Plague

All suspect cases of Plague must be reported immediately to Public Health, Communicable Disease Control:

During business hours:925-313-6740
After hours (County Communications):925-646-2441

Epidemiology:

Highly infectious after aerosolization
Person-to-person and animal-to-human transmission can occur with pneumonic plague via respiratory droplet

Clinical

Incubation period is 1-3 days (ranges up to 7 days)
Aerosolization would most likely result in pneumonic plague
Pneumonic plague presents with acute onset of high fevers, chills, headache, malaise and a productive cough, that is initially watery before becoming bloody

Laboratory Diagnosis

Bacterial cultures (blood, sputum, or lymph node aspirate specimens) should be handled in a Biosafety Level 2 facility
Wright, Giemsa, or Wayson stain shows gram negative coccobacilli with bipolar "safety-pin" appearance
Organism grows slowly (48 hrs for observable growth) on standard blood and MacConkey agar
Immunoflourescent staining for capsule (F1 antigen) is diagnostic

Patient Isolation

Strict respiratory isolation with droplet precautions (gown, gloves, and eye protection) until the patient has received at least 48 hours of antibiotic therapy and shows clinical improvement.

Treatment

Streptomycin (1 g IM bid) or gentamicin (5 mg/kg IM or IV qd) are the preferred antibiotics
Tetracyclines or flouroquinolones are alternative choices
Co-trimoxazole is recommended for pregnant women and children between the ages of 2 months and 8 years
Chloramphenicol should be used for plague meningitis

Prophylaxis

Antibiotic prophylaxis is recommended for all persons exposed to the aerosol or persons in close physical contact with a confirmed case
Tetracyclines or flouroquinolones are recommended for 7 days from last exposure to a case

For more detailed information, Please call 925-313-6740 or email Francie Wise, Director of Communicable Disease

Thanks to Santa Clara County for information provided on this page.

See more information designed specifically for health care providers.

Content provided by the Public Health Division of Contra Costa Health Services.