Bubonic Plague Research Articles

Will a re-emergence of ancient infectious diseases pose a new risk to humanity in the coming millennia?

Infectious diseases including smallpox, the black plague, cholera, and others have been responsible for the loss of millions of lives over the past millennia, prior to the development of effective treatment strategies during the recent century. Throughout history, epidemics and pandemics are known to have occurred intermittently throughout the world for over 2,500 years. During the 20th century, many of the causative infectious agents were identified, the evolution of vaccines and antimicrobials were developed, resulting in treatment strategies and public health measures that brought about the resolution and presumed virtual eradication of some of the infectious agents. Cholera is transmitted via the fecal-oral route, and outbreaks continue to occur, with the most recent epidemic in Haiti following the massive earthquake of 2010 despite the development of effective vaccines and supporting public health measures. While smallpox was deemed to have been eradicated by the WHO, the recent discovery of Alaskapox, a novel strain of orthopoxvirus that is genetically similar to ‘old-world’ smallpox claimed its first fatality in January 2024. The bubonic plague also continues to reappear in clusters, most recently in rural Oregon in the USA in early 2024. Thus, the emergence of variants of these and other devastating ancient diseases continues to require diligence in establishing and delivery of public health measures and therapeutic options to ensure the plagues of former millennia remain in the history books and not in the community during the present and future generations.

A Syphilis-Giving God? On the Interpretation of the Philistine’s Scourge

Abstract To understand a text, or any other form of art work, as referring to a disease is not always obvious. This uncertainty, although confined to rare cases, nevertheless allows us to explore the limits and blind spots of certain frameworks proposed to think about the relationship between art and disease, notably Susan Sontag’s book Ilness as metaphor. In this article, I take a closer look at the calamity described in chapters 5 and 6 of the first book of Samuel and its various exegeses in the Western World. This calamity (still considered by many to be a bubonic plague), was not associated with the pandemic imaginary by ancient commentators, artists, and doctors, and it is only in modern times that medical diagnoses of the text change in this sense. I propose to see that these seemingly innocuous changes in diagnostic interpretations actually reflect deep changes in the relation between illness and divine agency. After a brief critical review of Susan Sontag’s writings on interpretation and their relationship to Ilness as Metaphor, I will proceed to trace the complex interpretation history of this calamity, before drawing observations about the place of interpretation in literary criticism and in the medical sciences.

The plague, the skill-premium, and the road to modern economic growth

Abstract When bubonic plague arrived in Britain in the mid-14th century, it caused dramatic economic and structural change. Within 50 years, the skill-premium was reduced by half, and another 50 years on, agriculture’s share of the labor force had declined by more than 20 percentage points. This paper develops a two-sector pre-industrial growth model and draws on recent data sources covering Late Medieval and Early Modern Britain to explain these and the ensuing developments. Our main findings are that the skill-premium’s decline was related to the guild and apprenticeship system and that it and the other post-Plague adjustments were crucial determinants of the British trajectory toward industrialization. In particular, prior sectoral transformation and the skill-premium’s determination were important when the Early Modern population boom (1525–1654) threatened to reverse the adjustments caused by the Plague.

Public Health and Political Governance

Abstract In the light of the Covid-19 pandemic, its mutations, concealment by people and the resistance to vaccines against it, it is relevant to examine the outbreak of bubonic plague in colonial Lagos during the early twentieth century and the response by the British colonial authorities. The methodology applied to this study is historical, drawing information from medical, sanitary, land use and physical planning documents accessed from various archives as well as some secondary sources. It is clear that the colonial government’s housing and public health regulations, which allowed authorities to inspect people’s homes for cases of infectious disease, drove people to escape into the hinterland, increasing the spread of the plague. Consequently, the colonial authorities carried out a massive structural and physical reorganisation of towns and villages. They also embarked on large-scale land reclamation, decongested overcrowded houses and introduced sanitary measures to make the environment more habitable. This paper argues that through effective political governance structures the colonial government strategically eliminated the bubonic plague in Lagos.

The Natural and Clinical History of Plague: From the Ancient Pandemics to Modern Insights.

