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Can we make human plague history? A call to action
  1. Laurence Baril1,
  2. Xavier Vallès1,
  3. Nils Christian Stenseth2,3,
  4. Minoarisoa Rajerison4,
  5. Maherisoa Ratsitorahina1,
  6. Javier Pizarro-Cerdá5,
  7. Christian Demeure5,
  8. Steve Belmain6,
  9. Holger Scholz7,
  10. Romain Girod8,
  11. Joseph Hinnebusch9,
  12. Ines Vigan-Womas10,
  13. Eric Bertherat11,
  14. Arnaud Fontanet12,
  15. Yazdan Yazadanpanah13,
  16. Guia Carrara13,
  17. Jane Deuve14,
  18. Eric D'ortenzio13,15,
  19. Jose Oswaldo Cabanillas Angulo16,
  20. Paul Mead17,
  21. Peter W Horby18
  1. 1 Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
  2. 2 Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, Oslo, Norway
  3. 3 Key Laboratory for Earth System Modelling, Department of Earth System Science, Tsinghua University, Beijing, China
  4. 4 Plague Unit, Central Laboratory for Plague, Institut Pasteur de Madagascar, Antananarivo, Madagascar
  5. 5 Yersinia Research Unit, National Reference Centre 'Plague & Other Yersinioses',World Health Organization Collaborating Reference and Research Centre for Yersinia, Institut Pasteur, Paris, France
  6. 6 Natural Resources Institute, University of Greenwich, Kent, UK
  7. 7 Reference Laboratory for Plague, Bundeswehr Institute of Microbiology, Munich, Germany
  8. 8 Medical Entomology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
  9. 9 Rocky Mountain Laboratories, National Institute of Health, National Instittute of Allergy and Infectious Diseases, Hamilton, Ohio, USA
  10. 10 Immunology of Infectious Diseases Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
  11. 11 Alert and Response Operations Programme, Communicable Disease Surveillance and Response Department, World Health Organization, Geneve, Switzerland
  12. 12 Emerging Diseases Epidemiology Unit, Conservatoire National des Arts et Métiers, Paris, France
  13. 13 REACTing, Inserm, Université Paris Diderot, Paris, France
  14. 14 Department of International Affairs, Institut Pasteur, Paris, France
  15. 15 Service de Maladies Infectieuses et Tropicales, Hôpital Bichat - Claude-Bernard, Paris, France
  16. 16 Control de Epidemia Desastres y Otras Emergencias Sanitarias, Oficina General de Epidemiologia, Ministerio de Salud de Perú, Lima, Peru
  17. 17 Bacterial Diseases Branch, Division of Vector Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
  18. 18 Epidemic diseases Research Group Oxford (ERGO), Nutfield Department of Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr Xavier Vallès; xavier_valles04{at}

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Summary box

  • In spite of the historical capacity to disrupt human societies, plague is currently a neglected disease.

  • Given the resilience to be controlled in the wild, the focus should be put to prevent human transmission of plague.

  • Research priorities include new diagnostic and therapeutic tools which are urgently needed, especially to deal with the pulmonary form of plague.

  • A cross-disciplinary research approach is needed, including basic, ecological, clinical and social sciences.


Plague is a communicable rodent-borne disease caused by Yersinia pestis, a Gram-negative bacillus member of the Enterobacteriaceae family. As a zoonosis, plague is primarily a wildlife disease hat occasionally spills over to the human population, resulting in seasonal surges in human cases and localised outbreaks.1 2 The predominant clinical form among humans is bubonic plague, which, if untreated, has a lethality of 60%–90% but is readily treatable with antibiotics, reducing the death rate to around 5% if administered shortly after the infection.3 4 One to two per cent of all bubonic cases develop into secondary pneumonic plague, which in turn may be transmitted from person to person through respiratory droplets, producing primary pneumonic plague in close contacts. Without antibiotic treatment, pneumonic plague is nearly 100% fatal, but early antibiotic treatment substantially improves survival.4 Today, Y. pestis is present in at least 26 countries, with more than 30 different flea vectors and over 200 mammal host species.1–3 Although human plague cases continue to be reported from Asia and the Americas, most cases currently occur in remote, rural areas of sub-Saharan Africa, mostly in Democratic Republic of Congo and Madagascar (around 300–500 per year).5 However, large-scale transmission may also occur. During the 14th century, the Black Death, caused by Y. pestis, is estimated to have killed 30%–40% of the European population.1

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