In response to the increased number of human plague cases in
the
western United States, an Ad Hoc National Plague Prevention and
Control Committee held its first meeting February 22, and February
23,
1984, in Santa Fe, New Mexico. Sponsored by the New Mexico Health
and
Environment Department and CDC, the committee consisted of
representatives from four state health departments, the Indian
Health
Service, CDC, Pan American Health Organization/World Health
Organization, and one city health department. The agenda for the
conference was: (1) develop standards for epidemiologic and
environmental investigation of human plague cases in the United
States; (2) assess and improve current surveillance and control
strategies; and (3) establish short- and long-term research
objectives
aimed at preventing human plague cases.
The committee perceived a need to standardize investigation and
reporting of all U.S. human plague cases. Subcommittees were
appointed to develop surveillance forms for cooperative reporting
of
plague cases and field investigations by state and local health
departments. Data submitted on these forms will be analyzed by CDC
and used for ongoing plague research.
The committee concluded that current surveillance and control
strategies appeared to be effective when systematically and
intensively applied and that more effective and/or less costly
surveillance and control strategies needed to be developed and
defined.
The committee listed five priority areas for plague research
directed toward preventing human plague cases and deaths. They
are:
(1) studies on the basic biology of flea vectors and plague
ecology,
with emphasis on interactions among vector, pathogen, and weather
that
may prolong survival of infective fleas and increase human
transmission potential; (2) documentation of the role of pets in
transporting or transmitting plague to humans; (3) studies to
delineate plague risk factors among humans; (4) evaluation and
improvement of existing plague control strategies directed at
preventing human cases; and (5) development of improved and
simplified
laboratory diagnostic tests.
The committee recognized that human plague, despite its severe
morbidity and moderate-to-high mortality, remains a disease of low,
if
increasing, incidence and that cost-benefit ratios of plague
programs
should be carefully considered. Although plague in nature is
widespread throughout the western United States, definite
geographic
areas are identified as high-risk areas to humans. The committee
views selective and increased commitment of both federal and state
funds for research and the development of sound and cost-effective
surveillance and control methods in recognized human high-risk
areas
as an important first step toward reducing human plague morbidity
and
mortality.
Copies of the committee report may be obtained from Allan M.
Barnes, Ph.D., Plague Branch, Division of Vector-Borne Viral
Diseases,
Center for Infectious Diseases, CDC, P.O. Box 2087, Fort Collins,
Colorado 80522.
Reported by J Doll, PhD, Arizona Dept of Health Svcs; SB Werner,
MD, B
Nelson, PhD, California Dept of Health Svcs; J Emerson, DVM,
Colorado
Dept of Health; J Mann, MD, O Rollag, DVM, H Hull, MD, J Thompson,
N
Weber, New Mexico State Health and Environment Dept, T Brown,
Environmental Improvement Div, C Montman, Albuquerque Environmental
Health, G Heck, B Tempest, R Leach, R Grinnell, Indian Health Svc,
New
Mexico; J Rust, PhD, Pan American Health Organization/World Health
Organization; Plague Br, Div of Vector-Borne Viral Diseases, Center
for Infectious Diseases, CDC.
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