Overview

Plague has caused millions of deaths in pandemics over the past 2,500 years. Re-emerging in several countries during the 1990s, it is now considered a public health emergency due to its high outbreak risk. Plague is an acute bacterial infection caused by *Yersinia pestis*, with high mortality rates even though effective treatments exist, as outbreaks often occur in remote areas where diagnosis and care are challenging.

The severe pneumonic plague outbreak in Madagascar in 2017 underscored the need to update World Health Organization (WHO) guidelines. This manual provides comprehensive information on plague epidemiology and recommendations for surveillance, diagnosis, clinical management, and prevention. It also aligns with WHO's proposals from the 75th World Health Assembly to enhance global health emergency preparedness and response.

Key revisions include the use of rapid diagnostic tests in varied contexts, the inclusion of fluoroquinolones as a first-line treatment option, and updated protocols for personal protective equipment when handling plague-infected corpses. These recommendations were published in 2021 and are based on evidence reviewed during an international expert meeting in 2020. This manual is intended for health policymakers, emergency response teams, and healthcare workers in plague-endemic regions.