By: Arizona Department of Health Services (ADHS)
Summary: The Arizona Department of Health Services (ADHS) has been notified of a fatal human pneumonic plague case in Coconino County. Arizona has reported only 4 human cases in the past 10 years. The source of plague exposure is still under investigation.
Plague Highlights: Plague is a rare, potentially fatal disease caused by the bacterium Yersinia pestis. Y. pestis is endemic to the Southwestern US and northern Arizona (>4,500 feet elevation). Natural Y. pestis transmission cycles occur between fleas and wild rodents. People and domestic animals can become infected with Y. pestis by flea bites, direct contact with an infected animal, or inhaling respiratory droplets from an infected host. The three common clinical manifestations of plague include bubonic, septicemic, and pneumonic plague. Cats are especially susceptible to morbidity and mortality associated with plague, but dogs can also be infected. Plague is treatable with antibiotics given early during disease progression.
Veterinary Recommendations: Veterinarians can play a critical role in detecting plague, preventing further transmission to people and animals, and reporting suspected cases to the Arizona Department of Agriculture and ADHS.
- Consider plague as a differential diagnosis in animals with compatible clinical signs, especially for cats and dogs exposed to fleas or rodent reservoirs (e.g. prairie dogs). Most common clinical signs include fever, lethargy and regional lymphadenopathy. Other signs include respiratory signs or signs of sepsis. If plague is suspected, ideally obtain diagnostic samples before starting antibiotic treatment. However, do not delay treatment while waiting for diagnostic testing results.
Infection control protocols should be used when plague is suspected in a veterinary patient. This includes personal protective equipment such as gloves, gowns, eye protection, and N95 facemasks if respiratory signs are present. Ifplague is suspected, ideally obtain diagnostic samples before starting antibiotic treatment. However, do not delay treatment while waiting for diagnostic testing results.
Infection control protocols should be used when plague is suspected in a veterinary patient. This includes personal protective equipment such as gloves, gowns, eye protection, and N95 facemasks if respiratory signs are present. If pneumonic plague is suspected, isolate the patient until appropriate antibiotic therapy has been given for 48 hours. If fleas are found on or around the patient, treat exposed cages and exam rooms with a flea control product.
Promptly report any suspected plague cases or exposures to the local health department to facilitate timely public health interventions.
Report suspected plague cases in domestic animals to the Arizona Department of Agriculture (diseasereporting@azda.gov) or the Arizona Department of Health Services (vbzd@azdhs.gov).
Report dead wildlife to the Arizona Game and Fish Department (623-236-7201).
Develop an exposure protocol for potential situations in which staff and clients are exposed to an animal infected with Y. pestis. Maintain records of who has been exposed to animals with suspected plague and follow reporting procedures.
Resources:
Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel: By the National Association of State Public Health Veterinarians Veterinary Infection Control Committee, J Am Vet Med Assoc 2015 Dec 1;247(11):1252-77
Merck Veterinary Manual for clinical signs in veterinary patients: https://www.merckvetmanual.com/infectious-diseases/plague/plague-in-animals
CDC Plague Website: https://www.cdc.gov/plague/about/index.html
National Association of Public Health Veterinarians (NASPHV) Compendium of Veterinary Standard Precautions:https://www.nasphv.org/Documents/VeterinaryStandardPrecautions.pdf