Epidemiology of plague

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Distribution of plague infected animals 1998 World distribution of plague 1998.PNG
Distribution of plague infected animals 1998

Globally about 600 cases of plague are reported a year. [1] In 2017 the countries with the most cases include the Democratic Republic of the Congo, Madagascar, and Peru. [1]

Plague (disease) contagious and frequently fatal human disease

Plague is an infectious disease caused by the bacterium Yersinia pestis. Symptoms include fever, weakness and headache. Usually this begins one to seven days after exposure. In the bubonic form there is also swelling of lymph nodes, while in the septicemic form tissues may turn black and die, and in the pneumonic form shortness of breath, cough and chest pain may occur.

Democratic Republic of the Congo Country in Central Africa

The Democratic Republic of the Congo, also known as DR Congo, the DRC, DROC, Congo-Kinshasa, or simply the Congo, is a country located in Central Africa. It is sometimes anachronistically referred to by its former name of Zaire, which was its official name between 1971 and 1997. It is, by area, the largest country in Sub-Saharan Africa, the second-largest in all of Africa, and the 11th-largest in the world. With a population of over 78 million, the Democratic Republic of the Congo is the most populated officially Francophone country, the fourth-most-populated country in Africa, and the 16th-most-populated country in the world.

Madagascar island nation off the coast of Southeast Africa, in the Indian Ocean

Madagascar, officially the Republic of Madagascar, and previously known as the Malagasy Republic, is an island country in the Indian Ocean, approximately 400 kilometres off the coast of East Africa. The nation comprises the island of Madagascar and numerous smaller peripheral islands. Following the prehistoric breakup of the supercontinent Gondwana, Madagascar split from the Indian subcontinent around 88 million years ago, allowing native plants and animals to evolve in relative isolation. Consequently, Madagascar is a biodiversity hotspot; over 90% of its wildlife is found nowhere else on Earth. The island's diverse ecosystems and unique wildlife are threatened by the encroachment of the rapidly growing human population and other environmental threats.

Contents

Local outbreaks of the plague are grouped into three plague pandemics, whereby the respective start and end dates and the assignment of some outbreaks to either pandemic are still subject to discussion. [2] The pandemics were:

Pandemic global epidemic of infectious disease

A pandemic is an epidemic of disease that has spread across a large region; for instance multiple continents, or even worldwide. This may include communicable and noncommunicable diseases.

Egypt Country spanning North Africa and Southwest Asia

Egypt, officially the Arab Republic of Egypt, is a country spanning the northeast corner of Africa and southwest corner of Asia by a land bridge formed by the Sinai Peninsula. Egypt is a Mediterranean country bordered by the Gaza Strip and Israel to the northeast, the Gulf of Aqaba and the Red Sea to the east, Sudan to the south, and Libya to the west. Across the Gulf of Aqaba lies Jordan, across the Red Sea lies Saudi Arabia, and across the Mediterranean lie Greece, Turkey and Cyprus, although none share a land border with Egypt.

Plague of Justinian pandemic

The Plague of Justinian was a pandemic that afflicted the Eastern Roman (Byzantine) Empire, especially its capital Constantinople, the Sasanian Empire, and port cities around the entire Mediterranean Sea. One of the deadliest plagues in history, the devastating pandemic resulted in the deaths of an estimated 25–50 million people in two centuries of recurrence, equivalent to 13–26% of the world's population at the time of the first outbreak. The plague's social and cultural impact during the period of Justinian has been compared to that of the similar Black Death that devastated Europe 600 years after the last outbreak of Justinian plague. Procopius, the principal Greek historian of the 6th century, viewed the pandemic as worldwide in scope.

Europe Continent in the Northern Hemisphere and mostly in the Eastern Hemisphere

Europe is a continent located entirely in the Northern Hemisphere and mostly in the Eastern Hemisphere. It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the west and the Mediterranean Sea to the south. It comprises the westernmost part of Eurasia.

