CBRNE - Plague Follow-up

Updated: Apr 18, 2017
  • Author: Susan E Dufel, MD, FACEP; Chief Editor: Duane C Caneva, MD, MSc  more...
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Follow-up

Further Inpatient Care

Take care to isolate all infected individuals.

Hospital laboratories and the public health department should be notified whenever plague is considered.  Any delay in diagnosis may place other health care workers and patients at risk for exposure.

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Transfer

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

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Deterrence/Prevention

Actions to limit the risk of acquiring the plague should be considered and include but are not limited to the following: [4]

  • 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, but 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 also 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.

A genetically modified form of a Y pseudotuberculosis strain has been used to develop an oral vaccine that provides protection against both bubonic and pneumonic plague after a single dose. Development of the vaccine involved deleting genes coding for virulence factors and inserting Y pestis genetic material to increase cross-species immunogenicity. The developers propose that the vaccine could be used for mass vaccination in endemic areas and as a response to a bioterrorism incident. [26]

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Complications

See the list below:

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Prognosis

See the list below:

  • 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.
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Patient Education

See the list below:

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