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พุธ, 05 สิงหาคม 2009


CDC guidelines identify contacts within 2 meters (6.6 ft) as being at
greatest risk and do not consider the organism likely to be carried
through air ducts or vents (2). Isolation precautions, such as hand
washing, wearing latex gloves and gowns, and protection of mucous
membranes, should be undertaken for all bubonic plague patients for
48 hours. If no pneumonia is found or there are no draining lesions,
isolation can be discontinued.

Pneumonic plague patients should also be managed under respiratory
droplet precautions, including
- accommodation in an individual room,
- restriction of patient movement outside the room and access to the room, and
- masking of both patient and health-care deliverers.

It is thought that the risk of transmission is ended after the
completion of at least 4 days of therapy (3). The Working Group on
Civilian Biodefense recommended isolation during the 1st 48 hours and
until clinical improvement occurs (4).

Laboratory-acquired plague has been reported and can result in
primary pneumonic plague. Probably initially reported in Wu's 1926
classic monograph on plague (5), the laboratory transmission of
_Yersinia pestis_ appears to be rare. A case report with a review of
4 other cases was published in the USA in 1962 (6). _Y. pestis_ has
been found to maintain some viability for some periods of times (at
least 5 days) on environmental surfaces under controlled conditions
(7). Such an environmental risk for humans is likely to be minimal,
and environmental decontamination is not recommended (4).

A cluster of pneumonic plague in the USA occurred in the early part
of the 20th century in northern California (Fall of 1919) (8).

References
----------
1. Oyston PCF, Titball RW: Plague. In, Beyond Anthrax. The
Weaponization of Infectious Diseases. (Lutwick LI, Lutwick SM, eds)
Humana Press, New York, 2009, 55-76.
2. Dennis DT, Gage KL, Grantz N, et al: Plague manual: epidemiology,
distribution, surveillance and control. World Health Organization,
Geneva, 1999 [available from
<http://www.who.int/csr/resources/publications/plague/WHO_CDS_CSR_EDC_99_2_EN/en/>].
3. McGovern TW, Friedlander AM: Plague. In, Textbook of Military
Medicine: Medical Aspects of Chemical and Biological Warfare.
(Zajtchuk R, Bellamy RF, eds), Office of the Surgeon General, Borden
Institute, Washington, DC, 1997, pp 479-502 [available from
<http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch23.pdf>].
4. Inglesby TV, Dennis DT, Henderson DA, et al: Plague as a
biological weapon -- medical and public health management, JAMA 2000;
283: 2281-90 [available from
<http://jama.ama-assn.org/cgi/content/full/283/17/2281>].
5. Wu L-T: A Treatise on Pneumonic Plague. League of Nations, Geneva,
1926 [abstract available from
<http://www.ajtmh.org/cgi/content/abstract/s1-7/4/269>].
6. Burmeister RW, Tigertt WD, Overholt EL: Laboratory-acquired
pneumonic plague. Report of a case and review of previous cases. Ann
Intern Med 1962; 56: 789-800 [abstract available from
<http://www.annals.org/cgi/content/abstract/56/5_Part_1/789?ck=nck>].
7. Rose LJ, Donlan R, Banerjee SN, Arduino MJ: Survival of _Yersinia
pestis_ on environmental surfaces. Appl Environ Microbiol 2003; 69:
2166-71 [available from
<http://aem.asm.org/cgi/content/full/69/4/2166>].
8. Kellogg WH: An epidemic of pneumonic plague. Am J Public Health
1920; 10: 599-605 [available from
<http://www.ajph.org/cgi/reprint/10/7/599>]. - Mod.LL]
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