International quarantine regulations require that contact of
pneumonic plague patients must be quarantined for 6 days.
If cases appear within such a group, the quarantine must be
extended until 6 days have elapsed during which no new cases have appeared.
Prevention and Control Measures Applicable to the Susceptible.
(1) Immunization. Immunization is an important adjunct to a basic control
program of improved sanitation aimed at reducing the rat and flea protection against
human pneumonic plague.
(2) Specially treated clothing. In areas where plague is endemic, clothing
must be treated with permethrin. All troops whose activities bring them into contact with
ground that might harbor infected arthropods should have their blankets or sleeping bag
covers impregnated with permethrin. This repellent is not to be applied directly to the
(3) Repellents for skin application. Personnel in plague areas should treat
exposed portions of the skin with DEFT insect repellent. In an emergency, individuals
may apply the repellent to their clothing. Application to the uniform alone does not
protect the exposed skin.
(4) Insecticide powder. Sleeping bags and bedding should be dusted with
insecticide powder containing an appropriate insecticide.
(5) Avoidance of wild rodents. Contact with wild rodents should be avoided.
Animals that appear to be "tame" are more likely to be sick than tame.
5-36. ENDEMIC TYPHUS
Endemic (murine) typhus is a flea-borne disease caused by Rickettsia
typhi (sometimes referred to as Rickettsia mooseri).
a. Clinical Picture. Clinically, it resembles epidemic typhus (para 5-49a(1)
through (5), but the course tends to be milder and the fatality rate tower. Diagnosis is
confirmed by serological tests.
b. Occurrence. The disease is distributed wherever rats and people live in
close association, as in the same building. In the United States, it is seen in Gulf and
southern Atlantic coastal areas.
c. Cycle of Infection. A rat-flea-rat cycle of infection is maintained in nature.
Domestic rats are the most important reservoirs, and the rat flea, Xenopsylla cheopis,
the most common vector. The mode of transmission of the rickettsiae from flea to man