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Colorado Plague Case Is A Reminder That The 'Black Death' Never Really Went Away

July 10, 2024 6:00 AM EDT

The plague sounds like something out of a history book. But the disease—nicknamed the "Black Death" or "Great Pestilence"—that killed more than 25 million people, about a third of Europe, in medieval times is very much still with us today.

Colorado officials confirmed Tuesday a human case of the plague was detected in Pueblo County. It comes after another human case in Oregon in February.

Caused by the bacterium Yersinia pestis, which is often transmitted by fleas and passed through small animals like rodents or cats, the plague has been responsible for more than 200 million deaths throughout history, dating as far back as 3,800 years ago, according to an article published in the American Journal of Medicine. While the bulk of its casualties came during three major pandemics—in the 6th century in and around Constantinople, in 14th century Europe, and in 19th century Asia—outbreaks have persisted to modern day.

The U.S. Centers for Disease Control and Prevention says an average of seven cases are reported in the country each year, mostly in the western and southwestern states. Globally, there are about 1,000–3,000 cases per year, with the three most endemic countries being the Democratic Republic of Congo, Madagascar, and Peru, according to the World Health Organization.

There are two main forms of plague infection: bubonic, which is caused by a flea bite or blood contact with another infected animal or material and is characterized by swollen lymph nodes or "buboes"; and pneumonic, a severe lung infection caused by inhaling droplets, such as the coughs of infected humans or cats. Over 80% of plague cases in the U.S. Have been the bubonic form, according to the CDC, though the pneumonic form is more dangerous.

There is currently no vaccine available in the U.S. That can prevent plague infection, though there are steps you can take, including wearing insect repellent and applying flea control products to pets, to reduce the risk of infection. Today, however, most plague cases don't result in death because of advances in treatment, including with commonly available antibiotics—though untreated cases can be fatal. The overall risk of death for all types of plague in the U.S., according to Mayo Clinic, is around 11%.

The most important factor for survival is that medical attention begins promptly. Symptoms to watch out for include swollen lymph nodes, sudden fever, head and body aches, weakness, vomiting and nausea, shortness of breath, chest pain, and cough, particularly with bloody mucus.

French Minister Sent Terrifying Letter 'laced With Plague' And Filled With Racist Slurs

Minister of the Interior Gérald Darmanin was said to be the target for the contaminated letter in yet another shocking incident to blight the Paris Olympic Games

The French Minister for Interior and Overseas Gerald Darmanin (

Image: AFP via Getty Images)

A disturbing letter intended for a top French minister was reportedly laced with traces of the plague as well including as racist slurs.

The envelope was addressed to the Minister of the Interior Gérald Darmanin at the town hall of Roubaix northern France just outside Lille. Suspicions were raised, however, after noticing that it was unstamped and had undisclosed 'inscriptions' on its back. After workers at a sorting centre in the Côte-d'Or region of Longiv opened the envelope they found it filled with a black powder and a letter containing racist insults, according to French media.

Preliminary tests revealed the powder contained a "slight positivity for the plague". The disease - know as the Black Death - ravaged Europe in the Middle Ages and killed millions of people. Some estimates indicate that up to 50% of the continent's population was wiped out by it.

Darmanin has not spoken publicly about reports of the contaminated letter (

Image:

Getty Images)

Pasteur Institute is conducting new analyses on the substance to confirm the results while the Côte-d'Or prefecture was keen to point out that the initial result 'could be a false positive.' Police have launched an investigation for 'defamation and insults', although this could change depending on the results, which are expected on Monday.

The sender remains unclear, with police yet to offer a possible motive, and the minister himself has not spoken publicly about the letter. This is not the first incident to mar the Paris Olympics, which opened on Friday. High-speed lines into Paris from across the country were targeted in arson attacks just hours before the opening ceremony began.

The French minister believes members of the far left were responsible for Friday's arson attacks (

Image:

AFP via Getty Images)

The finger of blame was pointed at France's ultra left groups, Russia due to its Games ban and Islamic terrorists. There were scenes of chaos at Paris Gare du Nord and the city's Gare Montparnasse as thousands of passengers arrived to find trains cancelled or delayed. Darmanin spoke on France 2 TV on Monday morning about the attacks and was, "leaning towards the likelihood," that far-left extremists were behind the attacks.

