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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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