Since BW agent incubation times are variable, all patients should be considered potentially infectious during transport. Therefore, consideration should be given to quarantining patients for 17 days after AE from the BW area if plague or smallpox cannot be excluded. Reevaluate patients carefully for recurrent fever or other changes in clinical status. If clinical or laboratory findings suggest prodromal or syndromic smallpox, plague, or VHFs, institute appropriate isolation until the diagnosis is clarified. Do not evacuate across international borders unless authorized by the theater surgeon.
Pneumonic plague is highly transmissible person-toperson.
Droplet precautions are added to standard precautions for patients with pneumonic plague until sputum cultures are negative. Immediately notify the line and medical chain of command upon diagnosis. Do not evacuate across international borders unless authorized by the theater surgeon. Strict quarantine is required. Standard, contact, and airborne isolation precautions are to be observed.