Risk of plague transmission from human cadavers: a systematic review

Plague can be fatal. Ebola has raised concern of the risk of infection from bodies of people that have died from other dangerous infectious diseases. We sought to estimate the risk of human remains from someone who was infected with plague transmitting Yersinia pestis. With no clear direct evidence, we developed a causal chain and carefully searched and assessed the literature at each step: we assessed the infectiousness of body fluids of people ill with plague; we sought for reported infection acquired from human and animal cadavers; and examined evidence of body fluid infectiousness of cadavers, seeking any information about the length of infectiousness. We concluded that pneumonic plague can occur after intense manipulation of the cadaver, presumably from inhalation of respiratory droplets; and that bubonic plague can occur after contact with infected blood in people with skin cuts or abrasions. Establishing a quantitative measure of risk was not possible from the evidence available. Author summaryPlague is an infectious disease that is of particular concern due to its high risk for human outbreaks. Understanding the level and duration of infectiousness of the body of someone who was infected with plague is essential to establish adequate preventive measures while handling corpses. We found limited evidence that human cadavers who have died from plague remain infectious, both from inhalation of particles generated by handling and by direct skin contact.