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Here Is Exactly How Much You Should Panic About Bubonic Plague

Oregon just had their first case of bubonic plague in years—yes, the same bubonic plague responsible for the historical Black Death pandemics. But don't panic just yet. Plague is more common than you might think, and more treatable, too.

There are a few bubonic plague cases every year, actually

From the headlines, you might think this is the first case of plague in the U.S. In eight years, or the first in the world in eight years. It's actually just the first case Oregon has had since 2015. There have been cases in other states and elsewhere in the world. Plague isn't absent from the modern world, it's just rare.

According to the CDC, the U.S. Had nine cases (with two deaths) in 2020, the most recent year on their plague stats page. There was only one case in each of 2018 and 2019, but five cases in 2017, and a whopping 16 in 2015. That 2015 mini-outbreak is the last time there was a plague case in Oregon specifically.

Why this steady trickle of cases? Because a low level of plague is always simmering in rodent populations, especially in the southwest. (Researchers believe that plague originally came from rodents, possibly marmots in central Asia; it later spread to rats, and in the U.S. It now circulates in prairie dogs.)

This is why it's good to stay away from sick or dead rodents. In the recent Oregon case, the person seems to have caught plague from their cat. We don't know for sure where the cat got it from, but one strong possibility is that the cat got it from a local wild rodent (or its fleas).

Antibiotics work against bubonic plague

Plague sounds scary because we've heard the stories about the plague pandemics in medieval Europe. And, sure, if you lived in medieval Europe and caught the plague, you would be kind of screwed.

But plague is caused by a bacterium, Yersinia pestis. That bacterium can be killed with modern antibiotics. It's important to get treatment promptly, since this disease can still be fatal, and the earlier you're treated the better.

The CDC recommends seeking medical care as soon as you suspect you may have plague. Tell your doctor if you have recently been to (or live in) the western United States. One of the characteristic symptoms of plague is an extremely swollen and painful lymph node, called a bubo. Your doctor can test your blood or the bubo for signs of plague, and treat you accordingly.

How to protect yourself from the plague

The CDC has a list of tips for plague prevention here. Remember, this is an uncommon disease, so plague is not likely to be coming for you personally. But here are some sensible precautions:

Keep rodents away from your home (for example, by removing brush piles and food sources near the house).

Use insect repellents on yourself and your pets to reduce your chances of getting flea bites.

If your dog or cat roams free in plague-endemic areas, don't let them sleep on your bed.

Where are those plague-endemic areas? The CDC says most plague cases come from northern Arizona, northern New Mexico, southern Colorado, southern Oregon, California, and western Nevada.

The Black Death Has Resurfaced In 2024: Here Are 5 Things You Need To Know About The Bubonic Plague

Yersinia pestis bacteria causes bubonic plague in animals and humans Photo: Getty Images

The bubonic plague has emerged in Oregon for the first time in almost ten years.

Last week, health officials in the central region of Oregon reported that a person likely contracted the bubonic plague from their cat. Physicians promptly diagnosed the illness and administered antibiotics to the individual. Additionally, they traced and treated all contacts of the person and their cat as a precautionary measure. Consequently, authorities anticipate no further spread of the disease or fatalities.

The fundamentals of the plague are familiar to most individuals.

It is widely understood that during the 14th century, the plague resulted in the Black Death, a pandemic that potentially claimed 30% to 50% of the population in certain European regions, with an estimated death toll surpassing 50 million. Additionally, people are aware that the disease is transmitted through rodents and the fleas that bite them.

However, in the past decade, scientists have made significant advancements in understanding the plague and its effects on the human body. Here are several key revelations about the plague.

People of European Descent may Possess one (or two) Genes that offer Protection against the Plague

During the outbreak of the Black Death in Europe and the United Kingdom in the 1300s, it is believed that the disease not only reshaped society but also influenced the evolution of the human genome.

According to a study published in 2022, survivors of the plague in London and Denmark exhibited mutations in their genomes that conferred resistance to the plague-causing pathogen, Yersinia pestis.

Researchers identified four advantageous mutations in the genomes of these individuals. One of these mutations was estimated to increase the likelihood of surviving the plague by 40%, marking it as the most significant evolutionary advantage ever documented in humans for a single mutation, as per researchers interviewed by NPR.

