Yersinia pestis infection primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Preventive measures are directed to home, work, and recreational settings where the risk of acquiring plague is high.
Primary Prevention
Prophylactic Therapy
- Post-exposure prophylaxis (PEP) is indicated in persons who, in the previous six days:
- Have had close contact with pneumonic plague patients
- Are likely to have been exposed to Y. pestis-infected fleas
- Are likely to have had direct contact with body fluids or tissues of a Y. pestis-infected mammal
- Were exposed during a laboratory accident to known infectious materials
- The preferred antimicrobials for preventive or abortive therapy are the tetracyclines, chloramphenicol, or one of the effective sulfonamides.[1]
- True prophylaxis, meaning the administration of an antibiotic prior to exposure, may be indicated when persons must be present for short periods in plague-active areas under circumstances in which exposure to plague sources (fleas, pneumonic cases) is difficult or impossible to prevent.[1]
- Duration of post-exposure prophylaxis to prevent plague is 7 days.
- The recommended antibiotic regimens for PEP are as follows:
▸ Click on the following categories to expand treatment regimens.[1]
Plague Treatment ▸ Adult Patients ▸ Children ▸ Pregnant Patients |
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Hospital Precautions
Standard patient-care precautions should be applied to management of all suspected plague patients. These include prescribed procedures for:
- Handwashing
- Wearing of latex gloves and gowns
- Wearing protective devices to protect mucous membranes of the eye, nose and mouth during those procedures and patient-care activities likely to generate splashes or sprays of blood, body fluids, secretions and excretions.
Additionally, a patient with suspected respiratory plague infection should be specifically managed under respiratory droplet precautions, including:
- Management in an individual room
- Restriction of movement of the patient outside the room
- Masking of the patient as well as persons caring for the patient until the he/she is no longer infectious
Vaccination
Worldwide, live attenuated and formalin-killed Y. pestis vaccines are variously available for human use. [1]
The vaccines are variably immunogenic and moderately to highly reactogenic. They do not protect against primary pneumonic plague.[1]
In general, vaccinating communities against epizootic and enzootic exposures is not feasible; further, vaccination is of little use during human plague outbreaks, since a month or more is required to develop a protective immune response. [1]
The vaccine is indicated for persons whose work routinely brings them into close contact with Y. pestis, such as:[1]
- Laboratory technicians in plague reference research laboratories
- Persons studying infected rodent colonies
Risk Reduction Measures
Attempts to eliminate fleas and wild rodents from the natural environment in plague-infected areas are impractical. However, controlling rodents and their fleas around places where people live, work, and play is very important in preventing human disease. Therefore, preventive measures are directed to home, work, and recreational settings where the risk of acquiring plague is high. A combined approach using the following methods is recommended:
- Environmental sanitation
- Educating the public on ways to prevent plague exposures
- Preventive antibiotic therapy
Environmental Sanitation
- Effective environmental sanitation reduces the risk of persons being bitten by infectious fleas, of rodents and other animals in places where people live, work, and recreate.
- It is important to remove food sources used by rodents and make homes, buildings, warehouses, or feed sheds rodent-proof.
- Applying chemicals that kill fleas and rodents is effective but should usually be done by trained professionals.
- Rats that inhabit ships and docks should also be controlled by trained professionals who can inspect and, if necessary, fumigate cargoes.
Public Health Education
In the western United States, where plague is widespread in wild rodents, people living, working, or playing where the infection is active face the greatest threat. Educating the general public and the medical community about how to avoid exposure to disease-bearing animals and their fleas is very important and should include the following preventive recommendations:
- Watch for plague activity in rodent populations where plague is known to occur. Report any observations of sick or dead animals to the local health department or law enforcement officials.
- Eliminate sources of food and nesting places for rodents around homes, work places, and recreation areas; remove brush, rock piles, junk, cluttered firewood, and potential-food supplies, such as pet and wild animal food. Make your home rodent-proof.
- If you anticipate being exposed to rodent fleas, apply insect repellents to clothing and skin, according to label instructions, to prevent flea bites. Wear gloves when handling potentially infected animals.
- If you live in areas where rodent plague occurs, treat pet dogs and cats for flea control regularly and don't allow these animals to roam freely.
- Health authorities may use appropriate chemicals to kill fleas at selected sites during animal plague outbreaks.