"We have identified the profiles of several people," he said before adding: "This is the traditional type of action of the ultra left." He advised "caution" when asked if the identified people were close to the far left, saying: "The question is to know whether they were manipulated" or acted, "for their own benefit These are people who may be close to this movement."

Why Does The Plague Keep Coming Back To Plague Humans?

Throughout human history, different infectious diseases have taken the mantle of "most deadly disease" infecting humans.

In the past century alone, the human population has experienced many pandemics: COVID, HIV and various influenza outbreaks – to name a few. Some have lasted for centuries and persist today, such as tuberculosis. Others are often thought of as being consigned to the history books.

Before the 20th century, the most-deadly-disease mantle was held in Europe and surrounding areas by the bubonic plague. Three major pandemics of this disease have occurred in the past 1,500 years.

The first occurred from the fifth to the seventh century, killing about 15 million people in the Mediterranean basin, and heavily affecting the Byzantine, Sasanian and Roman empires.

A much larger second outbreak, called the Black Death, then occurred in 14th-century Europe, where over 50 million people, around 50% of the entire European population, died from this disease.

The third wave of this pandemic then occurred globally in the 19th and 20th centuries, killing a further 30 million people worldwide, many of these in China and India.

However, from the 1960s onwards, cases dropped dramatically, and the bubonic plague is not often considered a modern disease. Despite this, a new case was recently reported in the US, renewing interest in this disease.

Although no longer common in many parts of the world, the bubonic plague still exists in geographic pockets and can spread in communities if the right mix of conditions are present.

The bubonic plague, or plague for short, is caused by a bacterium called Yersinia pestis. There are three types of plague caused by this pathogen, each with a different part of the body as the main site of infection: pneumonic is mainly lung-based, septicemic is mainly blood-based, and bubonic is mostly in the lymph nodes.

Although one form can turn into another during an infection, generally which form a person has is driven by how they were infected.

Bubonic plague is the form of Y pestis infection that is spread by fleas that live on small animals, mostly rodents such as the house and field rat. These rodents serve as reservoirs for the bacteria: they show little-to-no symptoms but can pass the bacteria to others, including humans.

This transmission from rodents to humans takes place via fleas. These insects bite the rats and afterwards may jump and bite a human, injecting the plague bacterium into the lymphatic system of the human. The bacteria then travel through this system to the lymph nodes and infection begins.

The main symptom of bubonic plague is swollen lymph nodes, usually in the neck, groin, thighs and armpits. These swollen nodes, called buboes, can cause the tissue around them to turn black and die. They may also burst open, releasing the pus inside.

Other symptoms include fever, headaches and vomiting, and the pathogen may spread to other parts of the body, such as the lungs and blood, causing other forms of the plague. Bubonic plague kills 30-60% of people, whereas pneumonic and septicaemic are always fatal if left untreated.

So why was this so prominent hundreds of years ago but barely heard of today? It is all about having that crucial combination of vector (flea), reservoir (rodent) and bacteria (Y pestis) all occurring together and in close contact with humans.

Before the 19th century, people primarily thought that disease was spread by miasmas: noxious forms of air. It was only after the 1880s that people realised that microscopic organisms transmitted between humans, animals and the environment can cause diseases.

From this, sanitation improved in many parts of the world, separating rodents from humans and breaking the cycle of plague transmission. The invention of antibiotics, especially fluoroquinolones from the 1960s onwards, further drove down the cases of plague as proper treatment could now be given for all forms.

Today, we still see cases of plague in specific hotspots, mainly in Asia, Africa and South America. The Democratic Republic of Congo, Peru and Madagascar are the countries with the most cases.

Madagascar alone has dozens of cases a year, with more major outbreaks occurring in 2014 and 2017 (the latter had over 2,000 cases). The dense forest areas are home to many rodents, and contact between people and these ecosystems is the cause of these modern outbreaks.

The plague will probably never be eradicated. Because of its complex transmission network of fleas, rodents and humans, it is nearly impossible to find, control and treat all these aspects.

However, through proper handling of animals, separation of natural reservoirs and humans, and quick and effective treatment, the number of plague cases is decreasing every year, with hopes of negligible case numbers in sight.

Conor Meehan, Associate Professor of Microbial Bioinformatics, Nottingham Trent University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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