Key facts

Transmission

Bites of infected fleas
Breathing in droplets from the cough of an infected person or animal (cats)
Touching or skinning infected live or dead animals (such as rats, rabbits, squirrels or prairie dogs)

Symptoms

Sudden fever, chills, head and body-aches and weakness, vomiting and nausea.
Small lumps on the body that are swollen, hard and painful (called “lymph nodes”). These can turn into sores that discharge fluid.
Stomach pain, shock, and sometimes bleeding into the skin or inside the body; skin may turn black and die, especially on fingers, toes and nose.
Lung infection that starts very quickly, and causes difficulty with breathing, chest pain, coughing (sometimes of blood or mucous).
The person may stop breathing; the body may shut down, causing death.

Prevention

Reduction of rodent habitats
Social mobilization and behaviour change communication
Early identification of cases and treatment with antibiotics
Repair and screening of holes or cracks in houses
Storage of food in rodent-proof containers
Use of raised beds or sleeping areas
Safe handling and disposal of animal carcasses

Vulnerable people

Everyone in the community is vulnerable to plague
Young children, older people and people with other illnesses or health conditions may have a higher risk of severe illness

If an epidemic occurs

Detect plague cases rapidly and refer them to health facilities for early treatment with antibiotics
Employ social mobilization and behaviour change communication
Control fleas using environmental and chemical hygiene BEFORE controlling rats (eg, setting traps)
Actively search for rat carcasses and dispose of them correctly
Handle and dispose of animal carcasses safely
Avoid direct contact with people who have plague (caregivers should remain a distance of at least one metre from persons who are sick)
Caregivers and health workers should wear personal protective equipment (gloves, mask, gown/apron)
Isolate patients with pneumonic plague (lung infection)
Give antibiotics (chemoprophylaxis) to people who have been in close contact with a person who has pneumonic plague
Repair and screen holes and cracks in walls; store food in rodent-proof containers
Use raised beds or raise sleeping areas
Provide safe and dignified burials

Community-based assessment - questions

Make a map of the community and mark the information you gather on the map. Record other details.

When did people start to fall sick with plague?
How many people have fallen sick with plague? Where?
How many people have died? Where?
How many people live in the affected community or area? How many children under five years of age live in the area?
Who and where are the vulnerable people?
What are the community’s burial traditions and funeral procedures and practices?
How do people in the community store their food? (Are rats or other rodents able to eat it?)
Do people in the community sleep at ground level or on raised beds?
Do community members have any risky habits or practices when they come into contact with dead or live rodents?
Are there handwashing facilities in the community or at the health centre? Are soap and water always available?
Where are the local health facilities and services? (Include traditional and community carers.)
What are the community’s habits, practices and beliefs about caring for and feeding sick people. When babies and infants are sick, do women continue to breastfeed them?
Is a social mobilization or health promotion programme in place?
Which sources of information do people use most?
Are rumours or is misinformation about plague spreading in the community?

Volunteer actions

01. Community-based surveillance 02. Community mapping 03. Communicating with the community 04. Community referral to health facilities 05. Volunteer protection and safety 06. Personal protection equipment (PPE) for highly infectious diseases 19. Psychosocial support 20. Isolating sick people Plague 23. Chemoprophylaxis 26. Respiratory hygiene and coughing etiquette 28. Physical distancing 29. Hygiene promotion 34. Handwashing with soap 35. Handwashing in a highly infectious epidemic 36. Vector and reservoir control 38. Waste disposal and clean-up campaigns Plague 41. Handling and slaughtering animals 43. Social mobilization and behaviour change