Plague

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Nationally notifiable since 1988

1.0 National Notification

Only confirmed cases of disease should be notified.

2.0 Type of Surveillance

Routine case-by-case notification to the federal level

3.0 Case Classification

3.1 Confirmed case

Clinical evidence of illness with laboratory confirmation of infection:

• isolation of Yersinia pestis from body fluids
  OR
• a significant (i.e. fourfold or greater) rise in serum antibody titre to Y. pestis fraction 1 (F1) antigen by EIA or passive hemagglutination/inhibition titre

3.2 Probable case

Clinical evidence of illness with any of the following laboratory evidence:

• demonstration of elevated serum antibody titre(s) to Y. pestis F1 antigen (without documented significant [i.e. fourfold or greater] change) in a patient with no history of plague immunization
  OR
• demonstration of Y. pestis F1 antigen by immunofluorescence
  OR
• detection of Y. pestis nucleic acid
  OR
• > 1:10 passive hemagglutination/inhibition titre in a single serum sample in a patient with no history of vaccination or previous infection
  OR
• detection of Y. pestis antibody by EIA

4.0 Laboratory Comments

Serologic confirmation is done by demonstration of a significant (i.e.. fourfold or greater) rise in serum antibody titre to Y. pestis F1 antigen by EIA or passive hemagglutination/inhibition titre.

5.0 Clinical Evidence

Plague is characterized by fever, chills, headache, malaise, prostration and leukocytosis, and is manifest in one or more of the following principal forms:

Bubonic plague:

regional lymphadenitis

Septicemic plague:

septicemia with or without an evident bubo

Primary pneumonic plague:

inhalation of infectious droplets

Secondary pneumonic plague:

pneumonia, resulting from hematogenous spread in bubonic or septicemic cases

Pharyngeal plague:

pharyngitis and cervical lymphadenitis resulting from exposure to larger infectious droplets or ingestion of infected tissues

6.0 ICD Code(s)

6.1 ICD-10 Code(s)

A20.2

6.2 ICD-9 Code(s)

020.5

7.0 Type of International Reporting

Mandatory reporting to the WHO if illness constitutes a public health emergency of international concern (PHEIC) as defined by the International Health Regulations (2005).

Elimination or eradication efforts should be reported.

8.0 Comments

Probable case definitions are provided as guidelines to assist with case finding and public health management, and are not for national notification purposes.

9.0 References

Case definitions for diseases under national surveillance. CCDR 2000;26(S3). Retrieved May 2008, from http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/00vol26/26s3/index.html

Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR 1997;46(No. RR-10):25-6.

World Health Organization. Department of Communicable Disease Surveillance and Response (October 1999). WHO Recommended Surveillance Standards. 2nd ed. WHO/CDS/CSR/ISR/99.2. Retrieved May 29, 2007, from www.who.int/csr/resources/publications/surveillance/whocdscsrisr992.pdf

Dennis DT, Gage KL, Gratz N et al. Plague Manual. Epidemiology, Distribution, Surveillance and Control. WHO/CDS/CSR/EDC/99.2. Geneva: World Health Organization, 1999.

Prentice MB, Rahalison L. Plague. Lancet 2007;369:1196-207.

Date of Last Revision/Review:

May 2008