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                        Volume 70, Issue Supplement_1
                        1 May 2020
                        ISSN 1058-4838
                        EISSN 1537-6591
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                        Volume 70, Issue Supplement_1, 1 May 2020

                        Plague and Bioterrorism Preparedness

                        Supplement Articles

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S1–S2, https://doi.org/10.1093/cid/ciz1225

                        Yersinia pestis continues to cause naturally occurring outbreaks in certain regions worldwide and is a potential bioterrorism agent. This supplement presents new data on plague to advance current knowledge and inform new clinical guidelines for treatment and prophylaxis.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S3–S10, https://doi.org/10.1093/cid/ciz1226

                        Among 744 published cases of plague, fatality rates were similar for patients treated with aminoglycosides, tetracyclines, and fluoroquinolones. Treatment with sulfonamides was not commonly reported in recent decades. Dual antimicrobial therapy did not appear to improve outcomes compared to monotherapy.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S11–S19, https://doi.org/10.1093/cid/ciz1230

                        Aggregate data on plague antimicrobial treatment from 1939 to 2019 were reviewed. Tetracyclines, chloramphenicol, and aminoglycosides had the lowest associated case fatality rates. Monotherapy with fluoroquinolones could not be evaluated; patients treated with penicillin had the highest case fatality rate.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S20–S26, https://doi.org/10.1093/cid/ciz1227

                        Most US patients with plague have received effective antimicrobials. In this retrospective review, we demonstrate that although many factors contribute to survival, use of aminoglycosides and tetracyclines substantially improves survival, and fluoroquinolones may be equally as effective.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S27–S29, https://doi.org/10.1093/cid/ciz1232

                        This commentary introduces key issues for pregnant women during a plague outbreak or bioterrorism event and summarizes 2 systematic reviews in this supplement that will inform clinical recommendations for treatment and prophylaxis of plague among pregnant women.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S30–S36, https://doi.org/10.1093/cid/ciz1228

                        Untreated Yersinia pestis infection during pregnancy is associated with high maternal mortality, pregnancy complications, fetal loss, and neonatal death. Appropriate antimicrobial treatment can improve maternal survival, although even with antimicrobial treatment, the risk of maternal death and pregnancy loss remains.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S37–S50, https://doi.org/10.1093/cid/ciz1231

                        Most antimicrobials considered for plague during pregnancy have not been associated with consistent maternal/fetal/neonatal risks following prenatal exposure. Antimicrobials should be used for treatment and PEP of plague during pregnancy; the choice of antimicrobials may be influenced by these data.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S51–S59, https://doi.org/10.1093/cid/ciz1233

                        Pneumonic plague in the African green monkey model is very similar to the course of disease in humans; therefore, antimicrobials effective in this model have been approved for plague indications under the US Food and Drug Administration’s Animal Efficacy Rule.

                        Clinical Infectious Diseases, Volume 70, Issue Supplement_1, 1 May 2020, Pages S60–S65, https://doi.org/10.1093/cid/ciz1234

                        Delaying the treatment of pneumonic plague with ciprofloxacin and levofloxacin by 20–27 hours after fever onset substantially reduces their efficacy in African green monkeys.

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