Emergency Preparedness

Kern Medical Bioterrorism Response Guide Section 2-B – PLAGUE ( YERSINIA PESTIS )

PLAGUE (YERSINIA PESTIS) – OVERVIEW

Naturally Occurring Plague The most common form of plague, bubonic, occurs in humans who have been bitten by plague-infested fleas. The bacteria migrate to regional lymph nodes where they rapidly multiply and form a painful swollen lymph node (bubo). Another form of the disease, septicemic plague, can also result from a fleabite and is not normally associated with a bubo. Both forms of plague can result in secondary pneumonic plague by hematogenous spread of the bacteria to the lungs. Up to 80% of persons with bubonic plague can also become septicemic and about 15% will develop pneumonic plague. Pneumonic plague has occurred in persons who have had face-to-face contact with pet animals (e.g., cats) with pneumonic plague. Bioterrorism Epidemiology Pneumonic plague would be the most likely result of an intentional bioaerosol release. Numerous, previously healthy persons would require immediate emergency care including antibiotic therapy and life support systems. Pneumonic plague is transmitted by close, face-to-face (within 3 feet) contact with infectious respiratory droplets generated when the person coughs or talks. Incubation Period The range of time between a bioaerosol exposure and the development symptoms ranges from 1-6 days (average 2 - 4 days). Clinical Presentation The onset is generally fulminant and the person generally presents with a high fever, chills, malaise, headache, hypotension, myalgias and a productive cough. The sputum is generally bloody and, less commonly, watery or purulent. The pulmonary symptoms may progress rapidly to dyspnea, stridor, and cyanosis. Gastrointestinal symptoms may include nausea, vomiting, abdominal pain and diarrhea. Cervical buboes, although rarely seen in primary pneumonic plague, may be identified. Complications Any suspected case of plague ( Yersinia pestis ) MUST BE TREATED AS A PUBLIC HEALTH EMERGENCY and reported to the infection control practitioner [ insert telephone number ] and the local health department [ insert telephone number ] immediately.

5