Content Information
A. Isolation and Quarantine Requirements
Minimum Period of Isolation of Patient
Droplet Precautions are indicated when caring for patients with plague until pneumonia is excluded and appropriate antibiotic therapy has been initiated. In patients with pneumonic plague, Droplet Precautions should be maintained for 72 hours after starting treatment. For patients with bubonic plague, Standard Precautions are advised.
Minimum Period of Quarantine of Contacts
See Section B, Protection of Contacts, below.
B. Protection of Contacts of a Case
Cases with pneumonic plague are considered infectious throughout their symptomatic illness and for 72 hours following initiation of antibiotic treatment. People who have been in household or face-to-face contact with a case with pneumonic plague during the infectious period should be educated regarding signs and symptoms and recommended prophylaxis, and referred to their healthcare provider for antibiotic prophylaxis. They should be placed under surveillance for symptoms for 7 days. If contacts of a pneumonic plague case are unable to receive antibiotic prophylaxis, they should be placed under a strict quarantine for a 7-day period.
Bubonic plague is generally not transmitted person-to-person. Quarantine would generally not be required.
C. Managing Special Situations
Reported Incidence Is Higher than Usual/Outbreak Suspected
If multiple cases of plague occur, or if an outbreak is suspected, an investigation to determine the source of infection and mode of transmission (e.g., contact with diseased rodents) is needed. Plague in Iowa would most likely be associated with travel to the western part of the United States or another country with a known outbreak. Contact the Center for Acute Disease Epidemiology as soon as possible. The Center can help determine a course of action to prevent further cases and can perform surveillance for cases across county lines.
Note: If bioterrorism is suspected, IDPH and other authorities will work closely with local public health and public safety and provide instructions and information on how to proceed.
D. Preventive Measures
Personal Preventive Measures/Education
When handling the bubo aspirate and blood, laboratory personnel must use gloves and care to avoid aerosolization of these infected fluids. Laboratory workers who process the cultures should be alerted to take precautions; however, standard bacteriologic techniques that safeguard against skin contact with and aerosolization of cultures should be adequate.
To avoid plague, people should reduce the likelihood of being bitten by infected fleas or being exposed to patients with pneumonic plague by:
- Understanding the modes of transmission and heeding any plague advisories while visiting the southwest U.S.
- Preventing rodent access to food and shelter by ensuring appropriate storage and disposal of food, garbage and refuse.
- Using insect repellents while camping in rural plague-infected areas avoiding and reporting dead or sick animals to park rangers or public health authorities.
- Preventing flea infestations of pet dogs and cats.
- Avoiding unnecessary contact with rodents or rabbits, and using protective gloves if handling is necessary.
Additionally, a Y. pestis vaccine is recommended for persons whose occupations put them at high risk for exposure to Y. pestis or plague-infected rodents... Also, vaccine may be considered for persons traveling to, or residing in, areas with epizootic or epidemic plague.
National and International Travel
For more information regarding national/international travel and plague, contact the CDC’s Traveler’s Health Office at (877) 394-8747 or through the Internet at www.cdc.gov/travel.
Iowa Dept. of Public Health, Revised 7/15