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May stop additional isolation when:
48 hours after start of effective therapy
Symptoms
Initial signs and symptoms are nonspecific, fever, chills, malaise,
myalgia, nausea, prostration, sore throat, and headache.
Lymphadenopathy is common at site of flea bite.
Comments:
Plague bacilli are transmitted from normal reservoirs primarily by the
oriental flea Xenopsylla cheopis. The ground squirrel and other rodents
are the primary reservoir. Domestic cats may bring infected fleas
into contact with humans. Endemic rodent plagues exist in the western
U.S., most of South America, especially Brazil and the Andes region.
Asia, Africa, Indonesia, and former USSR also have endemic plagues.
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Incubation Period
1 – 7 days, can be longer in immunocompromised host
Period of Communicability
Rare person to person transmission of bubonic plague although drainage
is infectious and can be aerosolized. Pneumonic plague is infectious
from start of acute phase for duration of illness or until 3 days after
start of effective therapy. Fleas are infective for life.
Cohort (Inf. with Inf./Exp. with Exp./Non-Exp. with Non-Exp.)
Yes
Transport Issues
mask patient
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Who’s susceptible
General, disease does confer some resistance-but may not be sufficient
if exposed to large inoculum of bacteria.
Who’s exposed
Face to face contact with an infected patient
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Exclusion of symptomatic personnel from duty
Yes, until fit to work and 48 hours after start of effective therapy.
Exclusion of exposed susceptible personnel from duty
Yes, for 7 days after exposure to pneumonic plague or 48 hours after
start of effective therapy.
Isolation of exposed susceptible asymptomatic patients
Yes, for 7 days after exposure
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Prophylaxis for exposed
Doxcycline 100mg PO BID OR Ciprofloxin 500mg PO BID both for 7 days.
Alternative prophylaxis can be Chloramphenicol 25mg/kg PO QID for 7
days. Vaccine is not protective against aerosol in animal studies.
Treatment for the Ill
Gentamicin 5mg/kg IM or IV QD, or Gentamicin 1.7 mg/kg IM or IV TID
or Streptomycin 1g IM BID (if available). Alternative
treatment can be Doxycycline 100mg IV/PO BID or Ciprofloxin 400mg
IV/PO BID OR Chloramphenicol 25mg/kg IV QID. Treat for 10 – 14 days.
Military/Institutional Populations Special Issues
Disinfect surfaces with a 10% bleach solution. Launder linens. Use
dedicated instruments. Monitor in endemic areas.
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