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Today, plague is rare in the United States, but it has been known to occur in parts of California, Arizona, Colorado, and New Mexico

in Europe, massive plague epidemics killed millions of people. Plague can still be found in Africa, Asia, and South America.

someone with pneumonic plague coughs, tiny droplets carrying the bacteria move through the air. Anyone who breathes in these particles may catch the disease. An epidemic may be started this way.

Pneumonic plague symptoms appear suddenly, typically 2 - 3 days after exposure. They include: Cough Difficulty breathing Fever Frothy, bloody sputum Pain in the chest when you breathe deeply Severe cough Septicemic plague may cause death even before its symptoms occur. Symptoms can include: Abdominal pain Bleeding due to blood clotting problems Diarrhea Fever Nausea Vomiting

Bubonic plague symptoms appear suddenly, usually after 2 - 5 days of exposure to the bacteria. Symptoms include: Chills Fever General ill feeling (malaise) Headache Muscle pain Seizures Smooth, painful lymph gland swelling called a bubo Commonly found in the groin, but may occur in the armpits or neck, most often at the site of the infection (bite or scratch) Pain may occur in the area before the swelling appears

Bubonic plague -- an infection of the lymph nodes Pneumonic plague -- an infection of the lungs Septicemic plague -- an infection of the blood

Tests that may be done include:

Blood culture Culture of lymph node aspirate (fluid taken from an affected lymph node or bubo) Sputum culture

People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death may occur.

Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague

Oxygen, intravenous fluids, and respiratory support usually are also needed.

Patients with pneumonic plague should be strictly isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

Without treatment, about 50% of people with bubonic plague die. Almost all people with pneumonic plague die if not treated. Treatment reduces the death rate to 50%

Rat control and watching for the disease in the wild rodent population are the main measures used to control the risk of epidemics. A vaccination is available for high-risk workers, but its effectiveness is not clearly established

After recovering from typhoid fever, some people still can become carriers of the bacteria. This means that they'll have no symptoms, but do have the bacteria in their bodies and can pass it on to other people.

How People Get It People usually get typhoid fever by drinking beverages or eating food that has been handled by someone who has typhoid fever or is a carrier of the illness. Those infected also can pass the disease onto others directly (for example, by touching them with unwashed hands). People also get the illness by drinking water that is contaminated by sewage that contains the S. Typhi bacteria. For these reasons, the disease is common in areas with poor sanitation and inadequate water treatment. It is also common in tropical and subtropical areas around the world, including Africa, Asia, and Latin America

There is no specific treatment for those with yellow fever beyond good nursing and supportive care. The disease, however, is completely preventable. People can be rendered immune to the virus through vaccination, and outbreaks can be contained by eliminating or controlling mosquito populations. Thanks to such measures, the great yellow fever epidemics of the late 19th and early 20th centuries are no more. Nevertheless, the disease is still present in tropical Africa and South America, where access to vaccine is sometimes lacking

An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of

An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of mosquitoes. Yellow fever is one of the great epidemic diseases of the tropical world, and in earlier centuries it was one of the great plagues of the New World. At one time the tropical and subtropical regions of the Americas were subjected to devastating epidemics, and serious outbreaks occurred not only as far north as Philadelphia, New York, and Boston but also as far away as Spain, France, England, and Italy.

tious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of

Yellow fever is diagnosed clinically, with laboratory confirmatory testing available.

Yellow fever is an infectious disease caused by the yellow fever virus.

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include: Municipal water supplies Ice made from municipal water Foods and drinks sold by street vendors Vegetables grown with water containing human wastes Raw or undercooked fish and seafood caught in waters polluted with sewage

severe diarrhea.

bacteria travel through the blood to your lymph nodes, gallbladder, liver, spleen, and other parts of the body

bacteria, t

acteria enter your body

travel into your intestines

then into your blood

contaminated

Some persons become carriers

Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the abdomen and chest.

Typhoid fever is common in developing countries.

Fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.

High fever (103°F, or 39.5°C) or higher and severe diarrhea occur as the disease gets worse.

and abdominal pain.

Early symptoms include fever,

continue to release the bacteria in their stools for years, spreading the disease.

Abdominal tendernessAgitationBloody stoolsChillsConfusionDifficulty paying attention (attention deficit)DeliriumFluctuating moodHallucinationsNosebleedsSevere fatigueSlow, sluggish, lethargic feelingWeakness

Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.

Prevention

called the Black Death because one of the symptoms produced a blackening of the skin around the swellings.

Key Dates relating to the event: This terrible plague started in Europe in 1328 and lasted until 1351 although there were outbreaks for the next sixty years

buboes were red at first, but later turned a dark purple, or black.

spread of the Black Death followed all of the Trade Routes to every country

Nearly one third of the population of died - about 200 million people in Europe The 1328 outbreak in China caused the population to drop from 125 million to 90 million in just fifty years7500 victims of the disease were dying every day

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. In 1918 children would skip rope to the rhyme (Crawford):

The origins of this influenza variant is not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized. The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918). However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. Wilson had just given his 14 point address. There was virtually no response or acknowledgment to the epidemics in March and April in the military camps. It was unfortunate that no steps were taken to prepare for the usual recrudescence of the virulent influenza strain in the winter. The lack of action was later criticized when the epidemic could not be ignored in the winter of 1918 (BMJ, 1918). These first epidemics at training camps were a sign of what was coming in greater magnitude in the fall and winter of 1918 to the entire world.

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years.

"The 1918 has gone: a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked, the end at least for a time, of man's destruction of man; unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918).

riers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people (Brown).

With the military patients coming home from the war with battle wounds and mustard gas burns, hospital facilities and staff were taxed to the limit. This created a shortage of physicians, especially in the civilian sector as many had been lost for service with the military. Since the medical practitioners were away with the troops, only the medical students were left to care for the sick. Third and forth year classes were closed and the students assigned jobs as interns or nurses (Starr,1976). One article noted that "depletion has been carried to such an extent that the practitioners are brought very near the breaking point," (BMJ, 11/2/1918). The shortage was further confounded by the added loss of physicians to the epidemic. In the U.S., the Red Cross had to recruit more volunteers to contribute to the new cause at home of fighting the influenza epidemic. To respond with the fullest utilization of nurses, volunteers and medical supplies, the Red Cross created a National Committee on Influenza. It was involved in both military and civilian sectors to mobilize all forces to fight Spanish influenza (Crosby, 1989). In some areas of the US, the nursing shortage was so acute that the Red Cross had to ask local businesses to allow workers to have the day off if they volunteer in the hospitals at night (Deseret News). Emergency hospitals were created to take in the patients from the US and those arriving sick from overseas.

The Bush Hill Hospital, which housed the sick poor, was desperately understaffed. When Philadelphia’s mayor asked the public for help, a French-born merchant from Santo Domingo named Stephen Girard stepped up and recommended his compatriot, Dr. Jean Devèze, to head the hospital. Devèze refused to believe that yellow fever was contagious and he disapproved of Rush’s aggressive treatments. Devèze later became a world authority on yellow fever.

The first major American yellow fever epidemic hit Philadelphia in July 1793 and peaked during the first weeks of October. Philadelphia, then the nation’s capital, was the most cosmopolitan city in the United States. Two thousand free blacks lived there, as well as many recent white French-speaking arrivals from the colony of Santo Domingo, who were fleeing from a slave rebellion. Major Revolutionary political figures lived there, and in the first week of September, Thomas Jefferson wrote to James Madison that everyone who could escape the city was doing so. The epidemic depopulated Philadelphia: 5,000 out of a population of 45,000 died, and chronicler Mathew Carey estimated that another 17,000 fled.