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Epidemiology of Human Plague in the United States, 1900–2012 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

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Epidemiology of Human Plague in the United States, 1900–2012 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 1—January 2015


Epidemiology of Human Plague in the United States, 1900–2012

Kiersten J. KugelerComments to Author , J. Erin Staples, Alison F. Hinckley, Kenneth L. Gage, and Paul S. Mead
Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA


We summarize the characteristics of 1,006 cases of human plague occurring in the United States over 113 years, beginning with the first documented case in 1900. Three distinct eras can be identified on the basis of the frequency, nature, and geographic distribution of cases. During 1900–1925, outbreaks were common but were restricted to populous port cities. During 1926–1964, the geographic range of disease expanded rapidly, while the total number of reported cases fell. During 1965–2012, sporadic cases occurred annually, primarily in the rural Southwest. Clinical and demographic features of human illness have shifted over time as the disease has moved from crowded cities to the rural West. These shifts reflect changes in the populations at risk, the advent of antibiotics, and improved detection of more clinically indistinct forms of infection. Overall, the emergence of human plague in the United States parallels observed patterns of introduction of exotic plants and animals.
Plague is a globally distributed, zoonotic disease caused by the bacterium Yersinia pestis (1,2). In the late 1890s, rat-infested steamships introduced the disease into the continental United States (1,3,4). The first documented autochthonous human infection occurred in the Chinatown section of San Francisco, California, in March of 1900. Cases were soon reported in other port cities, including New Orleans, Galveston, Seattle, and Los Angeles (3,5). Along the Pacific Coast, infection spread from urban rats to native rodent species, and by the 1950s, Y. pestis had spread eastward to reach western portions of the Dakotas, Nebraska, Kansas, Oklahoma, and Texas. This distribution has remained static for >60 years, presumably the result of climatic and ecologic factors that limit further spread (3,59). Although poorly defined, these factors may be related to the ecology of vector species rather than that of rodent hosts (8).
The history of human plague in the United States provides a unique opportunity for long-term study of a zoonotic disease introduced onto a continent. Although the medical and scientific literature has detailed case histories and epidemiologic findings of plague cases in the United States, most reports have been limited in geographic scope or time frame (46,1021). We use data from all reported human plague cases in the United States during 1900–2012 to summarize and describe changes in the epidemiology of plague since its introduction.

Dr. Kugeler is an epidemiologist with the Bacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention.


We thank the clinicians, laboratorians, and public health professionals whose records were utilized for this analysis. We also thank Anna Perea for assistance with figure preparation.


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Suggested citation for this article: Kugeler KJ, Staples JE, Hinckley AF, Gage KL, Mead PS. Epidemiology of human plague in the United States, 1900–2012. Emerg Infect Dis. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.140564
DOI: 10.3201/eid2101.140564

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