WHO guidelines for plague management: revised recommendations for the use of rapid diagnostic tests, fluoroquinolones for case management and personal protective equipment for prevention of post-mortem transmission

Overview

Plague is an acute bacterial infection caused by Yersinia pestis. Although effective antimicrobials are available, plague still has high mortality because most outbreaks take place in remote places, where proper diagnosis and treatment remain challenging. Early identification of the disease is crucial to ensure prompt treatment and better outcomes. Pneumonic plague is highly contagious and of particular concern because of the high risk of triggering epidemics. Thus, plague is both a medical and a public health emergency.

Three key areas selected to be addressed in this guideline: (i) the use of rapid diagnostic tests (RDTs) for diagnosing plague in different contexts; (ii) the choice of antimicrobials for treating the different forms of plague, including whether fluoroquinolones should be introduced as a first-line medicine of choice; and (iii) the use of personal protective equipment in case of exposure to the dead body of a person who was infected with plague. The Evidence Review Team conducted systematic reviews to address each of the three key areas.