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May stop additional isolation when:
48 hours after start
of effective therapy
Symptoms
High fever, chills, headache, hemoptysis, and toxemia. Progresses
rapidly to dyspnea, stridor, and cyanosis. Death results from
respiratory failure, circulatory collapse, and bleeding diathesis.
Comments:
Patients who do not receive adequate treatment within 18 hours after
onset of symptoms are not likely to survive.
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Incubation Period
1-4 days, usually short
Period of Communicability
Fleas may remain infective for months. Pnuemonic plague is highly
comminicable, especially in appropriate climate conditions. Over
crowding facilitates transmission.
Cohort (Inf. with Inf./Exp. with Exp./Non-Exp. with Non-Exp.)
Private Room preferred, cohort patients if not available
Transport Issues
Mask patient, limit movement to essential for medical treatment
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Who’s susceptible
General, Immunity after recovery is possible
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
No, if appropriate prophylaxis is given
Isolation of exposed susceptible asymptomatic patients
No, if appropriate prophylaxis is given
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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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