eMedicine Specialties > Emergency Medicine > Warfare - Chemical, Biological, Radiological, Nuclear and Explosives

CBRNE - Plague: Follow-up

Author: Demetres G Velendzas, MD, Attending Staff, Department of Emergency Medicine, Manchester Memorial Hospital, Eastern Connecticut Health Network
Coauthor(s): Susan E Dufel, MD, FACEP, Program Director, Associate Professor, Department of Traumatology and Emergency Medicine, Division of Emergency Medicine, University of Connecticut School of Medicine; Deirdre Cronin, MD, Resident Physician, Department of Emergency Medicine, University of Connecticut School of Medicine, Farmington
Contributor Information and Disclosures

Updated: Sep 22, 2009

Follow-up

Further Inpatient Care

  • Take care to isolate all infected individuals.

Transfer

  • Whenever possible, patients suspected of having plague should not be transferred.
  • All transfers must comply with Consolidated Omnibus Budget Reconciliation Act (COBRA) regulations.
  • Transfers must be performed with the patient in strict isolation.

Deterrence/Prevention

  • Actions to limit the risk of acquiring the plague should be considered and include but are not limited to the following:3
    • Limit contact with rodents.
    • Treat domesticated animals for fleas.
    • Consider use of protective clothing, insect repellants (DEET), insecticides, and/or rodenticides, especially if in an endemic area.
    • Improve environmental sanitation, such as proper disposal of trash, which may serve to attract rodents.
    • Surface disinfection where appropriate
  • Use prophylactic antibiotics in close contacts (within 2-5 ft) of patients who are infected. In those who refuse treatment, close observation and isolation is mandated for 7 days. 
  • A plague vaccine exists.
    • It has not been commercially available in the United States since 1999.
    • Its use is recommended only for health personnel who may come into contact with Y pestis.
    • The vaccine may be useful for specialized care and for agricultural personnel who work in areas with endemic plague and are unable to minimize contact with wild animals. 
    • The amount of protection the vaccine provides is poor, especially for pneumonic plague. As such, it is not currently recommended in outbreak-type situations.
    • Recombinant subunit vaccine research has demonstrated inconsistent results conferring immunity to some primates and not others.8,7
    • An attenuated live vaccine using a strain of Yersinia pseudotuberculosis has shown promise in studies with mice.9

Complications

Prognosis

  • In those treated for bubonic plague, the mortality rate is 1-15%.
  • Primary or secondary septicemic plague has a 40% mortality rate, even in treated patients.
  • Pneumonic plague has 100% mortality if not treated within the first 24 hours.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider plague in cases of severe pneumonia and sepsis
  • Failure to institute early antibiotic therapy or empiric therapy as diagnostic studies proceed
  • Failure to ensure strict isolation of infected individuals and prophylactic antibiotics for the contacts
  • Failure to obtain proper consultation from an infectious disease specialist, medical intensivist, the CDC, and the Department of Health
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Thomas W McGovern, MD, to the development and writing of this article.



More on CBRNE - Plague

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References
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Further Reading

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Contributor Information and Disclosures

Author

Demetres G Velendzas, MD, Attending Staff, Department of Emergency Medicine, Manchester Memorial Hospital, Eastern Connecticut Health Network
Demetres G Velendzas, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Susan E Dufel, MD, FACEP, Program Director, Associate Professor, Department of Traumatology and Emergency Medicine, Division of Emergency Medicine, University of Connecticut School of Medicine
Susan E Dufel, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Deirdre Cronin, MD, Resident Physician, Department of Emergency Medicine, University of Connecticut School of Medicine, Farmington
Disclosure: Nothing to disclose.

Medical Editor

Dan Danzl, MD, Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital
Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Weiss, MD, DTM&H, Director of Stanford Travel Medicine, Medical Director of Stanford Lifeflight, Assistant Professor, Departments of Emergency Medicine and Infectious Diseases, Stanford University School of Medicine
Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Association for Oncology, Southern Clinical Neurological Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP, Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine
Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Association of Military Surgeons of the US
Disclosure: Nothing to disclose.

 
 
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