Is the Plague in the United States?

The short answer is that yes, the plague—caused by the bacterium Yersinia pestis—still exists in the United States, but it’s extremely rare. Thanks to modern medicine, public health measures and awareness, plague cases today are few and far between compared to historical outbreaks.

What Is the Plague?

Plague has three main forms:

• Bubonic plague: Characterized by swollen lymph nodes (called buboes), fever, chills and weakness.
• Septicemic plague: Occurs when infection spreads in the bloodstream, leading to rapid organ failure.
• Pneumonic plague: A severe lung infection that can spread person-to-person through respiratory droplets.

Left untreated, any form can be life-threatening. Thankfully, antibiotics are effective when given early.

Historical Context in the U.S.

• The most famous outbreak was the Third Pandemic in the early 1900s, which reached port cities like San Francisco.
• Rigorous quarantine, sanitation and wildlife monitoring largely ended widespread transmission by mid-20th century.

How Rare Is Plague Today?

Data from the Centers for Disease Control and Prevention (CDC) show:

• On average 7 cases per year in the entire United States.
• Most cases occur in rural Southwestern states: Arizona, California, Colorado, New Mexico and occasionally Oregon.
• About 1 in 7 reported cases is fatal, usually when diagnosis or treatment is delayed.

Why Does Plague Still Exist?

Plague survives in natural reservoirs—wild rodents (prairie dogs, squirrels, woodrats) and their fleas:

• Infected rodents carry Y. pestis.
• Fleas bite an infected animal, then bite humans or pets, transmitting the bacterium.
• A small number of cases result from handling infected animals (hunting, skinning) or rarely from person-to-person spread of pneumonic plague.

Who’s at Risk?

Although anyone can get plague, certain activities or situations increase risk:

• Living in or visiting rural areas where plague is endemic.
• Camping, hiking or working outdoors without proper insect repellent or protective clothing.
• Handling or skinning wild game without gloves.
• Allowing pets (cats especially) to roam freely in rodent-infested areas.

Signs and Symptoms

Early recognition is key. Common symptoms by form include:

Bubonic plague

• Sudden fever and chills
• Headache and fatigue
• Painful, swollen lymph nodes (groin, armpit or neck)

Septicemic plague

• Abdominal pain, shock, bleeding under the skin or from other organs
• Skin turning black (in severe cases)

Pneumonic plague

• High fever, severe cough, shortness of breath
• Chest pain, bloody or watery sputum

If you’re concerned about any of these symptoms, consider a free, online symptom check, using the doctor approved Ubie Symptom Checker to help guide your next steps.

Diagnosis and Treatment

• Diagnosis: Blood tests, lymph node aspirates or lung fluid samples confirm Yersinia pestis.
• Treatment: Prompt antibiotics (streptomycin, gentamicin, doxycycline or ciprofloxacin) usually lead to full recovery if started early.

Delays in treatment can significantly increase the risk of severe illness or death.

Preventing Plague

You can reduce your risk with simple precautions:

• Use insect repellent containing DEET on skin and permethrin on clothing.
• Avoid handling sick or dead wild rodents and rabbits; use gloves if contact is unavoidable.
• Keep pets indoors in endemic areas or use flea-preventive products.
• Seal cracks in your home to prevent rodents from entering.
• Report dead wildlife to local health or wildlife authorities.

Public Health Surveillance

State and local health departments work closely with the CDC to:

• Monitor rodent populations and flea activity.
• Investigate human cases and potential outbreaks.
• Educate communities in high-risk areas.

These measures keep case counts low and prevent large outbreaks.

What to Do If You Suspect Plague

• Seek medical attention immediately if you develop concerning symptoms, especially after possible exposure to wild rodents or fleas.
• Early antibiotic treatment is critical—don’t wait for test results if plague is likely.
• Let healthcare providers know about your travel and outdoor activities.

When to “Speak to a Doctor”

Plague is rare, but its symptoms overlap with common illnesses. If you experience high fever, severe swollen lymph nodes, unexplained bleeding or a rapidly worsening cough, it’s essential to get professional care right away. Use resources like the Ubie Symptom Checker to evaluate your symptoms, but always follow up with a healthcare professional for anything that could be life-threatening or serious.

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Plague remains part of our natural environment in parts of the United States, but modern medicine and public health efforts make it an uncommon threat. Staying informed, taking simple preventive steps and seeking prompt medical care if symptoms arise will keep you and your community safe. If you have any concerns or develop worrisome symptoms, please speak to a doctor without delay.