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| Emergency Preparedness |
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| Plague |
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Patient Handouts
What is plague?
Plague is a disease caused by Yersinia pestis (Y. pestis), a bacterium found in rodents (e.g., squirrels, prairie dogs or mice) and their fleas in many areas around the world.
How do people become infected with plague?
There are two ways:
- Pneumonic plague occurs when Yersinia pestis infects the lungs. Transmission can take place if someone breathes in Y. pestis particles, which could happen in an aerosol release during a bioterrorism attack, or by breathing in Y. pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague. Becoming infected in this way usually requires direct and close (within 6 feet) contact with the ill person or animal. It can be spread by sneezing or coughing.
- Bubonic plague is transmitted primarily by the bite from infected fleas; however, transmission can occur by bites or scratches from infected wild rodents and cats, or through contact with tissue from infected animals.
Can plague be spread from person to person?
Yes. The bacteria can spread from person to person by exposure to droplets in those who have close contact with a person with plague in his or her lungs.
What are the symptoms of plague?
Initial symptoms include fever, chills, muscle aches, headache, nausea, vomiting, diarrhea, abdominal pain and extreme exhaustion. Swollen and tender lymph nodes near where the infected flea bit the person are typical of bubonic plague. Pneumonic plague usually presents with a cough, bloody sputum and difficulty breathing.
How soon after infection do symptoms appear?
The incubation period for both types of plague is 2 to 7 days after exposure to the bacteria.
How is plague diagnosed?
Plague is diagnosed by isolating the bacteria from sputum, blood, spinal fluid or infected lymph nodes.
Can plague be treated?
Yes, plague can be treated with certain widely available antibiotics. If untreated, bubonic plague is fatal in approximately 50-60% of infected persons. Pneumonic plague is almost always fatal if not treated quickly after the onset of symptoms.
Can a person exposed to pneumonic plague avoid becoming sick?
Yes. People who have had close contact with an infected person can greatly reduce the chance of becoming sick if they begin treatment within 7 days of their exposure. Preventive treatment consists of taking antibiotics for at least 7 days.
Would medication be available in the event of a bioterrorism attack involving pneumonic plague?
Local jurisdictions, including Anne Arundel County, have plans for distributing medicines quickly in such an emergency. Large supplies of drugs would be needed in the event of a plague bioterrorism attack. These supplies are maintained in special stockpiles by the federal government and can be sent anywhere in the United States within 12 hours for distribution in local specifically arranged clinics.
Is a vaccine available to prevent pneumonic plague?
Currently, no pneumonic plague vaccine is available in the United States. Research is in progress, but we are not likely to have vaccines for several years or more. There is a vaccine for bubonic plague that is given to those who work in high-risk professions.
How can plague be prevented?
When traveling in areas such as the U.S. Southwest where plague is common, it is important to avoid being bitten by infected fleas, or having contact with plague-infected animals or persons infected with pneumonic plague. Patients with pneumonic plague should be quarantined until 3 full days of antibiotic treatment have been administered. Buildings should be rat-proofed, with appropriate storage and disposal of food, garbage and refuse. Dogs and cats in areas where plague is common should be treated with insecticides to prevent flea infestation.
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 were used for bioterrorism, it probably would be aerosolized (made airborne).
Why are we concerned about pneumonic plague as a bioweapon?
Yersinia pestis used in an aerosol attack could cause cases of the pneumonic form of plague. One to six days after becoming infected with the bacteria, people would develop pneumonic plague. Once people have the disease, the bacteria can spread to others who have close contact with them. Because of the delay between being exposed to the bacteria and becoming sick, people could travel over a large area before becoming contagious and possibly infecting others. Controlling the disease would be a challenge to public health. A bioweapon carrying Y. pestis is possible because the bacterium occurs in nature and could be isolated and grown in quantity in a laboratory. Even so, manufacturing an effective weapon using Y. pestis would require advanced knowledge and technology.
Additional information may be obtained from the Centers for Disease Control and Prevention at
www.cdc.gov.
Posted 6/23/04
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