However, the late medieval Black Death is sometimes seen not as the start of the second, but as the end of the first pandemic – in that case, the second pandemic's start would be 1361; also various the end dates of the second pandemic given in literature, e.g. ~1890 instead of ~1840. [2]

Antiquity

Amulet (800-612 BC) to ward off plague inscribed with a quotation from the Akkadian Erra Epic Amulet to ward off plague.jpg
Amulet (800–612 BC) to ward off plague inscribed with a quotation from the Akkadian Erra Epic
Nicolas Poussin, The Plague of Ashdod, 1630. Oil on canvas, 148 x 198 cm. Musee du Louvre, Paris, France, Giraudon/Bridgeman Art Library. Plague in Ashod.jpg
Nicolas Poussin, The Plague of Ashdod, 1630. Oil on canvas, 148 x 198 cm. Musée du Louvre, Paris, France, Giraudon/Bridgeman Art Library.

The word plague is believed to come from the Latin word plāga ("blow, wound") and plangere (“to strike, or to strike down”), via the German Plage (“infestation”).

Plasmids of Y. pestis have been detected in archaeological samples of the teeth of seven Bronze Age individuals from 5000 years ago (3000 BC), in the Afanasievo culture in Siberia, the Corded Ware culture in Estonia, the Sintashta culture in Russia, the Unetice culture in Poland and the Andronovo culture in Siberia. Y. pestis existed over Eurasia during the Bronze Age. Estimates of the age of the Most recent common ancestor of all Y. pestis is estimated at 5,783 years Before Present.

Plasmid small DNA molecule within a cell that is physically separated from a chromosomal DNA and can replicate independently

A plasmid is a small DNA molecule within a cell that is physically separated from chromosomal DNA and can replicate independently. They are most commonly found as small circular, double-stranded DNA molecules in bacteria; however, plasmids are sometimes present in archaea and eukaryotic organisms. In nature, plasmids often carry genes that benefit the survival of the organism, such as by providing antibiotic resistance. While the chromosomes are big and contain all the essential genetic information for living under normal conditions, plasmids usually are very small and contain only additional genes that may be useful in certain situations or conditions. Artificial plasmids are widely used as vectors in molecular cloning, serving to drive the replication of recombinant DNA sequences within host organisms. In the laboratory, plasmids may be introduced into a cell via transformation.

Bronze Age Prehistoric period and age studied in archaeology, part of the Holocene Epoch

The Bronze Age is a historical period characterized by the use of bronze, and in some areas proto-writing, and other early features of urban civilization. The Bronze Age is the second principal period of the three-age Stone-Bronze-Iron system, as proposed in modern times by Christian Jürgensen Thomsen, for classifying and studying ancient societies.

Corded Ware culture archaeological culture

The Corded Ware culture, CWC comprises a broad archaeological horizon of Europe between c. 2900 BCE – circa 2350 BCE, thus from the late Neolithic, through the Copper Age, and ending in the early Bronze Age. Corded Ware culture encompassed a vast area, from the Rhine on the west to the Volga in the east, occupying parts of Northern Europe, Central Europe and Eastern Europe.

The Yersinia murine toxin (ymt) allows the bacteria to infect fleas, which can then transmit bubonic plague. Early ancestral versions of Y. pestis did not have the ymt gene, which was only detected in a 951 calibrated BC sample. [5] [6]

Before Present (BP) years is a time scale used mainly in archaeology, geology and other scientific disciplines to specify when events occurred in the past. Because the "present" time changes, standard practice is to use 1 January 1950 as the commencement date of the age scale, reflecting the origin of practical radiocarbon dating in the 1950s. The abbreviation "BP" has alternatively been interpreted as "Before Physics"; that is, before nuclear weapons testing artificially altered the proportion of the carbon isotopes in the atmosphere, making dating after that time likely to be unreliable.

