I. IDENTIFICATION

A. CLINICAL DESCRIPTION: A febrile illness caused by the bacterium Yersinia pestis, with a variety of clinical symptoms including: regional lymphadenitis (bubonic plague), septicemia without evident buboes, pharyngitis and cervical lymphadentis, and pneumonia.

B. REPORTING CRITERIA: Clinical diagnosis initially; laboratory confirmation required to meet case definition.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Isolation of Y. pestis from a clinical specimen, OR
• Fourfold or greater change in serum antibody to Y. pestis fraction 1 (F1) antigen.

D. WISCONSIN CASE DEFINITION: A case that is laboratory confirmed.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY I: Report IMMEDIATELY BY TELEPHONE to the patient's local health officer upon identification of a case or suspected case. Complete and mail an Acute and Communicable Disease Case Report (DPH 4151) to the local health officer within 24 hours.

B. EPIDEMIOLOGY REPORTS REQUESTED: Acute and Communicable Diseases Case Report (DPH 4151).

C. PUBLIC HEALTH INTERVENTIONS:

• Ensure that appropriate isolation precautions are being taken at the facility in which the patient is hospitalized.
• Assess need for chemoprophylaxis and surveillance for persons exposed to case-patient.
• Source investigation (performed in cooperation with the BPH) should be conducted. Search for history of travel to plague-endemic areas, or contact with persons or animals from plague-endemic areas.

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-7321.

B. WSLH:

1. BACTERIAL SEROLOGY: (608) 262-3217
2. CULTURES: (608) 263-3421.

IV. RELATED REFERENCES

1. Heymann DL, ed. PLAGUE. Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:406-412.

2. Prevention of Plague: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1996; 45(No.RR-14): 1-15.

V. DISEASE TRENDS

1. There have been no reported cases of plague in Wisconsin since at least 1970.