This well-conceived and well-executed supplement gives DMs a robust toolkit for incorporating plagues into fantasy role-playing campaigns. The crunchy parts are for D&D 4e, but the first three (of five) chapters are largely crunch-free and could be used by GMs running any system. Those first three chapters describe the onset, progress, and aftermath of a plague. Author Creighton Broadhurst has done a particularly good job in these chapters of balancing realism/verisimilitude with compelling and efficient gameplay. Chapters 4 and 5 present 4e-specific options for players and DMs, including magic items, rituals, disease stat blocks, skill challenges, monsters, and even a god of disease. The text seems to have been well-edited, with very few grammatical errors slipping through. The typography needs more polish; in particular, using Times New Roman for the body text and Georgia for the footnotes creates an unpleasant clash of serifs. Aside from these relatively minor aesthetic points, I wholeheartedly recommend this supplement.