The Amarna letters and the Plague Prayers of Mursili II describe an outbreak of a disease among the Hittites, [7] [8] [9] though some modern sources say it may be Tularemia. [10] [ unreliable medical source? ] The First Book of Samuel [11] describes a possible plague outbreak in Philistia, and the Septuagint version says it was caused by a "ravaging of mice". [12]

In the second year of the Peloponnesian War (430 BC), Thucydides described an epidemic disease which was said to have begun in Ethiopia, passed through Egypt and Libya, then come to the Greek world. In the Plague of Athens, the city lost possibly one third of its population, including Pericles. Modern historians disagree on whether the plague was a critical factor in the loss of the war. Although this epidemic has long been considered an outbreak of plague, many modern scholars believe that typhus, [13] smallpox, or measles may better fit the surviving descriptions. A recent study of DNA found in the dental pulp of plague victims suggests that typhoid was actually responsible. [14]

In the first century AD, Rufus of Ephesus, a Greek anatomist, refers to an outbreak of plague in Libya, Egypt, and Syria. He records that Alexandrian doctors named Dioscorides and Posidonius described symptoms including acute fever, pain, agitation, and delirium. Buboes—large, hard, and non-suppurating—developed behind the knees, around the elbows, and "in the usual places." The death toll of those infected was very high. Rufus also wrote that similar buboes were reported by a Dionysius Curtus, who may have practiced medicine in Alexandria in the third century BC. If this is correct, the eastern Mediterranean world may have been familiar with bubonic plague at that early date. [15] [16]

In the second century, the Antonine Plague, named after Marcus Aurelius’ family name of Antoninus and also known as the Plague of Galen, who had first hand knowledge of the disease, may in fact have been smallpox. Galen was in Rome when it struck in 166 AD, and was also present in the winter of 168–69 during an outbreak among troops stationed at Aquileia; he had experience with the epidemic, referring to it as very long lasting, and describes its symptoms and his treatment of it, though his references are scattered and brief. According to Barthold Georg Niebuhr [17] "this pestilence must have raged with incredible fury; it carried off innumerable victims. The ancient world never recovered from the blow inflected upon it by the plague which visited it in the reign of M. Aurelius." The mortality rate of the plague was 7–10 percent; the outbreak in 165/6–168 would have caused approximately 3.5 to 5 million deaths. Otto Seek believes that over half the population of the empire perished. J. F. Gilliam believes that the Antonine plague probably caused more deaths than any other epidemic during the empire before the mid-3rd century.

First pandemic: Early Middle Ages

The Plague of Justinian in AD 541–542 is the first known attack on record, and marks the first firmly recorded pattern of bubonic plague. This disease is thought to have originated in China. [18] It then spread to Africa from where the huge city of Constantinople imported massive amounts of grain, mostly from Egypt, to feed its citizens. The grain ships were the source of contagion for the city, with massive public granaries nurturing the rat and flea population. At its peak, Procopius said the plague was killing 10,000 people in Constantinople every day. The real number was more likely close to 5,000 a day. [19] The plague ultimately killed perhaps 40% of the city's inhabitants, and then continued to kill up to a quarter of the human population of the eastern Mediterranean.

In AD 588 a second major wave of plague spread through the Mediterranean into what is now France. It is estimated that the Plague of Justinian killed as many as 100 million people across the world. [20] [21] It caused Europe's population to drop by around 50% between 541 and 700. [22] It also may have contributed to the success of the Arab conquests. [23] [24] An outbreak of it in the AD 560s was described in AD 790 as causing "swellings in the glands ... in the manner of a nut or date" in the groin "and in other rather delicate places followed by an unbearable fever". While the swellings in this description have been identified by some as buboes, there is some contention as to whether the pandemic should be attributed to the bubonic plague, Yersinia pestis, known in modern times. [25]

Second pandemic: from 14th century to 19th century

Doktorschnabel 430px.jpg
"Der Doktor Schnabel von Rom" ("Doctor Beak of Rome"). The beak is a primitive gas mask, stuffed with substances (such as spices and herbs) thought to ward off the plague.
Bubonic plague map.PNG
Map showing the spread of the Black Death (bubonic plague) in Europe during the 1331–1351 pandemic which is believed to have started in China and spread west, reaching the Black Sea by 1347

