Secular plague trend in Ceará State, Brazil

After its introduction into the State of Ceará, Brazil, in 1900, the plague was established in seven ecological complexes: Chapada do Araripe and the Ibiapaba, Baturité, Machado, Matas, Pedra Branca, and Uruburetama mountains. These natural foci were monitored successively from 1935 to 2004 by the National Health Department, National Plague Service, National Department of Rural Endemics, Superintendency of Public Health Campaigns, National Health Foundation, and finally by the National Health Surveillance Secretariat. Data analysis on human cases during these 70 years allowing identifying different plague circulation patterns in the human population, alternating high incidence with silent periods and characterizing a chronological periodicity with unique epidemiological characteristics, besides concluding that plague should still be considered a potential threat, thus justifying the revitalization of surveillance measures by strengthening all levels in the Unified National Health System.