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Plague |
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There are a variety of controls that should be implemented in order to protect workers from exposure to plague.
Workers that may be affected, either during regular work activities or during an emergency response, include, but are not limited to,
emergency responders, healthcare workers, laboratory personnel, and others. The
Plague Disease and Plague as a Bioweapon
pages of
this Safety and Health Topic provide extensive information on the hazards associated with plague and applicable controls. Additional
guidance specific to various types of workers, and associated issues on recognizing and controlling exposure to plague is provided in the
following sections:
Emergency Responders
What personal protective equipment should emergency responders use when
responding to a potential bio-attack involving plague? How should workers
decontaminate themselves if they think they have been exposed to plague?
In a covert attack involving aerosolized plague, there would be no emergency response activity involving emergency
responders. The first evidence that a potential attack had occurred would be diagnosis of the disease among exposed individuals, which
would happen several days after the actual release. However, it is possible that emergency responders would be required to respond to a
bio-attack incident, such as notification regarding an aerosol dissemination device or other suspicious release. The following references
provide additional information regarding PPE, decontamination, and other precautions for emergency responders to consider during such an
incident.
Healthcare Workers, Mortuary Workers, and
Others
What PPE, infection control, and related precautions should healthcare workers use when
treating patients with plague?
National infection control guidelines prescribe specific precautions to be taken when treating
patients with known or suspected plague. These precautions include "Standard", "Droplet" and "Airborne" Precautions, under
certain circumstances. Patient isolation and similar precautions may also be necessary. The following references provide detailed
information regarding infection control procedures for plague.
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OSHA Best Practices for Hospital-Based First Receivers of Victims. OSHA
(2005, January). Provides hospitals with practical information to assist them in
developing and implementing emergency management plans that address the
protection of hospital-based emergency department personnel during the receipt
of contaminated victims from mass casualty incidents occurring at locations
other than the hospital. Among other topics, it covers victim decontamination,
personal protective equipment, and employee training, and also includes several
informational appendices.
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Inglesby TV, Dennis DT, et al. Plague as a Biological Weapon: Medical and Public Health Management.
JAMA. 2000 May 3;283(17):2281-90. Provides specific recommendations for
infection control when treating plague patients.
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Bioterrorism Readiness Plan: A Template for Healthcare Facilities. The
Association for Professionals in Infection Control and Epidemiology (APIC) and
the Centers for Disease Control (CDC), (1999, April 13), 113 KB
PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on plague is contained in Section II, pp.
19-22.
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USAMRIID's Medical Management of Biological Casualties Handbook,
Sixth Edition. US Army Medical
Research Institute of Infectious Diseases (USAMRIID), (2005,
April), 2 MB
PDF, 187 pages. Provides recommendations regarding medical response to a biological
warfare attack on a civilian or military population. Includes information on
plague, including infection control recommendations, pp. 47-53. Appendix D
of this "Bluebook" describes these precautions in more detail.
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USAMRIID's Medical Management of Biological Casualties Handbook,
Sixth Edition. US Army Medical
Research Institute of Infectious Diseases (USAMRIID), (2005,
April), 2 MB
PDF, 187 pages. Provides recommendations regarding medical response to a
biological warfare attack on a civilian or military population. Specific
information on a number of potential bioterrorist agents is supplied, including
plague. Also known as the "Bluebook".
What precautions are necessary when handling the bodies of patients who have died from plague?
Similar infection control precautions, as listed previously for live individuals, should be implemented for the
post-mortem care of plague patients. These precautions apply to all workers performing post-mortem procedures on plague patients,
including healthcare workers, morticians, forensic personnel, or others.
-
Inglesby TV, Dennis DT, et al. Plague as a Biological Weapon: Medical and Public Health Management.
JAMA. 2000 May 3;283(17):2281-90. Provides specific recommendations for
infection control when treating plague patients, including post-mortem care.
-
Bioterrorism Readiness Plan: A Template for Healthcare Facilities. The
Association for Professionals in Infection Control and Epidemiology (APIC) and
the Centers for Disease Control (CDC), (1999, April 13), 113 KB
PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on plague is contained in Section II, pp.
19-22.
How should workers decontaminate themselves if they think they have been exposed to plague bacteria?
The risk of re-aerosolization of plague bacteria from contaminated persons is considered low. In situations where
there may have been gross exposure to plague, personal decontamination can be performed by removing contaminated clothing and washing
exposed skin with soap and water. Additional decontamination procedures can be found in the following document:
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Bioterrorism Readiness Plan: A Template for Healthcare Facilities. The
Association for Professionals in Infection Control and Epidemiology (APIC) and
the Centers for Disease Control (CDC), (1999, April 13), 113 KB
PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on plague is contained in Section II, pp.
