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Fig. 24.1 Geographic distribution of plague. Note the outlined area of sylvatic plague in the western United States.

Geographic Distribution

Throughout history, plague has swept in great pandemics over much of the world, touching the inhabitants of most major countries in the process. Plague is now a rare infection of mankind and is limited to areas of sylvatic infection in sub-Saharan Africa, Southeast Asia, India and parts of China, South America, and the southwestern United States (Fig. 24.1). Epidemics are unusual in recent decades and develop only when infected rats and fleas come into close proximity with humans in crowded urban areas.

In Asia, there are still endemic foci on the central Asian plateau, extending across northern China and Mongolia, as well as in southern China, Vietnam, and the rest of Southeast Asia and Indonesia. Sporadic cases of plague are still seen in India, Kurdistan, and the former Soviet Central Asian republics. In Africa, remaining foci of plague are found in Tanzania, Kenya, Uganda (primarily around Lake Albert), and the adjacent area of the Democratic Republic of Congo, as well as in Malawi, Botswana, Madagascar, South and West Africa, and Morocco. In the Americas, endemic foci of sylvatic plague, resulting in occasional human infections, occur primarily in the western and southwestern states of the United States, in Mexico, and in scattered areas of South America, including Ecuador, Peru, northeast Brazil, Bolivia, and northern Argentina.

From 1986 to 1990, the principal countries reporting cases of plague were Tanzania (1758 cases), Vietnam (1186), Democratic Republic of Congo (844), Madagascar (553), and an isolated endemic in 1986 in Uganda (340). There were over 100 cases reported during the same period in Bolivia, Brazil, Botswana, and China. In the 1990s, outbreaks of both bubonic and pneumonic plague have occurred in Vietnam, Myanmar (Burma), Tanzania, Democratic Republic of Congo, Madagascar, and Peru. In 1992, 1758 cases with 198 deaths were reported to the WHO, while in 1993 there were 151 deaths reported. India has seen a recent outbreak of plague in 1994; 2100 cases of suspected bubonic plague were reported from the central state of Maharashtra, while there were 52 deaths from the more serious pneumonic plague in the port city of Surat in Gujurat state. In the United States, there were only10 cases of plague reported in 1993, 14 in 1994, and 7 in 1995.

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