From 1331 to 1351, the Black Death, a massive and deadly pandemic originating in China, spread along the Silk Road and swept through Asia, Europe and Africa. [18] It may have reduced the world's population from 450 million to between 350 and 375 million. [26] China lost around half of its population, from around 123 million to around 65 million; Europe around one third of its population, from about 75 million to about 50 million; and Africa approximately 18 of its population, from around 80 million to 70 million (mortality rates tended to be correlated with population density so Africa, being less dense overall, had the lowest death rate). This makes the Black Death the largest death toll from any known non-viral epidemic. Although accurate statistical data does not exist, it is thought that 1.4 million died in England (13 of England's 4.2 million people), while an even higher percentage of Italy's population was likely wiped out. On the other hand, north-eastern Germany, Bohemia, Poland and Hungary are believed to have suffered less, and there are no estimates available for Russia or the Balkans. It is conceivable that Russia may not have been as affected due to its very cold climate and large size, hence often less close contact with the contagion.

The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. [27] According to Biraben, plague was present somewhere in Europe in every year between 1346 and 1671. [28] The Second Pandemic was particularly widespread in the following years: 1360–1363; 1374; 1400; 1438–1439; 1456–1457; 1464–1466; 1481–1485; 1500–1503; 1518–1531; 1544–1548; 1563–1566; 1573–1588; 1596–1599; 1602–1611; 1623–1640; 1644–1654; and 1664–1667; subsequent outbreaks, though severe, marked the retreat from most of Europe (18th century) and northern Africa (19th century). [29] According to Geoffrey Parker, "France alone lost almost a million people to plague in the epidemic of 1628–31." [30]

In England, in the absence of census figures, historians propose a range of pre-incident population figures from as high as 7 million to as low as 4 million in 1300, [31] and a postincident population figure as low as 2 million. [32] By the end of 1350, the Black Death subsided, but it never really died out in England. Over the next few hundred years, further outbreaks occurred in 1361–62, 1369, 1379–83, 1389–93, and throughout the first half of the 15th century. [33] An outbreak in 1471 took as much as 10–15% of the population, while the death rate of the plague of 1479–80 could have been as high as 20%. [34] The most general outbreaks in Tudor and Stuart England seem to have begun in 1498, 1535, 1543, 1563, 1589, 1603, 1625, and 1636, and ended with the Great Plague of London in 1665. [35]

Plague Riot in Moscow in 1771: During the course of the city's plague, between 50,000 and 100,000 died (1/6 to 1/3 of its population). Chumbunt.png
Plague Riot in Moscow in 1771: During the course of the city's plague, between 50,000 and 100,000 died (1/6 to 1/3 of its population).

In 1466, perhaps 40,000 people died of plague in Paris. [36] During the 16th and 17th centuries, plague visited Paris for almost one year out of three. [37] The Black Death ravaged Europe for three years before it continued on into Russia, where the disease hit somewhere once every five or six years from 1350 to 1490. [38] Plague epidemics ravaged London in 1563, 1593, 1603, 1625, 1636, and 1665, [39] reducing its population by 10 to 30% during those years. [40] Over 10% of Amsterdam's population died in 1623–1625, and again in 1635–1636, 1655, and 1664. [41] There were 22 outbreaks of plague in Venice between 1361 and 1528. [42] The plague of 1576–1577 killed 50,000 in Venice, almost a third of the population. [43] Late outbreaks in central Europe included the Italian Plague of 1629–1631, which is associated with troop movements during the Thirty Years' War, and the Great Plague of Vienna in 1679. Over 60% of Norway's population died from 1348 to 1350. [44] The last plague outbreak ravaged Oslo in 1654. [45]

