The Plague is as Deadly Today as in the Middle Ages
Most people have only heard of the plague as the disease that ravaged Europe in the Middle Ages.
Most people have only heard of the plague as the disease that ravaged Europe in the Middle Ages. But it's still around today, such as in Madagascar, and just as lethal as ever.The first symptoms that Paul Gaylord noticed felt like a common flu. Two days earlier, he had been bitten by his cat, which had appeared ill. At first, he was prescribed antibiotics to treat cat scratch fever — a bacterial infection that can be transmitted from cats to humans through bites and scratches.
Also Read | Entertainment News | Ram Charan Undergoes Successful Right Wrist Surgery in Coimbatore.
But the medication didn't help. Gaylord's condition worsened, he was admitted to intensive care, and eventually slipped into a coma. Doctors determined that he wasn't suffering from a case of the flu or cat scratch fever, but from the plague. This infectious disease is more commonly associated with the Black Death of the 14th century than with modern-day Oregon, USA, where Gaylord lived.
The infection has not lost any of its deadly potency, but its non-specific symptoms and rare occurrence in modern times make it difficult to identify. Gaylord barely survived, and in 2014, he shared his experience with the British newspaper The Guardian.
Three forms of plague: Bubonic, pneumonic, septicemic
The plague is caused by the bacterium yersinia pestis, which can spread extremely rapidly after entering the body in several possible ways. Once there, the bacterium can damage organ tissue and cause bleeding. If left untreated, it is nearly 100% lethal.
The most common type of plague caused by yersinia pestis is the bubonic plague, which is mostly spread by fleas, the so-called "vectors" of the disease. They transport the bacteria by first biting a plague-infected rodent and then carrying it to humans. Yersinia pestis spreads through the lymph nodes, causing painful swelling.
If the pathogen reaches the bloodstream, for example, through the bite of an infected mammal, it can lead to septicemic plague.
In the case of pneumonic plague, the pathogen enters the lungs through airborne droplets or aerosols from another person or animal infected with pneumonic plague. This is the only type of plague that is likely to be transferable from one human to another.
The plague: a pandemic in the Middle Ages, rarer today
According to the Robert Koch Institute (RKI), Germany's government agency for disease control and prevention, some 3,000 cases of plague were reported across the globe between 2010 and 2015, resulting in over 500 deaths. The most affected regions currently include the Democratic Republic of the Congo, Uganda, and — above all — Madagascar, where the last large outbreak occurred in 2017, and several hundred new infection cases are reported each year. The western United States has also seen occasional cases.
In the Late Middle Ages, between 1346 and 1353, the plague claimed between 25 and 50 million lives. The second in three waves of plague pandemic, it wiped out up to half of Europe's population in just a few years.
Why is there no plague left in Europe?
In Europe, the last reported cases of flea-born plague were recorded in France and Italy in 1945. Holger Scholz, molecular biologist and head of the Consultant Laboratory for Yersinia Pestis at the RKI's Center for Biological Threats and Special Pathogens, said that this low occurrence is largely down to the fact that rodents infected with the pathogen are no longer coming and going from people's homes,
In the Middle Ages, on the other hand, homes sheltered humans and rats side-by-side, providing fleas carrying yersinia pestis ample opportunity to spread the disease.
"Rats, especially black rats, normally aren't actual reservoir animals," said Scholz. Instead of being a long-term host for the pathogens they carry, "they will get sick and die." But research suggests that rats living in endemic areas have been able to build up a certain tolerance to the plague through persistent contact over the years.
According to the US Centers for Disease Control and Prevention (CDC), reservoir animals also include certain rat species, such as the pack rat, as well as various rodents of the squirrel family, such as the tarbagan marmot. In Europe, however, the remaining rodent population doesn't seem to be suitable for spreading the pathogen.
A matter of life and death: quick diagnosis and treatment
Holger Scholz and his team at the RKI work closely with partners in regions where the plague is still endemic, including Madagascar's Ministry of Public Health and the Laboratoire d'Analyses Médicales Madagascar. He says one of their main goals is to build up lab capacity in the country to help improve plague detection.
He says capacity-building is urgently needed, as diagnosis remains one of the key bottlenecks to effective treatment. To illustrate the point, Scholz tells DW of an incident involving a young man in the US, a jogger, who visited a doctor with flu-like symptoms but was just sent home to recover. "He died," Scholz says, "because nobody thought to check for the plague."
But effective antibiotic treatments are available. Nevertheless, each outbreak starts with "the first patients dying because they aren't properly diagnosed at first and therefore cannot be treated in time," Scholz says.
In many places, prompt treatment poses another hurdle. On Madagascar, for example, Scholz explains that it sometimes takes days for the antibiotics to get to where they're needed. Patients with pneumonic plague don't have that kind of time — without treatment, they usually only live another 48 hours after showing the first symptoms.
Could we see another plague pandemic?
Although yersinia pestis keeps causing local outbreaks, Scholz is confident that a fourth plague pandemic is highly unlikely, as it does not spread as easily as airborne viruses like SARS or COVID-19.
Plus, "we have entirely new methods for combating the disease," compared to the Middle Ages, Scholz points out.
But it would be an entirely different matter if the pathogen were to be genetically engineered and used as a biological weapon. Scholz's Center for Bioogical Threats and Special Pathogens also addresses the issue of bioterrorism.
Genome analysis makes it possible not only to distinguish between the countless strains of yersinia pestis, it also makes it possible to assign them to specific regions. "We can also determine whether it is a naturally occuring strain, or whether it may have been manipulated," Scholz explains.
Of course, plague pathogens can also be reintroduced to Europe and Germany by travelers returning from abroad, but researchers say the likelihood is extremely low. "Though you can never rule it out with absolute certainty," Scholz adds.
"We need to be able to detect a plague pathogen in any kind of material," Scholz says — whether in natural samples collected from patients and the environment, or other materials that, for example, might be installed in subway ventilation systems. To be able to do this, he says, diagnostic methods are constantly being developed and improved. And as they do, the risk of another big outbreak steadily lowers.
This article was translated form German
(The above story first appeared on LatestLY on Jul 27, 2026 03:10 PM IST. For more news and updates on politics, world, sports, entertainment and lifestyle, log on to our website latestly.com).
