Initial actions in suspected plague
Upon discovering a patient whose symptoms or epidemiological history indicate plague, the physician must act according to a strict algorithm.
First of all, it is necessary to notify administration (the chief medical officer or deputy) by phone or by sending a messenger.
Immediately after this, outbreak isolation is organized:
- The patient remains in the room where they were identified.
- Admission of other patients is stopped.
- Doors and windows are closed, and any entry, exit, or removal of items from the office is blocked.
- Ventilation is turned off, and ventilation openings are sealed airtight (e.g., with adhesive tape).
Before specialized protective clothing is delivered, the physician uses improvised means (gauze, cotton wool, towels) to protect the respiratory tract and mucous membranes.
Epidemiological history and personal protection
While in isolation with the patient, the physician must take a detailed epidemiological history. It is necessary to compile a list of all persons who contacted the patient during the maximum incubation period, find out the patient's travel route, as well as the suspected source and routes of transmission.
When the personal protection kit is delivered, the physician must:
- Treat exposed areas of the body and mucous membranes with emergency personal prophylaxis products (before donning the suit).
- Start their own emergency chemoprophylaxis.
- Change into protective clothing.
The physician remains in the focus and provides medical care to the patient until the arrival of the specialized epidemic response team. Upon arrival of the consultants, a full report on the work done is handed over to them. Also, current disinfection is carried out in the focus: the patient's excreta, wash water, and care items are disinfected.
Emergency antibacterial prophylaxis
A wide range of antibiotics is used for plague chemoprophylaxis. The duration of the course is usually 5–7 days.
Main drugs and course doses:
- Fluoroquinolones (oral for 5 days): ciprofloxacin (5.0 g), ofloxacin (2.0 g), pefloxacin (4.0 g).
- Tetracyclines: doxycycline (oral, 2.8 g for 7 days).
- Rifampicin (oral, 4.2 g for 7 days). Can be used both as monotherapy and in combinations (with trimethoprim, ampicillin, ciprofloxacin, ofloxacin, pefloxacin).
- Aminoglycosides (intramuscular for 5 days): gentamicin (0.8 g), amikacin (5.0 g), streptomycin (5.0 g).
- Cephalosporins (oral): ceftriaxone (5.0 g for 5 days), cefotaxime (14.0 g for 7 days), ceftazidime (14.0 g for 7 days).
- Sulfonamides: sulfamonomethoxine + trimethoprim (oral, 14.0 + 5.6 g for 7 days).
Briefly: answers to topical questions
Which drugs are used for routine specific vaccine prophylaxis of plague in endemic areas?
Live or chemical plague vaccine is used for routine specific vaccine prophylaxis of plague. The method of administration depends on the age and condition of the patient:
- Percutaneous administration — used for children, elderly individuals, and pregnant women.
- Subcutaneous administration — used for individuals aged 14 to 60 years.
Revaccination is carried out routinely after 1 year, and in an unfavorable epidemiological situation — after 6 months.
Class and exam questions
Can a patient with suspected plague be transferred to an infectious disease isolation box immediately after detection?
No, the patient must be strictly isolated at the site of detection. Any movement and removal of items from the room are strictly prohibited until the arrival of the epidemic response team.
How to protect the respiratory tract before the protective suit is delivered?
Any improvised means should be used: a towel, cotton wool, gauze, or bandages.
When can the physician leave the infection focus?
The primary contact physician is obliged to remain in the isolated room together with the patient until the arrival of the specialized epidemiological response team.
What else to study on this topic
- Clinical presentation and forms of plague
- Specific diagnosis of plague
- Rules for donning and doffing the anti-plague suit
- Management tactics for contacts
- Disinfection in the focus of particularly dangerous infections
Master the complete topic in the «Infectious Diseases» course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Plague Prophylaxis" and 3,312 more pages of the subject
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- AI tutor answers questions on the topic anytime
- 41 video lessons on the subject
Other topics in the section "Zoonotic infections — 2024 study guide"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.