This is a timeline of plague , describing major epidemics and key medical developments.
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.
An epidemic is the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less. For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.
|Time period||Key developments|
|3500-3000 BC (circa)||In 2018 a Swedish tomb was excavated and discovered to harbor evidence of Yersinia pestis within the interred human remains. The estimated date of this individual's death correlated to a period of European history known as the Neolithic Decline; the presence of plague in the remains is evidence for the plague as a potential cause of this event.|
|541–750 (circa)||The first plague pandemic spreads from Egypt to the Mediterranean (starting with the Plague of Justinian) and Northwestern Europe.|
|1346–1840||The second plague pandemic spreads from Central Asia to the Mediterranean and Europe. The Black Death of 1346-53 is considered to be unparalleled in human history. From 1347 to 1665, the Black Death is responsible for about 25 million deaths in Europe.|
|1866–1960s||The third plague pandemic, which originated in China, results in about 2.2 million deaths. Haffkine develops the first vaccine against bubonic plague. Antibiotic drugs are developed in the 1940s which dramatically reduce the death rate from plague.|
|1950–2000||Plague cases are massively reduced during the second half of the 20th century. However, outbreaks would still occur, especially in developing countries. Between 1954 and 1997, human plague is reported in 38 countries, making the disease a remerging threat to human health. Also, between 1987 and 2001, 36,876 confirmed cases of plague with 2,847 deaths are reported to the World Health Organization.|
|Recent years||Today, fewer than 200 people die of the plague worldwide each year, mainly due to lack of treatment. Plague is considered to be endemic in 26 countries around the world, with most cases found in remote areas of Africa. The three most endemic countries are Madagascar, the Democratic Republic of the Congo and Peru.|
The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organisation, was an agency of the League of Nations.
|Year/Period||Event type||Event||Present-day geographic location|
|430 BC||Epidemic||Plague of Athens devastates the city's population. The outbreak also affects much of the eastern Mediterranean region.||Greece, Mediterranean basin|
|224 BC||Plague infection is first recorded in China.||China|
|165–180 AD||Epidemic||Antonine Plague, also known as the plague of Galen, the Greek physician living in the Roman Empire who described it. It is suspected to have been smallpox or measles. The total deaths have been estimated at five million and the disease killed as much as one-third of the population in some areas and devastated the Roman army.||Iraq, Italy, France, Germany|
|250-270 AD||Epidemic||Plague of Cyprian breaks out in Rome. It is estimated to kill about 5000 people a day.||Italy|
|540 AD||Epidemic||Plague epidemic originates in Ethiopia spreads to Pelusium in Egypt.||Ethiopia, Egypt|
|541–542 AD||Epidemic||The Plague of Justinian breaks out and develops as an extended epidemic in the Mediterranean basin. Frequent outbreaks over the next two hundred years would eventually kill an estimated 25 million people. The Justinian Plague is considered the first recorded pandemic.||Mediterranean Basin|
|542 AD||Epidemic||The plague arrives in Constantinople (now Istanbul). By spring of 542, about 5,000 deaths per day in the city are calculated, although some estimates vary to 10,000 per day. The epidemic would go on to kill over a third of the city’s population.||Turkey|
|543 AD||Epidemic||After passing from Italy to Syria, Palestine, and Iraq, plague reaches what is now modern Iran.||Iran|
|627 AD||Epidemic||A large epidemic of plague breaks out in Ctesiphon, the capital of the Sasanian Empire, killing more than 100,000 people.||Iran|
|1334||Epidemic||The second plague pandemic breaks out in China. Widely known as the "Black Death" or the Great Plague, it is regarded as one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia.||Eurasia|
|1345||Plague occurs in southern Russia, around the lower Volga River basin.||Russia|
|1338–1339||Bubonic plague is reported in central Asia.|
|1346||Epidemic||Bubonic plague breaks out in China and India.||China, India|
|1347||Epidemic||The plague spreads to Constantinople, a major port city. It also infects the Black Sea port of Kaffa down from southern Russia.||Turkey, Ukraine|
|1347||Epidemic||Italian traders bring the plague in rat-infested ships from Constantinople to Sicily, which becomes the first place in Europe to suffer the Black death epidemic. The same year, Venice is also hit.||Italy|
