Plague, human in Nebraska

• Bubonic Plague: Swollen, painful lymph nodes (buboes), fever, chills, headache, weakness.
• Septicemic Plague: Fever, chills, extreme weakness, abdominal pain, shock, and bleeding under the skin or into organs (can develop from bubonic or occur primarily).
• Pneumonic Plague: Rapidly developing pneumonia with fever, headache, weakness, chest pain, and a cough with bloody or watery sputum. This form is highly contagious and can spread directly from person to person.

Plague primarily spreads to humans through the bite of fleas infected with *Yersinia pestis*, which typically feed on infected rodents. Transmission can also occur through direct contact with infected animal tissues or fluids, or by inhaling respiratory droplets from a person or animal with pneumonic plague.

• Avoid contact with sick or dead rodents and other animals.
• Use insect repellent containing DEET when outdoors in areas where plague is present to prevent flea bites.
• Keep homes and surrounding areas free of rodents by removing potential nesting sites and food sources.
• Use flea control products on pets living in endemic areas.
• A vaccine is not routinely recommended for the general public but may be considered for those at high risk, such as laboratory workers or healthcare personnel in outbreak areas.