These beneficial mutations were passed down to subsequent generations by survivors, resulting in many Europeans and Americans of European descent carrying these genetic variations today.

However, it is suggested that these advantageous genes may come with a trade-off. For instance, one of the mutations is associated with an increased susceptibility to autoimmune diseases like Crohn's disease.

Following years of Dormancy, the Plague has the Potential to Resurface in any Given Region

Annually, the world records between 200 to 700 cases of plague, although a significant number of cases likely remain undetected. The majority of these occurrences are concentrated in specific areas globally, with hot spots like Madagascar contributing to approximately three-quarters of reported cases. In the United States, fewer than a dozen cases are typically documented each year, primarily in the West.

However, the Yersinia pestis bacterium can manifest almost anywhere, including regions believed to have eradicated the disease or where it hasn't been observed for decades.

An instance of this resurgence occurred in Libya. After a 25-year absence of recorded plague cases, the disease reappeared in 2009. Initially, scientists speculated that the pathogen may have been introduced by an individual or animal from a neighboring country. However, analysis of the bacteria's DNA yielded a surprising revelation: the strain of plague in Libya closely resembled Y. Pestis originating from Central Asia thousands of years ago, distinct from strains found in neighboring countries.

"We think the plague is extinct in these places, but it's not," microbiologist Elisabeth Carniel at the Institut Pasteur told NPR for a January 2013 story. "The plague is still there."

The whereabouts of the plague during periods of inactivity remain elusive, with speculation suggesting that it circulates undetected among rodents and the fleas they harbor. It's plausible that the bacterium exists at such low levels that it remains unnoticed for decades.

Even in the Presence of Antibiotics, one form of the Plague can Result in an Exceptionally High Fatality Rate

The plague presents itself in various forms depending on the body part invaded by the bacteria. When a person is bitten by a flea, they typically develop bubonic plague, characterized by swollen and painful lymph nodes known as buboes.

The term "bubonic" originates from the Greek word "boubon," meaning groin, as some individuals experience swollen lymph nodes in their groin area.

Diagnosis of the disease can be confirmed by extracting a sample from the person's blood or lymph nodes and submitting it to a laboratory for testing.

However, if the bacteria spread to the lungs, it can lead to pneumonic plague. Unlike bubonic plague, there are often no distinctive signs of the plague in this case, according to the Centers for Disease Control and Prevention.

Pneumonic plague poses a significantly greater risk, as explained by medical entomologist Adelaide Miarinjara from Emory University. "It transmits pretty easily between people because it spreads through droplets, almost like COVID spreads."

Moreover, people can die more quickly with pneumonic plague due to its swift progression. "The key here is early diagnosis. If people aren't expecting it or don't seek treatment, they can die."

In 2017, Madagascar experienced a large outbreak of pneumonic plague when an individual from a rural area introduced the disease to the coastal city of Toamasina. This city had not encountered a case of the plague in nearly a century, according to Miarinjara, who was present in Madagascar at the time.

The disease was transmitted via public transportation, resulting in over 2,400 suspected cases, including nearly 1,900 cases of pneumonic plague. A study estimated that approximately 25% of individuals with confirmed cases succumbed to the disease during this outbreak.

Plague Bacteria induce Vomiting in Fleas

In the western United States, various rodents, including chipmunks, squirrels, and prairie dogs, can harbor the plague bacteria, which they can transmit to humans through bites and scratches.

However, most of the time, rodents—and often humans—contract Y. Pestis from a flea bite. Scientists now have a comprehensive understanding of how the flea transmits the bacteria during this process.

When a flea becomes infected, the plague bacteria reside within the insect's gut. Here, the bacteria produce a viscous, adhesive substance known as a biofilm. This film forms a small plug in the flea's throat, making it difficult for the insect to swallow. Consequently, when the flea bites an animal, it essentially regurgitates the biofilm—along with the plague bacteria—into the animal's bloodstream.

Microbiologist Viveka Vadyvaloo explained this process in a 2021 interview with the Washington State University Insider, stating, "You can imagine, you have something stuck in your throat and you try to take in some water but can't. You will vomit all that water out, and that's what happens to the flea. The blocked, starving flea will repeatedly bite its rodent or human host, creating more opportunities for infection."

The Black Death gave rise to the word "Quarantine"

The term "quarantine" originated from the Black Death pandemic, during which the city-state of Dubrovnik, now part of Croatia, implemented what is believed to be the first state-mandated isolation measure.

