Pediatric plague

The large reservoir of animal plague in the American West led to 121 cases of human plague from 1970 to 1980. The majority (55%) of recent cases have occurred in children 16 years of age and younger. In New Mexico 38 pediatric plague cases were reviewed to determine the epidemiologic, clinical, and laboratory feature of this disease. Thirty-one patients (82%) had bubonic plague and seven (18%) had primary septicemic disease. Primary septicemic plague had a significantly higher case-fatality ratio (71% vs 3%; P = .0002) and an increased risk of plague pneumonia (57% vs 6%; P = .01) compared with bubonic disease. Symptoms at onset, physical examination, and laboratory data at hospitalization (mean of three days after onset) were consistent with an acute, systemic febrile illness. Recovery from plague was slow, requiring an average of 5.9 days from initiation of effective antibiotics until fever lysis. Only a minority of plague patients were initially suspected to have plague, even by the time of hospitalization. Whereas clinical evidence, particularly in bubonic disease, should suggest plague, residing in or visiting a rural are of the West (especially from June through September) during the week prior to illness may be the only useful epidemiologic clue for the majority of patients who lack a history suggestive of exposure to animals or fleas. The importance of pediatric plague stems from the recent increase in cases, the significant increase in the proportion of all cases occurring in children, the public health implications of plague pneumonia (16% of cases), and the demonstrated potential for plague patients to travel to areas of the country unfamiliar with the disease and its sylvatic home in the American West.