PLAGUE EPIDEMIOLOGY

Plague
A zoonoses
Caused by Yersinia pestis, involving rodents and fleas
Transmitted by infected flea bites to humans living or
intruding into the same ecological environment
Occurs in many forms-
Enzootically
Epizootically
Sporadically
In epidemics including Anthroponotic
Problem statement

The data shows that from 2004 to 2009, 12503 cases of

human plague, including 843 deaths were reported by 16
countries in Africa, Asia and America
In 2004, India reported a localised outbreak of bubonic
plague in the Dangud village district of Uttarkashi
Fifteen people have been infected with bubonicplague in
2015 in the United States, as told by the Centres for
Disease Control and Prevention. Four of thosecaseswere
fatal.
 Epidemiological determinants
Agent factors
A. agent
Causative agent: Yersinia pestis, is a gram negative, non motile, coccobacillus,
that exhibits bipolar staining.
Bacilli occur in great abundance in bubos, spleen, blood, liver, and other viscera
of infected person and in sputum of pneumonic plague
Plague bacilli can survive and multiply in soil of rodent burrows

B. reservoir of infection
Wild rodents are the natural reservoirs of plague
In India, the wild rodent, Tatera indica has been incriminated as the main
reservoir.

C. Source of infection
Infected rodents
Fleas
Cases of pneumonic plagues
 Host factors
A. age and sex
All ages and both sexes are susceptible
B. human activities
Hunting, grazing, cultivation, harvesting and construction activities
offer opportunities for flea-man contact
C. Movement of people
D. immunity
Man has no natural immunity
Immunity after recovery is relative
 Environmental factors
A. Season
In northern India, the plague season starts from September to May.
With the onset of hot weather, the disease tends to die out.
In south India, there was no definite plague season
Disease was found active all year round

B. Temperature and humidity

Temperature of 20-25 deg C and relative humidity of 60% and above are
favourable
C. Rainfall
Heavy rainfall tends to flood the rat burrows. Responsible for keeping
certain states free from plague. Eg, Bengal.
D. Urban and rural areas
E. Human dwellings
Vectors of plague
o Most common vector is the rat flea, X.
cheopsis.
o Both sexes bite and transmit the disease

Blocked flea
A flea may ingest upto 0.5 cu mm of
blood which may contain as many as
5000 plague bacilli. The bacilli multiply
in the gut of rat flea and may block the
proventriculus so that no food can pass
through. Such a flea is called blocked
flea
Flea indices
useful in evaluating the effectiveness of a spray programme

1. Total flea inex

2. Cheopis index: more significant than total flea index.
If >1, indicative of potential
explosiveness of situation
3. Specific %age of fleas
4. Burrow index
 Human plague
Most frequently contracted from
A. bite of infected flea
B. direct contact with tissues of infected animal
C. droplet infection from cases of pneumonic plague
3 types of human plague
A. bubonic plague
B. pneumonic plague
C. Septicemic plague
Bubonic Plague

Most common type

Infected rat flea usually bite on lower
extremities
Bacilli proliferate in the regional lymph glands
Typical features-
Sudden fever, chills, headache, prostration
Painful lymphadenitis
Bubonic plague cannot spread from person to
person because bacilli are locked up in buboes
Pneumonic Plague
Primary pneumonic plague is
rare
Generally follows as a
complication of bubonic
septicaemic plague

Septicaemic Plague
Primary septicemic plague is
rare, except for accidental lab
infections
References:
Parks textbook of preventive and social medicine
Thank you