Talking About the Plague

Despite what you might read in the media, plague is nowhere in your future.

Joe Alton, M.D. | October 9, 2026

These days, when you read about the plague, it’s usually in history books. You probably know that this infectious disease (once called the “Black Death”) depopulated much of Europe and Asia in the Middle Ages. What you might not know, however, is that plague outbreaks still occur today.

Recently, Russian media outlets have reported that Darya Shipilova, a 28-year-old lab scientist, died several days after a broken test tube exposed her to Yersinia pestis, the bacterium responsible for the disease. Although no one else has fallen ill yet, almost 200 known contacts of the victim are under observation. As you can imagine, the press is wondering if she is patient zero in the next pandemic (and why she was handling plague germs).

A pandemic? Nope. Unlikely to become one, as well. In the 21st century, community-wide outbreaks of plague are rare; the worst are confined to the island of Madagascar, including one in 2017 that saw over 2000 cases and claimed more than 200 lives.

So What Is “Plague”?

We may have all heard of it, but what, really, is the plague? Do rats or their fleas cause it, as many believe?

Plague is a highly infectious disease caused by the bacterium Yersinia pestis. This bacterium is, indeed, found in fleas that infest rats and other rodents. The infection is transmitted from animal to animal (or human) when infected fleas jump on and bite a new host. Once established, different forms of plague can be spread by airborne droplets from coughs, in the blood, or even by contaminated water or food. By the way, neither the rodent host nor the flea is immune to Yersinia pestis; they become victims and succumb to the infection.

Although you learned about the “Black Death” in the 14th century AD, there have been various plague epidemics over the ages. 

The Justinian Plague in 541 AD killed 25 million people in a few years. In modern times, a plague outbreak in 1894 in Hong Kong is thought to have killed 10 million. It was during this epidemic that Yersinia pestis was first identified as the culprit from the fleas in rats.

In the last century, plague outbreaks have been reported in India, Vietnam, and sub-Saharan Africa. Occasional cases (averaging six or seven a year) are even reported in the Western part of the United States in people exposed to rodents like prairie dogs.

Types Of Plague

The symptoms of plague depend on the type:

Bubonic plague: Bubonic plague, the most common type, causes fever, chills, and other flu-like symptoms before it infects lymph nodes. An accumulation of bacteria, blood, and pus in these structures gives rise to painful, swollen lumps called “buboes.” Buboes are blackish in color and may be seen in the armpits, groin, and neck.

Other symptoms include vomiting of blood, gastrointestinal issues, breathing difficulty, seizures, and gangrene (loss of circulation) to the extremities such as toes, fingers, nose, and lips. If untreated, delirium and coma eventually occur, and death ensues within a week to ten days.

Pneumonic plague: Pneumonic plague infects the lungs and can develop in those with bubonic plague or who breathe in infected air droplets. The patient begins to cough up blood and develops chest pain and shortness of breath. If untreated, death occurs in less than 48 hours. This is, apparently, what killed Ms. Shipilova.

Septicemic plague: Bacteria may pass from buboes into the bloodstream or may directly enter the body through an open wound. Besides fever and other general symptoms, a depletion in blood clotting factors may cause spontaneous, unstoppable bleeding into the skin, lungs, kidneys, and other organs.

Treatment

Untreated pneumonic plague can be rapidly fatal, so early diagnosis and treatment are essential for survival and reduction of complications. Bubonic plague isn’t hard to diagnose due to the presence of buboes. Pneumonic plague, however, is more difficult to identify. Patient zero in the Madagascar epidemic was a man on a crowded minibus who was originally thought to have malaria.

The fact that plague is caused by bacteria makes it curable with early use of certain medicines. Antibiotics combined with supportive therapy like hydration are effective against plague if patients are diagnosed in time. Effective options include doxycycline, ciprofloxacin, and gentamicin.

Prevention

An ounce of policies that decrease the chance of plague are, as the old saying goes, worth a pound of cure.  Preventive measures include:

•   Advising people to take precautions against flea bites. Control fleas by using appropriate insecticides like permethrin.
•   Taking care when handling animal carcasses.
•   Avoiding unprotected contact with infected tissues (such as buboes), as well as coughs and sneezes of patients with suspected        pneumonic plague. Use gloves, masks, and even aprons if you’re a caregiver.
•  Isolating sick patients from common areas, such as places where food is prepared, so as not to infect others via airborne droplets.
•  Ensuring appropriate disposal of human waste.
•  Eliminating rodents from areas where humans may frequently contact them.

Strange local customs may be a factor in the spread of plague, including a unique tradition in Madagascar called “famadihana” (sometimes called “dancing with the dead” or “the turning of the bones”). The bodies of dead ancestors are dug up and wrapped in fresh cloth. Then, the family ritually dances with the corpses before reburying the remains. As you might imagine, digging up bodies of pneumonic plague victims is risky business. The bacterium seems to persist when buried and can still be passed to others for an extended period.

So, should you worry about getting the plague? Despite what you might read in the media, plague is nowhere in your future; that is, unless you’re a worker at a “biosafety lab” in Siberia or planning a long trip to Madagascar.

Joseph Alton, MD, is a physician, medical preparedness advocate, and NY Times bestselling author of The Survival Medicine Handbook: The Essential Guide For When Help Is NOT On The Way and other books.