|1347–1350||Medical development||During the 1347–1350 outbreak, doctors are completely unable to prevent or cure the plague. Some of the cures they try include cooked onions, ten-year-old treacle, arsenic, crushed emeralds, sitting in the sewers, sitting in a room between two enormous fires, fumigating the house with herbs, trying to stop God punishing the sick for their sin. Flagellants would go on processions whipping themselves.|
|1348||Medical development||Italian writer Giovanni Boccaccio in his book Decameron writes a description of symptoms of the plague.||Italy|
|1348–1350||Epidemic||The Black Death arrives at Melcombe Regis in the south of England. Over the next year, the plague spreads into Wales, Ireland and Northern England. By 1350, the plague reaches Scotland. The estimated death toll for the British Isles and Ireland is calculated at 3.2 million.||United Kingdom, Ireland|
|1349||Genocide||Black Death Jewish persecutions. A rumor rises claiming that Jews are responsible for the plague as an attempt to kill Christians and dominate the world. Supported by a widely distributed report of the trial of Jews who supposedly had poisoned wells in Switzerland, the rumor spreads quickly. As a result, a wave of pogroms against Jews breaks out. Christians start to attack Jews in their communities, burning their homes, and murder them with clubs and axes. In the Strasbourg massacre, it is estimated that people locked up and burned 900 Jews alive. Finally, Pope Clement VI issues a religious order to stop the violence against the Jews, claiming that the plague is “the result of an angry God striking at the Christian people for their sins.”||France, Switzerland|
|1351||Epidemic||Black Death epidemic reaches Russia, attacking Novgorod and reaching Pskov, before being temporarily suppressed by the Russian winter.||Russia|
|1352||Epidemic||The plague reaches Moscow, only a few hundred miles from Caffa, the first city struck by the epidemic. Thus, the Black Death completes a great circle, killing from one-third to one-half of medieval Europe’s total population.||Russia|
|1361–1364||Medical development||During an outbreak, doctors learn how to help the patient recover by bursting the buboes.|
|1374||Epidemic||Black Death epidemic re-emerges in Europe. In Venice, various public health controls such as isolating victims from healthy people and preventing ships with disease from landing at port are instituted.|
|1377||Program launch||The Republic of Ragusa establishes a landing station for vessels far from the city and harbour in which travellers suspected to have the plague must spend thirty days, to see whether they became ill and died or whether they remained healthy and could leave.||Croatia|
|1403||After finding thirty days isolation to be too short, Venice dictates that travellers from the Levant in the eastern Mediterranean be isolated in a hospital for forty days, the quarantena or quaranta giorni, from which the term quarantine is derived.||Italy|
|1629–1631||Epidemic||The Italian plague of 1629–1631 develops as a series of outbreaks of bubonic plague. About 280,000 people are estimated to be killed in Lombardy and other territories of Northern Italy. The Italian plague is estimated to have claimed between 35 and 69 percent of the local population.||Italy|
|1637||Epidemic||Plague breaks out in Andalusia, killing about 20,000 people in less than four months.||Spain|
|1647–1652||Epidemic||Plague ravages Spain. About 30,000 die in Valencia. The great Plague of Seville breaks out.||Spain|
|1665–1666||Epidemic||Great Plague of London. 100,000 people are killed within 18 months.||United Kingdom|
|1679||Epidemic||The Great Plague of Vienna kills at least 76,000 people.||Austria|
|1722||Publication||Daniel Defoe publishes A Journal of the Plague Year , a fictional account of the Great Plague of London in 1665. This novel is often read as non-fiction.||United Kingdom|
|1738||Epidemic||Great Plague of 1738 kills at least 36,000 people.||Romania, Hungary, Ukraine, Serbia, Croatia, Austria|
|1772–1850||Epidemic||The human plague is reported intermittently in the Chinese province of Yunnan, where the third plague pandemic would begin in the 1860s.||China|
|1867||Epidemic||The plague spreads from Yunnan Province to Beihai on the Chinese coastline.||China|
|1869||Epidemic||The plague is observed in Taiwan.||Taiwan|
|1894||Epidemic||The plague spreads to Guangzhou Province and results in the death of about 70,000 people.||China|
|1894||Scientific development||Working independently, both French bacteriologist Alexandre Yersin and Japanese bacteriologist Shibasaburo Kitasato isolate the bacterium that causes bubonic plague. Yersin discovers that rodents are the mode of infection. The bacterium is named yersinia pestis after Yersin.|