In the first half of the 17th century, the Great Plague of Milan claimed some 1.7 million victims in Italy, or about 14% of the population. [46] In 1656, the plague killed about half of Naples' 300,000 inhabitants. [47] More than 1.25 million deaths resulted from the extreme incidence of plague in 17th-century Spain. [48] The plague of 1649 probably reduced the population of Seville by half. [49] In 1709–1713, a plague epidemic that followed the Great Northern War (1700–1721, Sweden v. Russia and allies) [50] killed about 100,000 in Sweden, [51] and 300,000 in Prussia. [49] The plague killed two-thirds of the inhabitants of Helsinki, [52] and claimed a third of Stockholm's population. [53] Western Europe's last major epidemic occurred in 1720 in Marseilles, [44] in Central Europe the last major outbreaks happened during the plague during the Great Northern War, and in Eastern Europe during the Russian plague of 1770–72.

The Black Death ravaged much of the Islamic world. [54] Plague was present in at least one location in the Islamic world virtually every year between 1500 and 1850. [55] Plague repeatedly struck the cities of North Africa. Algiers lost 30,000–50,000 to it in 1620–1621, and again in 1654–1657, 1665, 1691, and 1740–1742. [56] Plague remained a major event in Ottoman society until the second quarter of the 19th century. Between 1701 and 1750, 37 larger and smaller epidemics were recorded in Constantinople, and 31 between 1751 and 1800. [57] Baghdad has suffered severely from visitations of the plague, and sometimes two-thirds of its population has been wiped out. [58]

Third pandemic: 19th and 20th centuries

Houses being burned in China in the 1890s during the bubonic plague pandemic Burning houses during bubonic plague-China-1890s.jpg
Houses being burned in China in the 1890s during the bubonic plague pandemic
Paul-Louis Simond injecting a plague vaccine in Karachi, 1898 Paul-Louis Simond injecting plague vaccine June 4th 1898 Karachi.jpg
Paul-Louis Simond injecting a plague vaccine in Karachi, 1898

The Third Pandemic began in China's Yunnan province in 1855, spreading plague to all inhabited continents and ultimately killing more than 12 million people in India and China alone. Casualty patterns indicate that waves of this pandemic may have come from two different sources. The first was primarily bubonic and was carried around the world through ocean-going trade, transporting infected persons, rats, and cargoes harboring fleas. The second, more virulent strain was primarily pneumonic in character, with a strong person-to-person contagion. This strain was largely confined to Manchuria and Mongolia. Researchers during the "Third Pandemic" identified plague vectors and the plague bacterium (see above), leading in time to modern treatment methods.[ citation needed ]

Plague occurred in Russia in 1877–1889 in rural areas near the Ural Mountains and the Caspian Sea. Efforts in hygiene and patient isolation reduced the spread of the disease, with approximately 420 deaths in the region. Significantly, the region of Vetlianka in this area is near a population of the bobak marmot, a small rodent considered a very dangerous plague reservoir. The last significant Russian outbreak of Plague was in Siberia in 1910 after sudden demand for marmot skins (a substitute for sable) increased the price by 400 percent. The traditional hunters would not hunt a sick Marmot and it was taboo to eat the fat from under the arm (the axillary lymphatic gland that often harboured the plague) so outbreaks tended to be confined to single individuals. The price increase, however, attracted thousands of Chinese hunters from Manchuria who not only caught the sick animals but also ate the fat, which was considered a delicacy. The plague spread from the hunting grounds to the terminus of the Chinese Eastern Railway and then followed the track for 2,700 km. The plague lasted 7 months and killed 60,000 people.[ citation needed ]

The bubonic plague continued to circulate through different ports globally for the next fifty years; however, it was primarily found in Southeast Asia. An epidemic in Hong Kong in 1894 had particularly high death rates, 90%. [59] As late as 1897, medical authorities in the European powers organized a conference in Venice, seeking ways to keep the plague out of Europe. Mumbai plague epidemic struck the city of Bombay (Mumbai) in 1896. The disease reached the Territory of Hawaii in December 1899, and the Board of Health's decision to initiate controlled burns of select buildings in Honolulu's Chinatown turned into an uncontrolled fire which led to the inadvertent burning of most of Chinatown on January 20, 1900. [60] Shortly thereafter, plague reached the continental US, initiating the San Francisco plague of 1900–1904. Plague persisted in Hawaii on the outer islands of Maui and Hawaii (The Big Island) until it was finally eradicated in 1960. [61]

