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

Relationship to patient (person count)

Exposures

Outcome plague illness

Touched patient

Handled excreta or sputum

Patient coughed near face

Listened to patient whispering

Exposure description

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.