Plague remains lethal but treatable, with diagnosis a persistent challenge

Key points

• Plague remains present in Madagascar and other regions, while occasional cases have also occurred in the western United States.
• The bacterium Yersinia pestis can cause bubonic, septicemic or pneumonic plague, with pneumonic infection capable of spreading between people.
• Untreated plague is nearly always fatal, while antibiotics can be effective when diagnosis and treatment occur promptly.
• The Robert Koch Institute recorded about 3,000 global cases and more than 500 deaths between 2010 and 2015.
• Madagascar, the Democratic Republic of the Congo and Uganda are among the regions currently most affected, according to the institute.
• Researchers at Germany’s disease-control agency are working with Malagasy partners to strengthen laboratory capacity and improve detection.
• Pneumonic-plague patients may die within about 48 hours after symptoms begin without treatment, according to molecular biologist Holger Scholz.
• The plague killed an estimated 25 million to 50 million people in Europe between 1346 and 1353.