Research done by a team of biologists from the Institute of Pasteur in Paris and Johannes Gutenberg University Mainz in Germany by analyzing the DNA and proteins from plague pits was published in October 2010, reported beyond doubt that all 'the three major plagues' were due to at least two previously unknown strains of Yersinia pestis and originated from China. A team of medical geneticists led by Mark Achtman of University College Cork in Ireland reconstructed a family tree of the bacterium and concluded in an online issue of Nature Genetics published on 31 October 2010 that all three of the great waves of plague originated from China. [62] [63]

Modern cases

1994 epidemic in Surat, India

In 1994, there was a pneumonic plague epidemic in Surat, India that resulted in 52 deaths and in a large internal migration of about 300,000 residents, who fled fearing quarantine. [103]

A combination of heavy monsoon rain and clogged sewers led to massive flooding which resulted in unhygienic conditions and a number of uncleared animal carcasses. It is believed that this situation precipitated the epidemic. [104] There was widespread fear that the sudden rush of people from this area might spread the epidemic to other parts of India and the world, but that scenario was averted, probably as a result of effective public health response mounted by the Indian health authorities. [105] Some countries, especially those in the nearby Gulf region, took the step of cancelling some flights and putting a pause on shipments from India.

Much like the Black Death that spread through medieval Europe, some questions still remain unanswered about the 1994 epidemic in Surat. [106]

Initial questions about whether it was an epidemic of plague arose because the Indian health authorities were unable to culture Yersinia pestis, but this could have been due to poor laboratory procedures. [106] Yet several lines of evidence strongly suggest that it was a plague epidemic: blood tests for Yersinia were positive, a number of individuals showed antibodies against Yersinia and the clinical symptoms displayed by the affected were all consistent with the disease being plague. [107]

Related Research Articles

Black Death Pandemic in Eurasia in the 1300s

The Black Death, also known as the Great Plague, the Black Plague, or the Plague, was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia and peaking in Europe from 1347 to 1351. The bacterium Yersinia pestis, which results in several forms of plague, is believed to have been the cause. The Black Death was the first major European outbreak of plague, and the second plague pandemic. The plague created a number of religious, social and economic upheavals which had profound effects on the course of European history.

Great Plague of London pandemic

The Great Plague, lasting from 1665 to 1666, was the last major epidemic of the bubonic plague to occur in England. It happened within the centuries-long time period of the Second Pandemic, an extended period of intermittent bubonic plague epidemics which originated in China in 1331, the first year of the Black Death, an outbreak which included other forms such as pneumonic plague, and lasted until 1750.

<i>Yersinia pestis</i> species of bacteria, cause of plague

Yersinia pestis is a gram-negative, nonmotile, rod-shaped coccobacillus bacteria, with no spores. It is a facultative anaerobic organism that can infect humans via the Oriental rat flea. It causes the disease plague, which takes three main forms: pneumonic, septicemic and bubonic plagues. All three forms were responsible for a number of high-mortality epidemics throughout human history, including: the sixth century's Plague of Justinian; the Black Death, which accounted for the death of at least one-third of the European population between 1347 and 1353; and the Third Pandemic, sometimes referred to as the Modern Plague, which began in the late nineteenth century in China and spread by rats on steamboats claiming close to 10,000,000 lives. These plagues likely originated in China and were transmitted west via trade routes. Recent research indicates that the pathogen may have been the cause of what is described as the Neolithic Decline, when European populations declined significantly. This would push the date to much earlier and might be indicative of an origin in Europe rather than Eurasia.

