Nelson Christina A, Meaney-Delman Dana, Fleck-Derderian Shannon, Cooley Katharine M, Yu Patricia A, Mead Paul S
CDC
National Center for Emerging and Zoonotic Infectious Diseases
MMWR Recomm Rep. 2021 Jul 16;70(3):1-27. doi: 10.15585/mmwr.rr7003a1.
This report provides CDC recommendations to U.S. health care providers regarding treatment, pre-exposure prophylaxis, and postexposure prophylaxis of plague. Yersinia pestis, the bacterium that causes plague, leads to naturally occurring disease in the United States and other regions worldwide and is recognized as a potential bioterrorism weapon. A bioweapon attack with Y. pestis could potentially infect thousands, requiring rapid and informed decision making by clinicians and public health agencies. The U.S. government stockpiles a variety of medical countermeasures to mitigate the effects of a bioterrorism attack (e.g., antimicrobials, antitoxins, and vaccines) for which the 21st Century Cures Act mandates the development of evidence-based guidelines on appropriate use. Guidelines for treatment and postexposure prophylaxis of plague were published in 2000 by a nongovernmental work group; since then, new human clinical data, animal study data, and U.S. Food and Drug Administration approvals of additional countermeasures have become available. To develop a comprehensive set of updated guidelines, CDC conducted a series of systematic literature reviews on human treatment of plague and other relevant topics to collect a broad evidence base for the recommendations in this report. Evidence from CDC reviews and additional sources were presented to subject matter experts during a series of forums. CDC considered individual expert input while developing these guidelines, which provide recommended best practices for treatment and prophylaxis of human plague for both naturally occurring disease and following a bioterrorism attack. The guidelines do not include information on diagnostic testing, triage decisions, or logistics involved in dispensing medical countermeasures. Clinicians and public health officials can use these guidelines to prepare their organizations, hospitals, and communities to respond to a plague mass-casualty event and as a guide for treating patients affected by plague.
本报告向美国医疗服务提供者提供了关于鼠疫治疗、暴露前预防和暴露后预防的疾控中心建议。导致鼠疫的鼠疫耶尔森菌在美国和世界其他地区引发自然发生的疾病，并被公认为一种潜在的生物恐怖主义武器。用鼠疫耶尔森菌发动的生物武器袭击可能会感染数千人，这就要求临床医生和公共卫生机构迅速做出明智的决策。美国政府储备了多种医疗对策，以减轻生物恐怖主义袭击的影响（如抗菌药物、抗毒素和疫苗），《21世纪治愈法案》要求针对这些对策制定关于适当使用的循证指南。2000年，一个非政府工作小组发布了鼠疫治疗和暴露后预防指南；从那时起，出现了新的人体临床数据、动物研究数据，以及美国食品药品监督管理局对其他对策的批准。为制定一套全面的更新指南，疾控中心对鼠疫的人类治疗及其他相关主题进行了一系列系统的文献综述，以便为本报告中的建议收集广泛的证据基础。在一系列论坛上，疾控中心综述和其他来源的证据被提交给了主题专家。疾控中心在制定这些指南时考虑了专家个人的意见，这些指南为自然发生的疾病以及生物恐怖主义袭击后人类鼠疫的治疗和预防提供了推荐的最佳做法。这些指南不包括关于诊断检测、分诊决策或分发医疗对策所涉及的后勤方面的信息。临床医生和公共卫生官员可以使用这些指南，让他们的机构、医院和社区做好应对鼠疫大规模伤亡事件的准备，并作为治疗鼠疫患者的指导。
