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The last occurrence of transmissions from rats to people, or people to people in the United States occurred in 1924 in Los Angeles. In that epidemic there were 32 cases of pneumonic plague with 31 fatalities. Since then there have been around 16 cases a year in the United States, most connected with rock squirrels and its common flea Oropsylla montana.
The most dangerous type of plague is pneumonic. It can be spread through aerosol droplets released through coughs, sneezes, or through fluid contact. It may also become a secondary result of a case of untreated bubonic or septicemic plague. Although not as common as the bubonic strain, it is more deadly...
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