Infection Control

• The use of standard precautions is appropriate for managing plague patients who do not have respiratory infections.
• In past epidemics, patient-to-patient transmission only seemed to occur after close contact, often for prolonged periods, with a patient that coughed bloody sputum. It is extremely rare for patients in the early stage of pneumonic plague to transmit the infection to others.
• Bubonic: Standard and contact precautions if any open wounds.
• Pneumonic: Standard and respiratory droplet precautions. (Note: Available evidence indicates that person-to-person spread of pneumonic plague is via respiratory droplets, not fine aerosols or droplet nuclei.)
• Septicemic: Standard precautions.
• Pneumonic plague patients are no longer infective after 24 to 48 hours of antibiotic treatment, because the sputum no longer contains live bacilli. However, they may still be ill and continue demonstrating signs of pneumonia.