Clinical Features of Plague in the United States: The 1969–1970 Epidemic

The incidence of bubonic plague in humans in the United States has increased markedly since 1965; there were nineteen cases in 1969–1970. All but four were acquired in New Mexico from sylvatic plague endemic in wild rodents. An epizootic in these animals has not been proved. Increasing outdoor recreation and establishment of rural communes may bring more people into contact with infected rodents, while suburban pets may transport fleas from rodents to man. The current patients were younger and included more females than previously reported. Initial clinical manifestations were often milder than expected, although there was one death. All patients had fever and a bubo, while malaise or myalgia, headache or confusion, and abdominal complaints were found in one-half of the cases. When this disease is kept in mind, early recognition and specific therapy are usually possible. However, delayed diagnosis may result from atypical manifestations, or illness that develops after travel to places distant from endemic areas such as the Southwestern United States.