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15 April 2005

Volume 40, Number 8
Clinical Infectious Diseases 2005;40:1166–1172
This article is in the public domain, and no copyright is claimed.
1058-4838/2005/4008-0016
DOI: 10.1086/428617
HEALTHCARE EPIDEMIOLOGY INVITED ARTICLE

Risk of Person‐to‐Person Transmission of Pneumonic Plague

Jacob L. Kool

Division of Vector‐Borne Infectious Diseases, National Center for Infectious Disease, Centers for Disease Control and Prevention, Fort Collins, Colorado

Plague has received much attention because it may be used as a weapon by terrorists. Intentionally released aerosols of Yersinia pestis would cause pneumonic plague. In order to prepare for such an event, it is important, particularly for medical personnel and first responders, to form a realistic idea of the risk of person‐to‐person spread of infection. Historical accounts and contemporary experience show that pneumonic plague is not as contagious as it is commonly believed to be. Persons with plague usually only transmit the infection when the disease is in the endstage, when infected persons cough copious amounts of bloody sputum, and only by means of close contact. Before antibiotics were available for postexposure prophylaxis for contacts, simple protective measures, such as wearing masks and avoiding close contact, were sufficient to interrupt transmission during pneumonic plague outbreaks. In this article, I review the historical literature and anecdotal evidence regarding the risk of transmission, and I discuss possible protective measures.

Received 12 August 2004; accepted 10 November 2004; electronically published 16 March 2005.

Reprints or correspondence: Dr. Jacob L. Kool, Div. of Vector‐Borne Infectious Diseases, National Center for Infectious Disease, Centers for Disease Control and Prevention, PO Box 2087, Ft. Collins, Colorado 80522 ().

[The plague] depopulated towns, turned the country into desert, and made the habitations of men to become the haunts of wild beasts.—

Warnefried, on the Justinian plague epidemic, about 542–594 A.D. [1]

There is probably no infectious disease which is so easy to suppress as lung plague.—

Wu Lien‐Teh, “Plague, a manual for medical and public health workers” [1]

Plague is a dangerous but cowardly disease.—

Sam Orochi‐Orach, Uganda, 2003 (personal communication)

Robert A. Weinstein, Section Editor

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