Yersinia pestis infection primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A plague vaccine is not currently available for use in the United States. Preventive measures are directed to home, work, and recreational settings where the risk of acquiring plague is high.
Prophylactic Therapy
Post-exposure prophylaxis 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, i.e. 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]
persons with known exposure to plague, such as close contact with a pneumonic plague patient or direct contact with infected body fluids or tissues. 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]
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Plague Treatment ▸ Adult Patients ▸ Children ▸ Pregnant Patients |
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Primary Prevention
Risk reduction: 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 not allow these animals to roam freely.
- Health authorities may use appropriate chemicals to kill fleas at selected sites during animal plague outbreaks.
- To avoid potential risk of exposure to hantavirus infection:
- Safely clean up rodent-infested areas.
- Air out infested spaces before cleanup.
- Spray areas of infestation and all excreta, nesting, and other materials with household disinfectant or 10% bleach solution then clean up, seal in bags, and dispose.
- Avoid sweeping, vacuuming, or stirring dust until the area is thoroughly wet with disinfectant;
- Wear rubber gloves; disinfect gloves before removal, and wash hands afterwards.
Prophylactic Antibiotics
Health authorities advise that antibiotics be given for a brief period to people who have been exposed to the bites of potentially infected rodent fleas (for example, during a plague outbreak) or who have handled an animal known to be infected with the plague bacterium. Such experts also recommend that antibiotics be given if a person has had close exposure to a person or an animal (for example, a house cat) with suspected plague pneumonia.
Persons who must be present in an area where a plague outbreak is occurring can protect themselves for 2 to 3 weeks by taking antibiotics. The preferred antibiotics for prophylaxis against plague are the tetracyclines or the sulfonamides.