801. A Century of Human Plague: United States, 1900-2008
Session: Abstracts: Oral Abstract Session: Bacterial Clinical Studies I
Friday, October 22, 2010: 3:45 PM
109-110
Background: Plague is a severe flea-borne zoonosis caused by Yersinia pestis.  The U.S. Public Health Service has collected information on human plague cases since the disease was introduced into the United States in 1900.

Methods: To describe changes in plague epidemiology in the US over the last century, we reviewed all confirmed and probable cases from 1900-2008.  Comparisons were made among cases occurring before and after 1944, the year antibiotics were first used to treat plague.

Results: A total of 989 plague cases were identified, with a single year maximum of 191 cases in 1907.  Median patient age was 28 years (range: <1-94); 65% were male.  Primary clinical manifestations were mostly bubonic (82%), but also septicemic (9%) and pneumonic (8%).  In the pre-antibiotic era, 515 plague cases (mean: 11/year) occurred in urban ports of 29 counties, mostly in CA (80%) but also in FL, LA, TX, and WA.  Most pneumonic cases (81%) were reported during this time; 83% of these were due to human transmissions in outbreaks.  The last human to human transmission was in 1924.  Patients were identified as White (56%), Asian (30%), and Hispanic (11%).  Pre-antibiotic mortality (66%) did not differ by sex, but was higher among Hispanics (81%) and Asians (95%) than among Whites (53%) (p<0.0001).  Since 1944, 474 cases (mean: 7/year) occurred in 110 rural and suburban counties in the West, with 54% of cases in NM.  Most septicemic cases (89%) were recorded during this time.  Exposures were in peridomestic, recreational and occupational settings.  The proportion of White non-Hispanics and Hispanics was similar as before 1944, however American Indians accounted for 33% of cases.  In the antibiotic era, 88% of patients received ≥1 effective drug, mortality declined to 16%, was lower in females (11%) than males (19%) (p=0.03), and did not differ by race.  Persons with known flea bite sought care earlier and had lower risk of mortality (RR: 0.7, 95%CI: 0.6-0.9) than those without a recognized bite.

Conclusion: In the last 109 years, plague has shifted from a disease of urban coastal populations capable of pneumonic outbreaks to a rare zoonosis in rural and suburban areas of the West.  Despite effective antibiotics, plague mortality still occurs.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Speakers:
Kiersten J. Kugeler , Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
Alison F. Hinckley , Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
Paul S. Mead , Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO

Disclosures:

K. J. Kugeler, None

A. F. Hinckley, None

P. S. Mead, None

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