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Plague:
Overview for Health Care Providers
One page summary of: Organism/Stability, Natural
Reservoir, Route of Infection, Communicability, Case
Fatality, Incubation Period, Clinical Manifestations,
Laboratory test/Sample collection, Treatment, Prophylaxis,
Infection Control, Vaccine, Public Health
Plague: Guidance
for Health Care Providers
Key Medical and Public Health Interventions After Identification
of a Suspected Case
What is plague?
Plague is a disease caused by bacteria that live in certain rodents
(e.g., squirrels, prairie dogs, or mice) and other small mammals
(e.g., rabbits or hares).
Who gets plague?
Anyone can get plague, but it occurs more often in people working
in or visiting areas with infected animals. Cases often occur in
areas where housing and cleanliness is poor. They are usually associated
with infected rats and fleas that live in the home. Plague is rare
in the United States. Fewer than 20 people in the U.S. are diagnosed
with plague every year. Cases generally occur in the western and
southwestern parts of the country. Worldwide, from 1,000 to 3,000
cases of plague are diagnosed every year.
How is plague spread?
Plague bacteria live in certain animals, such as rodents and other
small mammals. Fleas feed on the animals and get infected. The disease
may be spread to people if they are bitten by the infected fleas.
People may also get the disease through close contact with infected
animals (e.g., through an animal bite or scratch or through handling
animal tissues). If the disease gets into the lungs, it may be spread
from person-to-person by droplets released when coughing.
Could plague be used for bioterrorism?
Yes. Plague is considered to be one of the agents that could be
used for bioterrorism because the disease can be spread from person-to-person
and would cause increased illness and death in the population if
used as a weapon. If plague was used for bioterorrism, it probably
would be aerosolized (made airborne).
What are the symptoms of plague?
Symptoms can include fever, chills, nausea, headache and body aches.
Specific types of plague also lead to other symptoms. For bubonic
plague, patients develop a swollen, painful lymph node (called a
“bubo”) near where the infected flea bit the person.
For septicemic plague (bloodstream infection), patients develop
abdominal pain, shock and bleeding into skin and other organs. For
pneumonic plague (lung infection), patients develop a cough with
bloody or watery sputum and have difficulty breathing.
How soon after exposure do symptoms
appear?
The symptoms appear anywhere from one to eight days after exposure.
How is it diagnosed and treated?
There are special laboratory tests that can be used to diagnose
plague. Samples may be taken from the swollen lymph node, blood,
spinal fluid, or other body sites.
Specific antibiotics are prescribed by a doctor to treat plague. If pneumonic and septicemic plague patients do not receive early treatment, the disease is almost always fatal. Untreated bubonic plague is fatal about half of the time. Even with early treatment, death from plague can occur five to fourteen percent of the time.
What can be done to prevent the spread
of plague?
Travelers to areas where plague occurs should avoid contact with
rodents and fleas, avoid handling sick or dead stray animals, and
stay away from rodent infested places. Persons with plague and their
clothing and belongings should be treated to kill all fleas. Rodents
and fleas should be controlled where the disease has occurred. Persons
with plague that results in pneumonia should be isolated in the
hospital until 48 hours after antibiotics have been started. Some
close contacts should also be treated with antibiotics and watched
for any signs of illness.
Is there a vaccine for plague?
The vaccine for plague was discontinued in the United States in
1999 and is no longer available.