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Disease plays a large role in CKII, due to the lethality of diseases in the Middle Ages, and generally bad side effects they give you. Most characters are capable of living through the majority of diseases, though some may still die when an outbreak occurs.

All diseases are represented by health traits.

Normal diseases[edit]

Disease Description
Ill.png Generic Illness

The most simple type of "disease", the trait Ill reduces martial by 1, health by 2, and fertility by 10%.
Unless the ill person in question is very old, weak, or has another disease, the odds of someone dying from this trait is very low.
Generic Illness and Pneumonia are mutually exclusive. You need to have a health level of at least 3 to recover from this disease.

Pneumonic.png Pneumonia

Incompatible with "Ill", the pneumonic trait is far far more deadly. It reduces all attributes by 2 and reduces health by 4.
It also reduces fertility by 50%, making most characters very unlikely to procreate. The trait is often deadly; do not expect to have your rulers survive this one every time.
You need to have a health level of at least 4 to recover from this disease.

Leper.png Leprosy

Another moderate disease, leprosy makes holding a large kingdom or empire together very difficult.
It reduces diplomacy and health by 2, and fertility by 20%. It also reduces sex appeal by 50, and all vassals opinions of you by 20.
Though leprosy has a +10 bonus with other lepers, chances are that you will not make use of that bonus often. You need to have a health level of at least 4 to recover from this disease.

Syphilitic.png Great Pox

A moderately dangerous disease, syphilis reduces all attributes by 1, health by 2, and fertility by 20%. Furthermore, it reduces sex appeal of the character by 30.
This disease will most likely shorten the lifespan of your character, though it will not necessarily result in an abnormally early death.
One of the more dangerous features of this disease is that it can be passed down to children if one of the parents has this trait.
This makes long-lived heirs more rare if your ruler suffers from syphilis. You need to have a health level of at least 6 to recover from this disease.
There is a chance to remove this disease by choosing Theology focus.

Epidemic diseases[edit]

Epidemics begin with an outbreak in one province, and can spread through adjacent provinces on the first day of each month.

When a province is affected by an epidemic:

  • A dark green cloud appears over the city sprawl.
  • Characters in the province will randomly become infected. Characters who have already contracted and recovered from the disease are not immune.
  • City tax income is reduced.
  • Supply limit is reduced, and attrition is greatly increased for troops in excess of the supply limit. These effects make warfare more difficult, especially when large armies are required or multiple diseases are present.

Rulers can protect against epidemics by relocating their capital or by sending individual characters to other locations. Children age 6-15 can be sent for education in other courts. Adults can lead troops or perform council missions in safer provinces. With DLC icon Reaper's Due.png The Reaper's Due, note that only land provinces are safe: leading troops at sea while an epidemic ravages your capital is a sure way to contract Scurvy .

Conversely, sending a character to an infected location can serve as a quiet way to dispose of a rival or an unwanted heir.

Outbreaks always begin in coastal cities. Cities with higher income are at higher risk. A capital that is far inland may be safest. The Black Death only arrives in 1300-1400 AD.

List of epidemic diseases[edit]

Epidemic Contagiousness Outbreak Duration Trait Effects Recovery MTTH
(for 45yo with 5 base_health)
Tuberculosis epidemic.png Tuberculosis
30% 1.2% 30 months Tuberculosis.png -2 health 24 months
Typhoid fever epidemic.png Typhoid fever
(Slow Fever)
30% 1.2% 30 months Typhoid fever.png -2 health 4 months
Typhus epidemic.png Typhus
(Camp Fever)
50% 4% 10 months Typhus.png -4 health 12 months
Bubonic plague epidemic.png Bubonic plague
(The Plague, Black Death)
95% 1% 10 months Bubonic plague.png -7 health 3 months
Measles epidemic.png Measles 60% 3% 8 months Measles.png -2 health 5 months
Smallpox epidemic.png Smallpox 50% 8% 8 months Smallpox.png -3 health 5 months
Smallpox epidemic.png Syphilis
(Great Pox)
50% 8%
(Dlc icon sunset invasion.png Sunset Invasion)
8 months Syphilitic.png -3 health, -20% fertility Recovery ONLY with Possessed  trait

With Reaper's Due[edit]

With The Reaper's Due the disease system is more complex. Characters will first gain symptoms which will then be diagnosed by their Court Physician. Hospitals are also added to fight epidemics on a province level and the epidemics also affect the level of prosperity in the province.

Outbreaks can begin in any province, and can spread through single ocean tiles. Infected provinces tend to lose prosperity and may experience its opposite, depopulation. Basic hospitals provide resistance to depopulation.

Upgraded hospitals can also prevent the province from becoming infected. This makes them useful not only in your capital but also in provinces near your capital, especially at chokepoints such as the Grisons-Lombardy mountain pass.

The Black Death is larger and more deadly, and gets a chance of major outbreak to occur 200 years into any game, regardless of start date. After a major outbreak has happened the disease becomes endemic and may break out again, but likely on a smaller scale. The Black Death has special patterns. It may miss India, Africa, Scandinavia, Britain, or the Steppe. It also has a chance to miss a discontinuous region called the Historical Plague Exclusion Zone. Once you see evidence of which regions it is skipping, try to move your capital there.

Epidemics can never spread to Iceland, because it does not share any sea zones. However, Iceland is a small duchy in a weak de jure empire, so moving your capital there may reduce both demesne levies and vassal levies. Iceland is also far from everything else, increasing the risk of independence factions.

