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Prevention of plague

In endemic areas, the control of plague in humans is based on the 2 main factors
  • ·         Reduction of the likelihood of being bitten by infected fleas
  • ·         Exposure to infected droplets from either humans or animals with plague pneumonia.
In the United States, residence and outdoor activity in rural areas of western states where epizootics occur are the main risk factors for infection.
How to assess the potential risk of plague to human in specific area?
To assess potential risks to humans in specific areas, surveillance for Y. pestis infection among animal plague hosts and vectors is carried out regularly as well as in response to observed animal die-offs.

What are the personal protective measures?
  • Personal protective measures is very essential include avoidance of areas where a plague epizootic has been identified and publicized (e.g., by warning signs or closure of campsites).
  • Sick or dead animals should not be handled by the general public.
  • Hunters and zoologists should wear gloves when handling wild-animal carcasses in endemic areas.
  • General measures to avoid rodent fleabite during outdoor activity are appropriate and include the use of insect repellant, insecticide, and protective clothing.
  • General measures to reduce peridomestic and occupational human contact with rodents are advised and include rodent-proofing of buildings and food-waste stores and removal of potential rodent habitats (e.g., woodpiles and junk heaps).
  • Flea control by insecticide treatment of wild rodents is an effective means of minimizing human contact with plague if an epizootic is identified in an area close to human habitation.
  • Control of rodents-Any attempt to reduce rodent numbers must be preceded by flea suppression to reduce the migration of infected fleas to human hosts. An oral F1-V subunit vaccine using raccoon poxvirus (RCN) as a vector protects prairie dogs against Y. pestis injections and is being investigated for efficacy in preventing disease in wild animals, hence potentially reducing human exposure
Prevention of infection from suspected host
  •  Patients in whom pneumonic plague is suspected should be managed in isolation, with droplet precautions taken  until pneumonia is excluded or effective antimicrobial therapy has been given for 48 h.
  • The  main infective risk is posed by patients in the final stages of disease who are coughing up sputum with plentiful visible blood and/or pus.
  • Cotton and gauze masks were protective in these circumstances.
  •  Current surgical masks capable of barrier protection against droplets, including large respiratory particles, are considered protective; a particulate respirator (e.g., N95 or greater) is not required.
Antimicrobial Prophylaxis
 Postexposure antimicrobial prophylaxis for  7 days is recommended following household, hospital, or other close contact with persons with untreated pneumonic plague. (Close contact is defined as contact with a patient at <2 m.) In animal aerosolinfection studies, levofloxacin and ciprofloxacin are associated with higher survival rates than doxycycline