagainstVaccination is oflimited useand is ineffectiveagainst

pneumonic form ofplague.pneumonic form ofplague.


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ContCont

3.3. Environmental sanitationEnvironmental sanitation

Removingfood sources used by rodents.Removingfood sources used by rodents.

Rodents proofing homes, buildings.Rodents proofing homes, buildings.

Eliminate rodent habitat around homeEliminate rodent habitat around home

Applying chemicals to killfleaand rodents.Applying chemicals to killfleaand rodents.

4.4. Treatment petsTreatment pets

Such as dogs and cats for properflea control.Such as dogs and cats for properflea control.

5.5. Public health educationPublic health education

Risks, transmission, prevention.Risks, transmission, prevention.


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VaccinesVaccines

TheThekilledkilled--wholewhole--cellvaccinecellvaccinediddid notnotprotect againstprotect against

primary pneumonic plague.primary pneumonic plague.

TheThelivevaccineslivevaccines were illwere ill--defined and retaineddefined and retained

enoughenough virulencevirulence to beunsuitablefor current use.to beunsuitablefor current use.

A subunit vaccine protects miceagainst respiratoryA subunit vaccine protects miceagainst respiratoryinfection withinfection with Y pestisY pestis is in clinical trials.is in clinical trials.


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Plague Final