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Understanding Plague: Bioterrorism, Epidemiology, and Clinical Implications

This lesson provides an overview of plague, focusing on the pathogen Yersinia pestis, its epidemiology, and potential bioterrorism threats. Participants will learn about plague's clinical syndromes, including bubonic, pneumonic, septicemic, and pharyngeal forms. The discussion includes natural occurrences, transmission routes, and historical contexts as a bio-terror agent. Understanding the incidence and case fatality rates in the U.S. and worldwide will be key. Special emphasis is placed on recognizing potential bioterrorism scenarios involving plague and proactive public health measures.

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Understanding Plague: Bioterrorism, Epidemiology, and Clinical Implications

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  1. Bioterrorism Agents: Plague Lesson 1 Introduction and Overview

  2. Objectives • Identify plague bacterium • Epidemiology • Natural Occurrence

  3. Bio-Terror Threat • Plague can cause large numbers of cases • Could create panic • Considered for use since 14th century

  4. Clinical Syndromes • Bubonic • Pneumonic • Septicemic • Plague Meningitis • Pharyngeal “Safety Pin” Y. Pestis in blood

  5. Bubonic Plague • Infected flea bite • Exposure through break in skin • No person-to-person • Untreated progresses to pneumonic

  6. Pneumonic Plague • Inhalation of plague bacteria • Disease progression • Respiratory failure • Shock • Rapid death • Person-to-person transmission

  7. Septicemic Plague • Primary Form • Direct inoculation in bloodstream • Secondary Form • Development of untreated pneumonic or bubonic plague

  8. EpidemiologyNatural Reservoirs • Bites of infected flea • Most common – Oropsylla montana • Blood meal from bacteremic animal • Regurgitates into human/ animal host • Common reservoirs • Deer mice • Ground squirrels

  9. EpidemiologyTransmission • Bite of infected flea • Respiratory droplets • Direct contact (6 feet) • Direct skin/mucous membrane less common • BT event – Respiratory droplets or aerosols

  10. Plague IncidenceUnited States,1970-2003 • Endemic to US • Bubonic Most Common • 83% Bubonic • 2% Primary Pneumonic • 15% Septicemic • 5 to 15 cases per year • Greatest Concentrations • Arizona, Colorado, New Mexico, Utah

  11. Plague Case Fatality RatesUnited States, 1970 - 1977 • In US, 14% died • Untreated – 50 to 90% • Treated – 15% • Deaths mostly from delays in diagnosis and treatment

  12. Plague IncidenceWorldwide, 1970 - 1998 • All inhabited continents, but Australia • 1,500 to 3,000 cases annually • Greatest Concentrations • Asia, South America

  13. Plague Bioterrorism Scenario • Most dangerous as aerosol • Outbreak of pneumonic • Possibly pharyngeal or ocular • Report all suspect cases to public health immediately

  14. Review Questions – PlagueLesson 1 Overview

  15. Plague Review QuestionsLesson 1, Question 1 • Santa Fe, New Mexico hospital • Treating suspect plague case • Hearing of more cases in area When do you start to worry about bioterrorism?

  16. Plague Review QuestionsLesson 1, Question 1 When do you start worrying about bioterrorism? • Unrelated clusters • Unusual rise in cases • Both of the above • None of the above

  17. Plague Review QuestionsLesson 1, Question 1 When do you start worrying about bioterrorism? Answer - C. Both of the above • Unrelated clusters • Unusual rise in cases

  18. Plague Review QuestionsLesson 1, Question 2 • Abnormally large, tender lymph node • Right arm • Lab specimen for preliminary testing What organism causes plague?

  19. Plague Review QuestionsLesson 1, Question 2 What organism causes plague? • B. anthracis • C. botulinum • C. burnetii • Y. pestis

  20. Plague Review QuestionsLesson 1, Question 2 What organism causes plague? D. Y. pestis

  21. Plague Review QuestionsLesson 1, Question 3 • New Hampshire hospital • Labs – Unable to rule out plague • Recent US travel Where in the US would you expect the patient to get plague?

  22. Plague Review QuestionsLesson 1, Question 3 Where in the US would you expect the patient to get plague? • Western US, Southwest • Eastern US, Southeast • Northern US, Northeast • Southern US, Southwest

  23. Plague Review QuestionsLesson 1, Question 3 Where in the US would you expect the patient to get plague? A. Western US, Southwest

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