- Septicemic plague may be a secondary illness caused by complications from bubonic or pneumonic plague, or it can occur by itself.
- Plague bacteria enter the bloodstream.
- This form of the disease is not contagious.
- Symptoms appear two to six days after infection.
- Initial symptoms include nausea, vomiting, fever, and chills.
- Later symptoms include low blood pressure, abdominal pain, shock, and, finally, internal bleeding.
Death occurs rapidly if this form of plague is untreated.
Even with treatment, the recovery rate is only 50 percent.
Plague can be difficult to diagnose because its initial symptoms are flulike and the disease progresses so rapidly. Because plague is contagious in the inhaled form, a bioterrorism attack involving plague could go undetected until large groups of people begin exhibiting symptoms.
- If bubonic plague is suspected, physicians check for the presence of a painful, swollen lymph node called a bubo, which occurs no more than 24 hours after initial symptoms.
- Blood cultures, a sputum sample, or examination of a lymph node sample can confirm plague.
- Physicians will ask for a travel history from the patientif he or she has traveled to a known outbreak area.
Treatment of plague with antibiotics must begin immediately to be effective. Containing a plague outbreak involves isolation and other precautions so that plague does not quickly spread in communities and overwhelm the healthcare systems.
- Antibiotics, such as streptomycin, gentamicin, the tetracyclines, and chloramphenicol, are all effective against plague.
- Determining which antibiotic to prescribe depends on patient age and health and on availability of the drug, in addition to the number of cases in an area.
- Antibiotic treatment for pneumonic plague must begin within 24 hours after the first symptoms to be successful.
- Patients with pneumonic plague should be isolated.
- Antibiotics are recommended for people exposed to someone who has pneumonic plague.
- As a precaution, antibiotics may be administered to a person before plague is diagnosed.
There is currently no licensed plague vaccine available in the United States.
Clinical trials on a vaccine for pneumonic plague are underway. For more information, see NIAID's website.
Preventing plague starts with controlling flea and rat populations, the two known carriers of plague.
Insect repellents should be used to prevent flea bites.
People traveling to an outbreak area may be given a three-week course of preventive antibiotics.
Assessing the Risk
Although plague bacteria are under study in many countries, safeguards in these labs would make a potent strain minimally available to terrorists.
Plague is moderately stable in the environment. It can remain infectious for up to an hour after being released into the air, but the organism will break down more quickly if exposed to sunlight or heat.
Terrorists would have to be highly skilled to refine plague into an aerosol attack.
Plague is highly lethal even with treatment.
More information on disasters and emergencies is available at the U.S. Department of Health and Human Service's website: http://www.hhs.gov/emergency