International travel and health



The plague bacillus, Yersinia pestis.


Plague is a zoonotic disease affecting rodents and transmitted by fleas from rodents to other animals and to humans. Direct person-to-person transmission does not occur except in the case of pneumonic plague, when respiratory droplets may transfer the infection from the patient to others in close contact.

Nature of the disease

Plague occurs in three main clinical forms:

  • Bubonic plague is the form that usually results from the bite of infected fleas. Lymphadenitis develops in the drainage lymph nodes, with the regional lymph nodes most commonly affected. Swelling, pain and suppuration of the lymph nodes produces the characteristic plague buboes.
  • Septicaemic plague may develop from bubonic plague or occur in the absence of lymphadenitis. Dissemination of the infection in the bloodstream results in meningitis, endotoxic shock and disseminated intravascular coagulation.
  • Pneumonic plague may result from secondary infection of the lungs following dissemination of plague bacilli from other body sites. It produces severe pneumonia. Direct infection of others may result from transfer of infection by respiratory droplets, causing primary pulmonary plague in the recipients.

Without prompt and effective treatment, 50–60% of cases of bubonic plague are fatal, while untreated septicaemic and pneumonic plague are invariably fatal.

Geographical distribution

There are natural foci of plague infection in rodents in many parts of the world. Wild rodent plague is present in central, eastern and southern Africa, South America, the western part of North America and in large areas of Asia. In some areas, contact between wild and domestic rats is common, resulting in sporadic cases of human plague and occasional outbreaks.

Risk for travellers

Generally low except in rural areas of countries or areas at risk, particularly if camping or hunting or if there is contact with rodents.


A vaccine effective against bubonic plague is available exclusively for individuals with a high occupational exposure to plague; it is not commercially available in most countries.


Avoid any contact with live or dead rodents.