Abstract
Plague has been responsible for two major historic pandemics (6th-8th century CE; 14th-19th century CE) and a modern one. The recent Malagasy plague outbreaks raised new concerns on the deadly potential of the plague-causing bacteria Yersinia pestis. Between September 2014 and April 2015, outbreaks of bubonic and pneumonic plague hit the Malagasy population. Two hundred and sixty-three cases, including 71 deaths, have been reported in 16 different districts with a case fatality rate of 27%. The scope of our study was to ascertain whether the risk factors for health in modern-day populations exposed to plague and in ancient populations that faced the two historic pandemics varied or remained substantially unaltered. The risk of mortality of the Malagasy population with those obtained from the reconstruction of three samples of European populations exposed to the historic pandemics was contrasted. The evidence shows that the risks of death are not uniform across age neither in modern nor in historic populations exposed to plague and shows precise concentrations in specific age groups (children between five and nine years of age and young adults). Although in the post-antibiotic era, the fatality rates have drastically reduced, both modern and historic populations were exposed to the same risk factors that are essentially represented by a low standard of environmental hygiene, poor nutrition, and weak health systems.
Highlights
Plague has been responsible for two major historic pandemics (6th–8th century CE; 14th–19th century CE) and a modern one
We provide evidence that, in the post-antibiotic era, the fatality rates have declined, both modern and past populations were exposed to the same risk factors that are essentially represented by a low standard of environmental hygiene, poor nutrition, and weak health systems
With respect to the bone representation index (BRI), i.e., the ratio between the actual number of bones removed during excavation and the total number of elements of the skeleton that should have been present, 63% of the bones were represented for each skeleton [8]
Summary
Plague has been responsible for two major historic pandemics (6th–8th century CE; 14th–19th century CE) and a modern one. The recent Malagasy plague outbreaks raised new concerns on the deadly potential of the plague-causing bacteria Yersinia pestis. Conclusions: in the post-antibiotic era, the fatality rates have drastically reduced, both modern and historic populations were exposed to the same risk factors that are essentially represented by a low standard of environmental hygiene, poor nutrition, and weak health systems. Essentially a rodent disease that can be transmitted accidentally to humans, has been responsible for two major historic pandemics (6th–8th century CE; 14th–19th century CE) and a modern one [1,2,3,4]. The recent Malagasy outbreaks of bubonic and pneumonic plague have raised new concerns about the deadly potential of the plaguecausing bacteria Yersinia pestis [6]. From 1980 onwards, outbreaks have re-surfaced nearly every year and, over the past three years, the annual number of cases has steadily increased [6]
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