The objectives of this project are to: 1) reduce human morbidity and mortality due to plague in Uganda, 2) reduce the risk of disease spread to other populations including the United States, 3) fill gaps in our knowledge and understanding of plague ecology and human risk factors, 4) field evaluate emergency intervention measures for bubonic plague outbreaks including measures applicable within the United States, and, 5) collect plague bacterial isolates from a variety of animal sources in Uganda for CDC archiving and future research. This project specifically addresses the President's National Strategy on Homeland Security by providing a unique opportunity to field test emergency control measures and by providing CDC an archive of plague isolates for future studies. This project specifically addresses CDC mission priorities on Global Disease Detection and Healthy People 2010. Identification of vector and reservoir species, collection of strain isolates from animal sources, and the identification of human plague risk factors will be accomplished by conducting environmental and ecological investigations at the residences and villages of plague cases as they occur. Uganda has averaged approximately 300 plague cases per year (1999-2003), which is likely a significant underestimate of total disease burden. Risk factors will additionally be explored through a village-based case-control study in which environmental and ecological parameters will be compared between villages with a history of plague cases vs. villages without a history of plague cases (matched for ecological and demographic similarity as much as possible). Temporal and geographical risk models will also be attempted utilizing global positioning system (GPS) and climatic parameters found to correlate with plague risk in other regions of the world. Long-term climate data collection stations will be erected at selected locations within the endemic region. Specific methods to control plague will be developed based upon identified risk factors and ecological findings. These methods may use known or novel techniques and will be evaluated by their application at the village level - measuring disease morbidity and mortality reduction as well as ecological risk reduction such as flea or rodent density). Reduction of disease morbidity and mortality is, of course, the backbone of public health. This project achieves that through sound scientific investigation followed by direct application. ? ? ? ?
