Note to UWMC/HMC patients: This vaccine information statement was written by Public Health-Seattle & King County. If you have questions on this information, please consult your UWMC/HMC health care provider.

DESCRIPTION OF THE DISEASE:
Plague is a natural infection of rodents and their fleas. Fleas transfer the infection to various animals and humans. The initial response, called bubonic plaque, is commonly swelling and tenderness in the lymph nodes that receive drainage from the fleabite site. The involved nodes ("buboes") may open and drain and fever is usually present.

The bacteria, Yersinia pestis, may spread through the bloodstream to different parts of the body. Spread to the lungs results in pneumonia and the stage known as pneumonic plaque. Person-to-person (or animal-to-person) transmission can then occur from aerosolized droplets of sputum. Early treatment is critical to prevent deaths.

In recent years, plague has been reported from parts of Africa, Asia, South America, the former Soviet Union, and the southwestern United States. Risk of plague to travelers in any of these areas is small.

PLAGUE VACCINE:
The vaccine licensed for use in the US is a whole cell bacterial vaccine, inactivated with formaldehyde and preserved in phenol.

SCHEDULE OF ADMINISTRATION:

• The PRIMARY SERIES consists of three doses, with the first dose given at the initial visit, the second 1-3 month after dose 1 and the third dose 5-6 months after dose 2.
• BOOSTERS: When exposure is continuing, two booster doses should be given at six month intervals. Subsequently, if exposure continues or recurs after more than six months, restarting boosters at one- to two-year intervals should provide sufficient protection.

WHO SHOULD RECEIVE PLAGUE VACCINE:

• Vaccination is recommended for all laboratory personnel working with antimicrobial-resistant Y. pestis organisms, persons engaged in aerosol experiments with Y. pestis, and persons involved in field operations (e.g. disaster programs) in enzootic areas where exposure cannot be prevented.
• Vaccination should be considered for laboratory personnel regularly working with Y. pestis or plague-infected rodents, persons working and residing in enzootic or epidemic areas where avoidance of rodents and fleas is impossible, and persons whose vocation brings them in regular contact with wild rodents and rabbits in enzootic areas.

WHO SHOULD NOT RECEIVE PLAGUE VACCINE:

• Persons with hypersensitivity to any of the constituents (including beef protein, soya, casein, and phenol) should not ' receive the vaccine.
• Severe local or systemic hypersensitivity reactions to previous vaccine are justification for withholding subsequent vaccine.

PRECAUTIONS:

• PREGNANCY: Vaccine should not be administered during pregnancy unless there is substantial risk of infection.
• AGE UNDER 18 YEARS OR OVER 61 YEARS: No safety and immunogenicity data are available supporting vaccine use in persons less than 18 or more than 61 years old.
• SUSCEPTIBILITY FOLLOWING VACCINATION: Vaccination may reduce the severity of infection, but not completely prevent it. Whenever a person has been exposed, whether vaccinated or not, a medical consultation should be sought to evaluate the need for treatment.
  

SIDE EFFECTS:

• Mild pain, erythema, and induration at the injection site occur frequently.
• Fever, headache, and malaise are more common and more severe following repeated doses generally give increased frequency of reactions.
• Rarely, hives and hypersensitivity reactions occur with subsequent immunizations.

QUESTIONS:
If you have questions about plague and/or plague vaccination, please ask us now or call your doctor before you receive the vaccine.

REACTIONS:
If the person who received the vaccine experiences any of the above side effects and visits a doctor, hospital or clinic after vaccination, please report it to the Seattle-King County Department of Public Health.

Note to UWMC/HMC patients: If you have questions on this information, please consult your UWMC/HMC health care provider.

Revised 7/29/98

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Page Designed and Maintained by:
Elizabeth Rudy, R.Ph.
UWMC/HMC Drug Information Center

Email--druginfo@u.washington.edu

Page Last Revised: 2/2/00

http://depts.washington.edu/druginfo/Vaccine/HealthDept/Plague.html