Global & Disaster Medicine

Guidance for the management of suspected pneumonic plague cases identified on aircraft and ships


Key messages

• Pneumonic plague is transmitted between humans most often by inhaling infected respiratory droplets. The transmission happens at close distance (usually defined as less than two metres) and only symptomatic patients are infectious.

• The infection can cause severe disease in humans but can be successfully treated with antibiotics, especially if antibiotic treatment is insituted early.

• A case of pneumonic plague can be suspected on aircraft or ships when a traveller (passenger or a crewmember) leaving an affected area has fever associated with persistent coughing and/or impaired breathing.

• The training of crewmembers and the increase in their awareness should reduce the risk of transmission on-board.

• A surgical mask and standard infection control precautions can be used to effectively reduce the spread of droplets from a suspected patient, if isolation measures are not possible.

• A surgical mask can be used to protect travellers (passengers and crewmembers) from infection by a suspected pneumonic plague case.

• Local authorities of the arrival airport/mooring port of call should be kept informed immediately after the identification of a suspected case of pneumonic plague on-board, in order to plan for mitigating the risks of further spread.

• All passengers should be advised about self-monitoring of plague compatible symptoms in case of an onboard event; collection of passenger contact details is crucial for further contact tracing.

• Early post-exposure prophylaxis should be considered for passengers and crewmembers who came into close contact with the ill passenger.

• After disembarkation, disinfection measures should be considered which comply with relevant national and international recommendations.

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