The black death past and present. 1. Plague in the 1980s

This paper considers firstly the epidemiology of plague in the 1980s. The largest number of cases occurred in Tanzania. Most cases were in children and young adults; in the USA the male:female ratio was about 2:1. Plague had a seasonal distribution. Almost all cases arose from bites of infected rodent fleas, and Rattus spp. were the most important reservoir hosts. Virulence is linked with the presence of a 45 MDa plasmid. The predominant clinical form of plague is bubonic, followed by septicaemic, meningitic and pneumonic. For treatment, streptomycin is the antibiotic of choice, with tetracycline and chloramphenicol as alternatives. Treatment given on the first 1-2 d of illness is highly effective, and resistance is not a problem. Rodent control, insecticide application, and avoidance of contact with rodents and their fleas remain the prime means of control. Plague vaccine is not in general use.