|1896–1897||Medical development||Russian bacteriologist Waldemar Haffkine successfully protects rabbits against an inoculation of virulent plague microbes, by treating them previously with a subcutaneous injection of a culture of the microbes in broth. The first vaccine for bubonic plague is developed. The rabbits treated in this way become immune to plague. In the next year, Haffkine causes himself to be inoculated with a similar preparation, thus proving in his own person the harmlessness of the fluid. This is considered the first vaccine against bubonic plague.||India (Bombay)|
|1899||Epidemic||Plague is first introduced in Latin America in Paraguay, followed by Brazil and Argentina in the same year.||Paraguay, Brazil, Argentina|
|1901||Epidemic||Plague infection is first reported in Uruguay.||Uruguay|
|1902||Epidemic||Plague infection is first reported in Mexico.||Mexico|
|1903||Epidemic||Plague infection is first reported in Chile and Peru.||Chile, Peru|
|1905||Epidemic||Plague infection is first reported in Panama.||Panama|
|1908||Epidemic||Plague infection is first reported in Ecuador and Venezuela.||Ecuador, Venezuela|
|1910||Epidemic||Pneumonic plague breaks out in Manchuria, killing about 60,000 people over the course of a year.||China|
|1912||Epidemic||Plague infection is first reported in Cuba and Puerto Rico.||Cuba, Puerto Rico|
|1921||Epidemic||Plague infection is first reported in Bolivia.||Bolivia|
|1924–1925||Epidemic||Plague breaks out in Los Angeles. 32 people get infected and only 2 survive. It is the last rat-borne epidemic occurring in the United States.||United States|
|1940s?||Medical development||Antibiotics developed||?|
|1947||Publication||French novelist Albert Camus publishes The Plague , a novel about a fictional outbreak of plague in Oran, Algeria. The book helps to show the effects the plague has on a populace.||France|
|1994||Epidemic||Plague in India. The country experiences a large outbreak of pneumonic plague after 30 years with no reports of the disease. 693 suspected bubonic or pneumonic plague cases are reported.||India|
|2003||Epidemic||An outbreak of plague is reported in Algeria, in an area considered plague-free for 50 years.||Algeria|
|2006||Epidemic||100 cases of suspected pneumonic plague, including 19 deaths, are reported in Orientale Province, Congo.||Democratic Republic of the Congo|
|2006||Epidemic||13 cases, with two deaths, are reported in the states of New Mexico, Colorado, California, and Texas.||United States|
|2009||Infection||Plague is reported in Libya, after 25 years without a case of the disease.||Libya|
|2013||Infection||A case of bubonic plague is reported in a region of Kyrgyzstan bordering Kazakhstan.||Kyrgyzstan|
|2013||Infection||783 cases of plague are reported worldwide in 2013, including 126 deaths.|
|2014||Scientific development||Researchers at Duke University School of Medicine and Duke-NUS Medical School Singapore find the yersinia pestis bacteria to hitchhike on immune cells in the lymph nodes and eventually ride into the lungs and the blood stream, thus spreading bubonic plague effectively to others.||United States, Singapore|
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The Black Death, also known as the Great Plague or the Plague, or less commonly the Black 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.
Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.
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.
The 1918 influenza pandemic was an unusually deadly influenza pandemic, the first of the two pandemics involving H1N1 influenza virus. It infected 500 million people around the world, including people on remote Pacific islands and in the Arctic, and resulted in the deaths of 50 to 100 million, making it one of the deadliest natural disasters in human history.
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.
A plague doctor was a medical physician who treated victims of the bubonic plague. In times of epidemics, such physicians were specifically hired by towns where the plague had taken hold. Since the city was paying their salary, they treated everyone: both the wealthy and the poor. However, some plague doctors were known to charge patients and their families additional fees for special treatments or false cures. Typically they were not professionally trained nor experienced physicians or surgeons, but rather they were often either second-rate doctors unable to otherwise run a successful medical practice or young physicians seeking to establish themselves. These doctors rarely cured their patients; rather, they served to record a count of the number of people contaminated for demographic purposes.
The Italian Plague of 1629–1631 was a series of outbreaks of bubonic plague which ravaged northern and central Italy. This epidemic, often referred to as the Great Plague of Milan, claimed possibly one million lives, or about 25% of the population. This episode is considered one of the later outbreaks of the centuries-long pandemic of bubonic plague which began with the Black Death.
