Home page  |  About this library  |  Help  |  Clear       English  |  French  |  Spanish  
Expand Document
Expand Chapter
Full TOC
to previous section to next section

close this bookWHO Recommended Surveillance Standards (WHO; 1999; 157 pages)
View the documentAcknowledgements
View the documentAcronyms
View the documentIntroduction
View the documentNational Coordination of Communicable Disease Surveillance
View the documentExplanatory notes
View the documentSurveillance activities: criteria and WHO Department
View the documentCommunicable disease contacts in Regional Offices
close this folderDiseases
View the documentB20-B21-B22-B23-B24 AIDS
View the documentA22 Anthrax
View the documentA23 Brucellosis
View the documentA00 Cholera
View the documentA81.0 Creutzfeldt-Jakob disease
View the documentA90, A91 Dengue fever (A90) including Dengue haemorrhagic fever (DHF) & Dengue shock syndrome (DSS, A91)
View the documentA36 Diphtheria
View the documentB72 Dracunculiasis (Guinea worm disease)
View the documentA98.3, A98.4 Ebola-Marburg viral diseases
View the documentA83.0 Japanese encephalitis
View the documentB74 Lymphatic filariasis
View the documentB96.3 Haemophilus influenzae type b
View the documentB15-B17 Acute viral hepatitis
View the documentB20-B24 HIV infection
View the documentJ10, J11 Influenza
View the documentA96.2 Lassa fever
View the documentA48.1 Legionellosis
View the documentB55.1, B55.2 Cutaneous leishmaniasis
View the documentLeishmania / HIV co-infections
View the documentB55.0 Visceral leishmaniasis
View the documentA30 Leprosy
View the documentA27 Leptospirosis
View the documentB50-54 Malaria
View the documentB05 Measles
View the documentA39 Meningococcal disease
View the documentA87 Viral meningitis
View the documentB73 Onchocerciasis
View the documentA37.0 Pertussis
View the documentA20 Plague
View the documentA36 Poliomyelitis
View the documentA82 Rabies
View the documentA02.0 Salmonellosis
View the documentB65 Schistosomiasis
View the documentA50-52 Syphilis
View the documentA33 Tetanus, neonatal
View the documentB56-0, B56-1 African trypanosomiasis
View the documentB57 American trypanosomiasis
View the documentA15-A19 Tuberculosis
View the documentA75.3 Scrub typhus
View the documentA95.9 Yellow fever
open this folder and view contentsSyndromes
View the documentAnnex 1 Software free and in the public domain
View the documentAnnex 2 Proposed surveillance definitions
View the documentAnnex 3 Role and use of Geographic Information Systems (GIS) and mapping for epidemiological surveillance

A20 Plague


Case report universally required by International Health Regulations


Disease endemic in many countries and often has epidemic potential. Plague is transmitted to humans through flea bites or direct exposure to respiratory droplets or infected animal tissues. Surveillance of human and animal disease is important to predict and detect epidemics and to monitor control measures.

Case report universally required by International Health Regulations.


Clinical description

Disease characterized by rapid onset of fever, chills, headache, severe malaise, prostration, with


bubonic form: extreme painful swelling of lymph nodes (buboes)

pneumonic form: cough with blood-stained sputum, chest pain, difficult breathing


Note: Both forms can progress to a septicaemic form with toxaemia: sepsis without evident buboes rarely occurs.

Laboratory criteria for diagnosis


• Isolation of Yersinia pestis in cultures from buboes, blood, CSF or sputum or

• Passive haemagglutination (PHA) test, demonstrating an at least fourfold change in antibody titre, specific for F1 antigen of Y. pestis, as determined by the haemagglutination inhibition test (HI) in paired sera.

Case classification

Suspected: A case compatible with the clinical description May or may not be supported by laboratory finding of Gram stain negative bipolar coccobaccili in clinical material (bubo aspirate, sputum, tissue, blood).
Probable: A suspected case with


• Positive direct fluorescent antibody (FA) test for Y. pestis in clinical specimen or

• Passive haemagglutination test, with antibody titre of at least 1:10, specific for the F1 antigen of Y. pestis as determined by the haemagglutination inhibition test (HI) or

• Epidemiological link with a confirmed case.

Confirmed: A suspected or probable case that is laboratory-confirmed.


In all situations: Immediate case-based reporting of suspected cases from peripheral level to intermediate and central level. Laboratory-based reporting of all confirmed cases required in all situations.

During an outbreak: Intensified surveillance: active case-finding and contact-tracing should be undertaken in order that treatment start for cases and contacts; targeting environmental measures; community education. A daily report of the number of cases and contacts as well as their treatment status and vital status must be produced. A weekly report must summarize the outbreak situation, the control measures taken, and those planned to interrupt the outbreak.

International: Mandatory reporting of all suspected and confirmed cases to WHO within 24 hours.


Case-based data at peripheral level for investigation and reporting


• Case classification (suspected/probable/confirmed), unique identifier, name, geographical information, age, sex, clinical syndrome, history of contact with rodents, presence of flea bites, household or face-to-face contacts for previous seven days, names and geographical location of contacts

Case-based data at central and regional level


• Case classification (suspected/probable/confirmed)
• Unique identifier, age, sex, geographical area, number of contacts identified, number of contacts treated


Cases by week/month, geographical area, age, sex.



• Detect trends in sporadic and endemic disease patterns
• Identify high risk areas
• Give early warning of outbreak
• Detect clusters of cases and outbreaks
• Confirm the impact of control measures and the end of an outbreak


Epizootic surveillance:


• Periodical surveys of rodent populations and of their fleas, and monitoring of plague activity in these populations; this alerts public health authorities to increased human plague risks, thus allowing prevention and control measures to be implemented before human cases occur

• Serological surveillance of wild carnivore and outdoor-ranging dog and cat populations is recommended in zones surrounding endemic ones

• Ports close to endemic areas should be placed under surveillance and require periodic sanitation to prevent increases in rodent populations.

Countries with endemic areas must have a risk assessment policy for every new development work that could affect local ecology (e.g., roads, dams, agriculture)


Regional Offices

See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".

Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Communicable Diseases Surveillance and Response (CSR)


E-mail: tikhomirove@who.ch / outbreak@who.ch
Tel: (41 22) 791 2656/2850/2111
Fax: (41 22) 791 4878/0746 attn CSR
to previous section to next section

Please provide your feedback   English  |  French  |  Spanish