Sending your court into seclusion often protects you, but has risks such as becoming Craven  and experiencing food shortages. Seclusion may fail if a courtier is exposed to the outside or contracts the disease before becoming secluded.


Name Command ID Diplomacy Martial Stewardship Intrigue Learning Health Opinions Other modifiers Miscellaneous Cost
Ill.png Ill ill 25 -1 -1 -10% Fertility
-1 Personal Combat Skill
The Reaper's Due replaces the "ill" trait with unlinked symptoms
Pneumonic.png Pneumonic pneumonic 26 -2 -2 -2 -2 -2 -4 -50% Fertility
-3 Personal Combat Skill
Syphilitic.png Has Great Pox syphilitic 27 -1 -1 -1 -1 -1 -2 -10 Attraction -20% Fertility 10% Inherit Chance -44
Leper.png Leper leper 28 -1.5 -35 Attraction
-5 General
-95% Fertility
-2 Personal Combat Skill
Tuberculosis.png Consumption has_tuberculosis 34 -2 -1 -2 -2 -2 Personal Combat Skill Epidemic
Typhoid fever.png Has Slow Fever has_typhoid_fever 35 -2 -1 -1 -3 -10% Fertility
-4 Personal Combat Skill
Typhus.png Camp Fever has_typhus 36 -1 -2 -1 -2 -4 -20% Fertility
-4 Personal Combat Skill
Bubonic plague.png The Plague has_bubonic_plague 37 -2 -3 -2 -3 -2 -7 -50% Fertility
-10 Personal Combat Skill
Epidemic (nearly mapwide, many special events)
Measles.png Measles has_measles 38 -2 -1 -2 -10% Fertility
-3 Personal Combat Skill
Smallpox.png Smallpox has_small_pox 39 -2 -1 -2 -3 -25% Fertility
-10 Personal Combat Skill
Syphilitic.png Aztec Disease has_aztec_disease 132 -3 -2 -2 -3 -2 -4 -30 Attraction -20% Fertility
-3 Personal Combat Skill
Epidemic (after Aztec arrival)
Sickly.png Sickly sickly 144 -2.5 Children can be born sickly.
Removed between the ages of 2 to 6.
Flu.png Flu flu 225 -1 -1 -1 -1 -1 -2 -30 Attraction -1 Personal Combat Skill Common and brief
Dysentery.png Dysentery dysentery 226 -1 -1 -4 -30 Attraction -25% Fertility
-2 Personal Combat Skill
Gout.png Gout gout 227 -2 -1 -2 -2 Personal Combat Skill
Food poisoning.png Food Poisoning food_poisoning 228 -2 -2 -2 -2 -2 -3 -25 Attraction -50% Fertility
-1 Personal Combat Skill
Rabies.png Rabies rabies 229 -3 -2 -3 -2 -7 -20 Attraction
-5 Vassal
+2 Personal Combat Skill
-50 Rationality
Cancer.png Cancer cancer 230 -3 -20% Fertility More likely when old
Dancing plague.png Dancing Plague dancing_plague 235 -1 -1 -1 -1 -1 -2 -25% Fertility Epidemic (rare)
Scurvy.png Scurvy scurvy 238 -1 -1 -1 -1 -1 -3 -2 Personal Combat Skill Gained when leading troops at sea
More likely after 3 years at sea
More likely when an epidemic is ravaging your capital


Name Command ID Diplomacy Martial Stewardship Intrigue Learning Health Opinions Other modifiers Possible diseases
Cough.png Cough cough 207 -1 -0.25 -5 Attraction Pneumonic Consumption Measles Flu Cancer
Fever.png Fever fever 208 -1 -1 -10% Fertility
-1 Personal Combat Skill
-10 Rationality
Pneumonic Has Great Pox Consumption Has Slow Fever Camp Fever The Plague Measles Smallpox Aztec Disease Flu Dysentery Gout Food Poisoning Rabies
Diarrhea.png Diarrhea diarrhea 209 -2 -2 -1 -10 Attraction -20% Fertility
-1 Personal Combat Skill
Has Slow Fever Camp Fever Flu Dysentery Food Poisoning Cancer
Vomiting.png Vomiting vomiting 210 -2 -2 -1 -10 Attraction -30% Fertility
-1 Personal Combat Skill
Flu Food Poisoning Cancer
Chest pain.png Chest Pain chest_pain 211 -2 -1 Personal Combat Skill Pneumonic Consumption Cancer
Cramps.png Cramps cramps 212 -2 -0.5 -1 Personal Combat Skill Food Poisoning The Plague
Rash.png Rash rash 213 -0.5 -5 Attraction -10% Fertility Has Great Pox Camp Fever Measles Smallpox Aztec Disease
Headache.png Headache headache 214 -1 -1 -1 -0.5 -1 Personal Combat Skill
-10 Rationality
Has Great Pox Camp Fever Smallpox Aztec Disease Flu Cancer
Abdominal pain.png Abdominal Pain abdominal_pain 215 -1 -10% Fertility Has Slow Fever Camp Fever Flu Dysentery Cancer
Fatigue.png Fatigue fatigue 216 -1 -1 -0.25 -20 Rationality Consumption Camp Fever Flu Gout Rabies Cancer
Malaise.png Malaise malaise 217 -0.75 Has Slow Fever The Plague Smallpox Aztec Disease Flu Rabies Cancer
Infection.png Infection infection 218 -3 -3 -3 -3 -3 -2 -15 Attraction -1 Personal Combat Skill

See also[edit]