WHO guidelines for plague management

Rationale for these guidelines

With the re-emergence of plague guidance is needed on detecting and treating the disease. Corpses are a significant source of plague infections and therefore clear, evidence-based risk analyses of their infectivity are needed to gauge the right level of protection required during procedures or handling of the body that is proportional to the estimated risk.

The WHO guidelines on plague surveillance, diagnosis, prevention and control were published in 2009 by the WHO Regional Office for South-East Asia (2). In 2014, a scientific meeting was convened to revise these guidelines. However, the deliberations were general and were not formalized in a published document. Moreover, uncertainties remain regarding the best practices for managing this disease. There is no guidance regarding the use of the relatively new RDT for plague, which could allow for faster identification of cases and prompt treatment, especially in remote areas without laboratory facilities to perform microbiological diagnosis. Although streptomycin has been used for decades with good results, it causes significant adverse effects and requires parenteral administration. Other antibiotics have been used to treat plague infections, such as fluoroquinolones, but in the absence of a consensus about first-line treatments. Because plague is highly contagious, strict, empirically based measures have been recommended for handling the bodies of humans who were infected with the disease, including the use of full personal protective equipment. However, these measures are complex, difficult to implement in resource-constrained settings and culturally inappropriate in others; meanwhile, there has been a lack of scientific evidence endorsing such practices.

Following the most recent Ebola virus disease outbreaks, there was a call for WHO and partners to designate 2019 as a year of action on preparedness for health emergencies. Although Y. pestis was not included in the WHO R&D Blueprint list of diseases and pathogens for priority research and development, plague has the potential to trigger large outbreaks with high mortality. WHO-endorsed guidelines are needed that have clear and evidence-based recommendations for managing the disease. The decision to develop this set of simplified guidelines was taken in order to clarify key technical questions before the next plague epidemic season in the countries that are most affected.