Plague infection control

Fig. 23-6. Known worldwide foci of human plague infection. Data sources (1) Human plague in 1990. WHO Weekly Epidemiological Record. 1 Nov 1991 44 321-324. (2) Human plague in 1993. WHO Weekly Epidemiological Record. 17 Feb 1995 7 45-48. (3) Barkway J. World Health Organization, Geneva, Switzerland. Personal communication, February 1996. (4) Ken Gage, Ph.D., Centers for Disease Control and Prevention, Fort Collins, Colorado. Personal communication, March 1996.

Military leaders during the Middle Ages recognized that victims of infections could become weapons in themselves. Gabriel de Mussis, a notary, saw the Tatar attack on Caffa, a well-fortified, Genoese-controlled seaport (modern Feodosiya, Ukraine), in 1346. De Mussis described how the plague-weak-... 

Fig. 23-7. A femoral bubo (a), the most common site of an erythematous, tender, swollen, lymph node in patients with plague. This painful lesion may be aspirated in a sterile fashion to relieve pain and pressure it should not be incised and drained. The next most common lymph node regions involved are the inguinal, axillary (b), and cervical areas. Bubo location is a function of the region of the body in which an infected flea inoculates the plague bacilli. Photographs Courtesy of Ken Gage, Ph.D., Centers for Disease Control and Prevention, Fort Collins, Colo.

All plague-control measures must include insecticide use, public health education, and reduction of rodent populations with chemicals such as chole-calciferol.2,25 Fleas must always be targeted before rodents, because killing rodents may release massive amounts of infected fleas.56 Use of insecticides in rodent areas is effective because rodents pick up dust on their feet and carry it back to their nests, where they distribute it over their bodies via constant preening.2 Plague must be reported to the World Health Organization as an internationally quarantinable disease for which travelers may be detained up to 6 days. 

Johnson Johnson s Levaquin (levofloxacin), an antibiotic intended to treat pneumonic plague, became the first product to receive FDA (2012a) approval via the Animal Rule. The product received approval based on testing in African green monkeys infected with pneumonic plague. None of the placebo control group survived contact with the virus, whereas 94% of the Levaquin group survived. 

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