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.
The first cholera pandemic (1817–24), also known as the first Asiatic cholera pandemic or Asiatic cholera, began near Calcutta and spread throughout Southeast Asia to the Middle East, eastern Africa and the Mediterranean coast. While cholera had spread across India many times previously, this outbreak went further; it reached as far as China and the Mediterranean Sea before receding. Hundreds of thousands of people died as a result of this pandemic, including many British soldiers, which attracted European attention. This was the first of several cholera pandemics to sweep through Asia and Europe during the 19th and 20th centuries. This first pandemic spread over an unprecedented range of territory, affecting almost every country in Asia.
The second cholera pandemic (1826–1837), also known as the Asiatic cholera pandemic, was a cholera pandemic that reached from India across western Asia to Europe, Great Britain, and the Americas, as well as east to China and Japan. Cholera caused more deaths, more quickly, than any other epidemic disease in the 19th century. The medical community now believes cholera to be exclusively a human disease, spread through many means of travel during at the time, and spread through warm fecal-contaminated river waters and contaminated foods. During the second pandemic, the scientific community varied in its beliefs about the causes of cholera.
The third cholera pandemic (1846–60) was the third major outbreak of cholera originating in India in the nineteenth century that reached far beyond its borders, which researchers at UCLA believe may have started as early as 1837 and lasted until 1863. In Russia, more than one million people died of cholera. In 1853–54, the epidemic in London claimed over 10,000 lives, and there were 23,000 deaths for all of Great Britain. This pandemic was considered to have the highest fatalities of the 19th-century epidemics.
The fourth cholera pandemic of the 19th century began in the Ganges Delta of the Bengal region and traveled with Muslim pilgrims to Mecca. In its first year, the epidemic claimed 30,000 of 90,000 pilgrims. Cholera spread throughout the Middle East and was carried to Russia, Europe, Africa and North America, in each case spreading via travelers from port cities and along inland waterways.
Social distancing is a term applied to certain nonpharmaceutical infection control actions that are taken by public health officials to stop or slow down the spread of a highly contagious disease. The objective of social distancing is to reduce the probability of contact between persons carrying an infection, and others who are not infected, so as to minimize disease transmission, morbidity and ultimately, mortality.
The 2010 Haitian cholera outbreak was the first modern large-scale outbreak of cholera – a disease once considered beaten back largely due to the invention of modern sanitation. Since its reintroduction to Haiti in October 2010, cholera has spread across the country and has become endemic, causing high levels of both morbidity and mortality. Since its reintroduction to Haiti following the 2010 Haitian earthquake, nearly 800,000 Haitians have been infected by cholera, and more than 9,000 have died, according to the United Nations (UN). Cholera transmission in Haiti today is largely a function of eradication efforts including WASH, education, and oral vaccination, and climate variability. Early efforts were made to cover up the source of the epidemic, but thanks largely to the investigations of journalist Jonathan M. Katz and epidemiologist Renaud Piarroux, today it is widely believed to be the result of contamination by infected United Nations peacekeepers deployed from Nepal. In terms of total infections, the outbreak has since been surpassed by the war-fueled 2016–17 Yemen cholera outbreak, although the Haiti outbreak is still the most deadly modern outbreak.
Seven cholera pandemics have occurred in the past 200 years, with the seventh pandemic originating in Indonesia in 1961. Additionally, there have been many documented cholera outbreaks, such as a 1991-1994 outbreak in South America and, more recently, the 2016–18 Yemen cholera outbreak.
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.
Diseases and epidemics of the 19th century reached epidemic proportions in the case of one emerging infectious disease: cholera. Other important diseases at that time in Europe and other regions included smallpox, typhus and yellow fever.
In October 2016, an outbreak of cholera began in Yemen and is ongoing as of February 2019. In February and March 2017, the outbreak was in decline, but the number of cholera cases resurged after 27 April 2017, reportedly ten days after Sana'a's sewer system stopped working. Devastation of Yemeni infrastructure, health, water and sanitation systems and facilities by Saudi-led coalition air strikes led to the spread of cholera. Saudi-led coalition airstrikes are deliberately targeting water systems in Yemen. The UN accused the Saudi-led coalition of "complete disregard for human life".
Globally about 600 cases of plague are reported a year. In 2017 the countries with the most cases include the Democratic Republic of the Congo, Madagascar, and Peru.