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Volume 12, Number 3—March 2006

Research

Pneumonic Plague Cluster, Uganda, 2004

Elizabeth M. Begier*Comments to Author , Gershim Asiki†, Zaccheus Anywaine†, Brook Yockey‡, Martin E. Schriefer‡, Philliam Aleti§, Asaph Ogen-Odoi§, J. Erin Staples*‡, Christopher Sexton‡, Scott W. Bearden‡, and Jacob L. Kool‡
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Nyapea Hospital, Nebbi District, Uganda; ‡Centers for Disease Control and Prevention, Fort Collins, Colorado, USA; §Uganda Virus Research Institute, Entebbe, Uganda

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Table A1

Summary of contacts of index patients A1 and B1 after onset of bloody sputum

Relationship to patient (person count) Exposures
Touched patient Handled excreta or sputum Patient coughed near face Listened to patient whispering Exposure description Outcome plague illness
Index patient A1*
Mother (1) Yes Yes Yes Yes Primary caregiver during illness; washed body after death. Case A2
1.5-y-old daughter (1) Yes No No No Slept facing A1 (chest level) for 1 night in same bed, the night before A1's death. No
Husband (1) Yes No No No Slept in same bed facing away from A1 the night before her death; bicycled her to traditional healers; checked on her at healer's home in afternoon for ≈1 h. No
Traditional healer (1) Yes Yes No No A1 spent her last day at healer's home, and healer buried bag of her bloody sputum. Provided A1 with tea and porridge. Spoke with her at a distance <2 m. No
Father (1) Yes No No No Spent several hours with A1 during last day; spoke with her at a distance <2 m. No
Other male relatives (4) Yes† No No No Put A1's body in casket; washed hands afterwards. No
Funeral attendees (50) No No No No Viewed A1's body in casket; no one touched body. No
Index patient B1‡
Sister (1) Yes Yes Yes Yes B1's primary caregiver during illness after bloody sputum noted, including during transport. Case B2
Brother (1) Yes Yes No Yes Oversaw B1's transport on bicycle for care; assisted with care; washed B1's body after death No
Wife (1) Yes No Yes Yes B1's primary caregiver before bloody sputum and afterwards assisted primary caregiver before B1 left family compound; slept in same hut as B1 the night before death with her head 1.8 m from that of B1. No
6-y-old daughter (1) Yes No No No Slept in bed with B1 until too ill night before death, then slept with siblings as follows. No
Other children (3) Yes No No No Slept in same hut as B1 night before death with their heads 1.8 m from that of B1. No
Other female attendants (8) Yes No No No Assisted in caring for B1 before his departure for clinics No
Brothers 2 and 3 (2) Yes Yes No No Assisted in keeping B1 upright while he was being transported on a bicycle to clinics; 1 helped wash body after death. No
Neighbor (1) Yes No No Yes Friend of patient; listened to B1 speak very close to his face before departure to clinics. No
Nursing assistants at 2 clinics (2) Yes No No No Assessed and treated patient, including multiple intramuscular injections. No
Funeral attendees (150) No No No No 75 touched blanket that wrapped B1's body to view face; same blanket was used during final days of illness. No

*Bloody sputum developed in patient A1 on December 16, 2004, and she spent that night at her home in the same bed as her husband and child. She rode seated on the back of bike to the traditional healer's home in the morning. She worsened over the course of the day and was coughing frank blood by the afternoon. She died that night at the healer's home while being cared for by her mother (A2).
†Only touched patient after death, not included in close contacts.
‡Bloody sputum developed in patient B1 in the early morning of December 18, 2004. B1's daughter was moved out of his bed to sleep with his wife and their other children in the same hut with their heads ≈1.2 m from his. His sister (B2) came in and began caring for him. At dawn, B1 was placed on a chair on the back of a bicycle and transported to 3 clinics in succession (1 was closed). B1 died that night at a relative's home shortly after he arrived there.

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