At that time, Dubrovnik, a prosperous merchant city situated along the Adriatic Sea, aimed to prevent the spread of bubonic plague. To achieve this, city authorities enforced a policy requiring visitors to spend 40 days on a remote island outside the city before being allowed ashore.

This waiting period was referred to as "quarantino," derived from the Italian word for "40."

According to Ivana Marinavić, head of educational programs at the Lazarettos of Dubrovnik, "the first quarantine was pretty much improvised." The Lazarettos, constructed specifically for quarantine purposes, were among the first buildings built for this purpose.

Breaking quarantine during the plague carried severe consequences. As Marinavić stated, "Torture, or cutting your nose or your ears off," were among the punishments imposed for non-compliance.

A Shadow Of The Black Death Has Reappeared In The Pacific Northwest

While rare, the bubonic plague still infects more than a handful of humans each year in the United States.

The once-deadly disease known as Black Death is typically transmitted to humans via flea bites.

This is the first case in Oregon in eight years, and is tied to an infected pet cat.

A disease doesn't get the named Black Death for nothing. Infamous for wiping out roughly a third of Europe's population in the 14th century, the bubonic plague has recently been largely kept in check thanks to modern antibiotic medicine. But that hasn't stopped the plague from appearing in humans in the United States annually, with the latest case coming from Oregon.

A rural Deschutes County resident was likely infected with the bubonic plague from a heavily symptomatic pet cat with "a fairly substantial" infection, Richard Fawcett, health officer for the county told NBC News.

The bubonic plague is usually transmitted to humans via flea bites. And cats, such as in the recent Oregon case, are a common culprit. Fleas and rodents are the most likely carriers of the plague, and cats interact with both. The plague can also get passed through bodily fluids, which just may have been the case in Oregon, considering there was a sick cat with a draining abscess in the equation.

The infection starts in the lymph nodes, which is where the plague gets its bubonic name. In the Oregon case, the infection had reached the bloodstream before hospitalization. Fawcett said the patient "responded very well to antibiotic treatment."

But that doesn't mean everyone is in the clear yet. The patient may have developed a cough—a potential sign of the pneumonic plague, the version of the plague that transmits human-to-human. Health officials in Deschutes County gave antibiotics to the patient's close contacts.

"If we know a patient has the bacteria in the blood, we might decide to be on the safe side," Fawcett said.

When the plague is introduced to the body (typically through a bite), the bacterium Yersinia pestis travels through the lymphatic system to the nearest lymph node, and replicates itself, according to the World Health Organization. The lymph node then becomes inflamed and painful. Human-to-human spread of the bubonic plague is rare, but if the plague advances to the lungs, it can turn into a more severe case of pneumonic plague. That version is both transferable between humans and more deadly.

The CDC reports an average of seven plague cases annually in the U.S. Over the last few decades, with the most coming from New Mexico. Cases are typically centered in two regions—either New Mexico, northern Arizona, and Colorado, or California, southern Oregon, and western Nevada.

"It's the same thing that caused the Black Death, but that was in the pre-antibiotic era," David Wagner, director of the Biodefense and Disease Ecology Center at Northern Arizona University's Pathogen and Microbiome Institute, tells NBC. "Now it's very easily treated with simple antibiotics."

More than 80 percent of plague cases in the U.S. Are bubonic and confined to the lymph nodes. Of the seven average cases annually, they almost all comes from the rural wilderness of the West. The last case in Oregon was in 2015, attributed to a flea bite on a hunting trip. Of the nine cases reported nationwide in 2020, two lead to deaths.

The plague killed over one third of the European population in the 1300s and came back again, both in Europe and China in a second wave. It returned again (largely in Asia) in the 1800s, and continued to spread to India and eventually San Francisco. Introduced to the U.S. In the early 20th century via rats on ships carrying the plague, the last time the plague turned into an epidemic in the U.S. Was in the 1920s.

Tim Newcomb is a journalist based in the Pacific Northwest. He covers stadiums, sneakers, gear, infrastructure, and more for a variety of publications, including Popular Mechanics. His favorite interviews have included sit-downs with Roger Federer in Switzerland, Kobe Bryant in Los Angeles, and Tinker Hatfield in Portland.

Bubonic Plague Symptoms