Abstract
Knowing whether human corpses can transmit plague will inform policies for handling the bodies of those who have died of the disease. We analyzed the literature to evaluate risk for transmission of Yersinia pestis, the causative agent of plague, from human corpses and animal carcasses. Because we could not find direct evidence of transmission, we described a transmission pathway and assessed the potential for transmission at each step. We examined 3 potential sources of infection: body fluids of living plague patients, infected corpses and carcasses, and body fluids of infected corpses. We concluded that pneumonic plague can be transmitted by intensive handling of the corpse or carcass, presumably through the inhalation of respiratory droplets, and that bubonic plague can be transmitted by blood-to-blood contact with the body fluids of a corpse or carcass. These findings should inform precautions taken by those handling the bodies of persons or animals that died of plague.
Highlights
Were patient Was there some methods used characteristics effort to trace all for tracing adequately contacts from the contac
The studies documented a total of 250 cases in 7 countries: 114 in China [27,28,29], 96 in the United States [8,19,30,31,32,33,34,35], 17 in Libya [36], 12 in Kazakhstan [37], 9 in Madagascar [23], 1 in South Africa [38], and 1 in Saudi Arabia [39]
Infectiousness of Body Fluids of Corpses or Carcasses We identified 2 studies that detailed the infectious period of plague-infected animal carcasses; we could not find any studies documenting the duration of infectiousness of human corpses
Summary
We used different inclusion criteria for each potential transmission pathway (Table 1). Because we assumed that the consumption of human corpses was rare, we excluded cases caused by the consumption of infected meat. We excluded cases caused by transmission from vectors, such as fleas. We searched PubMed, Embase, Science Citation Index, and Scopus for literature published by May 20, 2019, and identified all relevant studies regardless of language, publication status, or publication date (Appendix, https://wwwnc.cdc.gov/EID/ article/27/8/20-0136-App1.pdf). Study Selection First, we (2 review authors) independently screened the abstracts of articles retrieved by the search strategy and classified them using predefined eligibility criteria (Table 1). For the second stage of screening, we retrieved full-text copies and applied the same criteria. We resolved any discrepancies through discussion and excluded studies that did not meet the inclusion criteria (Figure 3; Appendix Table 1)
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