19-22.
What cleaning and disinfection procedures should be utilized in facilities that treat plague patients or handle
the bodies of patients who have died from plague?
The principles of Standard Precautions are generally applied for the cleaning, disinfection, and sterilization of
equipment and environmental control in facilities. For more information, refer to the following:
-
Bioterrorism Readiness Plan: A Template for Healthcare Facilities. The
Association for Professionals in Infection Control and Epidemiology (APIC) and
the Centers for Disease Control (CDC), (1999, April 13), 113 KB
PDF,
34 pages. Provides information on infection control, patient treatment,
post-exposure management, decontamination, prophylaxis, and laboratory
procedures. Specific information on plague is contained in Section II, pp.
19-22.
Laboratory Workers
What biosafety procedures should laboratory personnel utilize when handling
materials potentially contaminated with plague?
Specific biosafety procedures, including PPE, engineering controls, and additional work practices have
been established for handling plague bacteria in laboratories. Refer to the following references for more information.
- Biosafety. Centers for Disease Control (CDC),
Office of Health and Safety. Provides links to
material on biosafety regulations, references, and related material.
- Biosafety in Microbiological and Biomedical Laboratories (BMBL), 4th Edition. Centers for
Disease Control (CDC) and the National Institutes of Health (NIH), (1999, May).
This comprehensive reference on laboratory biosafety practices, including specific
information on plague, is available in PDF sections.
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Hawley RJ, Eitzen EM Jr.
Biological Weapons - A Primer for Microbiologists. Annual Review of Microbiology.
2001 Oct;55:235-53.
Provides biosafety information for laboratory and field personnel, including
discussions on engineering controls, PPE, and decontamination methods.
Environmental Persistence, Identification, and Decontamination
How long would aerosolized plague from a bioweapon persist in the environment?
According to an analysis by the World Health Organization (WHO), in a worst case scenario, a plague aerosol would be
effective and infectious for as long as one hour. Y. pestis is very sensitive to sunlight and heating and does
not survive long outside its host.
Can plague be detected in the environment following a bioterrorist attack?
There are various methods that can be utilized for detecting bioterrorist agents, including plague. These include
surface and air sample gathering techniques, followed by identification methods such as culture growth or polymerase chain reaction (PCR).
However, plague bacteria is very fragile, would not persist for long in the environment, and therefore sampling and analysis would not be
considered necessary. In the event of a bioterrorist attack involving plague, local, state, and federal responders would determine the need
for sampling based on the specific circumstances associated with the release.
What environmental decontamination would be required following a release of aerosolized plague?
There is no evidence to suggest that environmental decontamination following an aerosol release is warranted.
A plague aerosol would only remain viable for approximately 1 hour after release, long before the first cases of pneumonic plague
would alert health personnel to a clandestine attack. The following references provide additional information on environmental detection,
persistence, and decontamination of plague bacteria:
Public Health Response
What actions would be taken by public health authorities in the event of a bioterrorist attack involving plague?
Various actions may be taken by public health authorities to treat and prevent further infections due to a release of
plague bacteria. These measures may include mass distribution of medications, surveillance, quarantine, and communication procedures. The
following references provide additional information.
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Plague Information. Centers for Disease Control (CDC). Contains extensive
information regarding plague, including specific resources on surveillance and
investigation.
- Community-Based Mass Prophylaxis: A Planning Guide for Public Health Preparedness. Agency
for Healthcare Research and Quality (AHRQ), (2004, August). Also available as a
1 MB
PDF, 76 pages. Includes information on surveillance, stockpiling,
distribution, dispensing, followup, and other planning and organizational
concerns. Also describes the implementation of a comprehensive operational
structure for dispensing/vaccination clinics based on the National Incident
Management System (NIMS).
- Strategic National Stockpile (SNS). Centers for Disease Control (CDC), (2005, January 20).
Provides basic information on the SNS system.
- Barbera J, Macintyre A, et al. Large-Scale Quarantine Following Biological Terrorism in the United States: Scientific Examination, Logistic and Legal Limits, and Possible Consequences.
JAMA. 2001 Dec 5;286(21):2711-7. Includes information on possible logistics, legal limits, and
possible consequences of initiating quarantine procedures. Discusses quarantine
vs. isolation, legislative framework, considerations in making quarantine
decisions, and recommendations for developing a disease containment strategy.
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