Pneumonic plague plague that results in infection located in lung, which results from direct inhalation of the bacillus and has symptom fever, has symptom chills, has symptom cough and has symptom difficulty breathing

Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis. Symptoms include fever, headache, shortness of breath, chest pain, and cough. They typically start about three to seven days after exposure. It is one of three forms of plague, the other two being septicemic plague and bubonic plague.

A plague pit is the informal term used to refer to mass graves in which victims of the Black Death were buried. The term is most often used to describe pits located in Great Britain, but can be applied to any place where bubonic plague victims were buried.

Septicemic plague Human disease

Septicemic plague is one of the three main forms of plague. It is caused by Yersinia pestis, a gram-negative species of bacterium. Septicemic plague is a life-threatening infection of the blood, most commonly spread by bites from infected fleas.

Third plague pandemic pandemic

Third Pandemic is the designation of a major bubonic plague pandemic that began in Yunnan province in China in 1855. This episode of bubonic plague spread to all inhabited continents, and ultimately more than 12 million people died in India and China, with about 10 million killed in India alone. According to the World Health Organization, the pandemic was considered active until 1960, when worldwide casualties dropped to 200 per year.

The Great Plague of Seville (1647–1652) was a massive outbreak of the disease in Spain that killed up to a quarter of Seville's population.

Bubonic plague Human and animal disease

Bubonic plague is one of three types of plague caused by bacterium Yersinia pestis. One to seven days after exposure to the bacteria, flu-like symptoms develop. These symptoms include fever, headaches, and vomiting. Swollen and painful lymph nodes occur in the area closest to where the bacteria entered the skin. Occasionally, the swollen lymph nodes may break open.

Black Death migration where the black death spread to

The Black Death was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia and peaking in Eurasia from 1331 to 1353. Its migration followed the sea and land trading routes of the medieval world. This migration has been studied for centuries as an example of how the spread of contagious diseases is impacted by human society and economics.

Theories of the Black Death are a variety of explanations that have been advanced to explain the nature and transmission of the Black Death (1347–51). A number of epidemiologists and since the 1980s have challenged the traditional view that the Black Death was caused by plague based on the type and spread of the disease. The confirmation in 2010 and 2011 that Yersinia pestis DNA was associated with a large number of plague sites has renewed focus on plague as the leading hypothesis, but has not yet led to a final resolution of all these questions.

Black Death in England pandemic in England in 14th century

The Black Death was a bubonic plague pandemic, which reached England in June 1348. It was the first and most severe manifestation of the Second Pandemic, caused by Yersinia pestis bacteria. The term "Black Death" was not used until the late 17th century.

The 1994 plague in India was an outbreak of bubonic and pneumonic plague in south-central and southwestern India from 26 August to 18 October 1994. 693 suspected cases and 56 deaths were reported from the five affected Indian states as well as the Union Territory of New Delhi. These cases were from Maharashtra, Gujarat, Karnataka, Uttar Pradesh, Madhya Pradesh and New Delhi. There are no reports of cases being imported to other countries.

The second plague pandemic is a major series of epidemics of the plague that started with the Black Death, which reached mainland Europe in 1348 and killed up to a half of the population of Eurasia in the next four years. Although it died out in most places, it became epizootic and recurred regularly until the nineteenth century. A series of major plagues occurred in the late 17th century and it recurred in some places until the 19th. After this a new strain of the bacterium appeared as the third pandemic.

Sylvatic plague is an infectious bacterial disease caused by the bacterium Yersinia pestis that primarily affects rodents such as prairie dogs. It is the same bacterium that causes bubonic and pneumonic plague in humans. Sylvatic, or sylvan, means 'occurring in wildlife,' and refers specifically to the form of plague in rural wildlife. Urban plague refers to the form in urban wildlife.

21st century Madagascar plague outbreaks Outbreaks of plague in Madagascar during the 21st century

Madagascar has experienced two outbreaks of bubonic and pneumonic plague in the 21st century. In 2014, 40 died, and in 2017, 221 died.

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