The human pathogen Yersinia pestis is responsible for bubonic, septicemic, and pneumonic plague. A deeply comprehensive overview of its historical context, bacteriological characteristics, genomic analysis based on ancient DNA (aDNA) and modern strains, and its impact on historical and actual human populations, is explored. The results from multiple studies have been synthesized to investigate the origins of plague, its transmission, and effects on different populations. Additionally, molecular interactions of Y. pestis, from its evolutionary origins to its adaptation to flea-born transmission, and its impact on human and wild populations are considered. The characteristic combinations of aDNA patterns, which plays a decisive role in the reconstruction and analysis of ancient genomes, are reviewed. Bioinformatics is fundamental in identifying specific Y. pestis lineages, and automated pipelines are among the valuable tools in implementing such studies. Plague, which remains among human history's most lethal infectious diseases, but also other zoonotic diseases, requires the continuous investigation of plague topics. This can be achieved by improving molecular and genetic screening of animal populations, identifying ecological and social determinants of outbreaks, increasing interdisciplinary collaborations among scientists and public healthcare providers, and continued research into the characterization, diagnosis, and treatment of these diseases.

Using paleopathology to provide a deep-time perspective that improves our understanding of one health challenges: Exploring urbanization

Abstract The question posed is how deep-time perspectives contribute to tackling contemporary One Health challenges, improving understanding and disease mitigation. Using evidence from the field of paleopathology, it is possible to explore this question and highlight key learning points from the past to focus the minds of those making healthcare policy decisions today. In previous centuries urbanization led to poorer health for a wide range of indicators, including life expectancy, sanitation and intestinal parasites, airway disorders such as maxillary sinusitis, metabolic diseases such as rickets, and even conditions resulting from clothing fashions such as bunions. Modern concerns regarding the quality of urban air and rivers show we have still to incorporate these lessons. When we consider major infectious diseases affecting past societies such as bubonic plague, tuberculosis and leprosy, interaction between humans and wild mammal reservoirs was key. Wild red squirrels in Britain today remain infected by the medieval strain of leprosy that affected people 1,500 years ago. It is clear that the One Health focus on the interaction between humans, animals and their environment is important. Eradicating zoonotic infectious diseases from humans but not these reservoirs leaves the door open to their spread back to people in the future.

A Tangled Web

Few debates in modern academia are as heated as the one among scholars who consider the arrival of bubonic plague in Constantinople in the spring of 542 as a demographic and social disaster and those who argue for less tumultuous outcomes. Whatever side one stands on in the current discussion, the pandemic’s immediate impact on the administration, economy, politics, society and religious culture within Constantinople and the wider empire seems clear. In this article I will suggest that increased competition amongst Constantinople’s elites for a shrunken pool of suitable brides and grooms for their sons and daughters was one hitherto underappreciated result of the pandemic. The sixth-century eastern Roman historian, Procopius of Caesarea, offers ample evidence not only about the devastation wrought by the bubonic plague but also its impact on the political alliances in Constantinople. His digressions in Secret History concerning marital politicking amongst Constantinople’s elites provide evidence of this impact. Capitalizing on advances in our knowledge about Procopius both as an author and historical figure, I will analyze his writings on three levels: as history, literature and propaganda. By pondering what motivated Procopius to focus on these marital alliances and, moreover, pondering links between them, the paper offers some revisionist takes on these digressions, both as literary devices and as actual events.

A Defence of the Traditional Chronology of 542–545, Again

The chronology of the campaigns of the years 542–545 has been the subject of debate, with Michael Whitby defending the traditional interpretation that Procopius’ long account of the bubonic plague concealed the end of the year 542, whereas Geoffrey Greatrex has championed the chronology of Kislinger and Stathakopoulos, which locates Khusro’s march to Adarbiganon and the Roman defeat at Anglon in late 542 and the siege of Edessa in 543, with Procopius failing to note the end of a year during peace negotiations in 544–545. Considerations of the progress of Khusro I’s invasion in 542 in light of his probable speed of march, and the distances he had to cover, coupled with the relatively slow advance of bubonic plague over large land masses and Procopius’ practice in arranging his material, point to the missing year-end, being that of 542/543. While the new chronology cannot absolutely be ruled out, the assumptions on which it is based are shaky.

«Черная смерть» в Золотой Орде: поле для исследований по истории и археологии Казахстана в XIII–XIV веках

The Black Death (the pandemic of bubonic plague caused by the bacterium Yersinia pestis) is critical for understanding the collapse of the Golden Horde and its aftermath in the 14th century. Recent historical and aDNA research argues that the Qinghai-Tibetan plateau is the point of origin for the rise of new highly virulent strains of the bacterium. It has been argued recently that this disease was present in the region during the lifetime of Chinggis Khan. The pandemic spread through Kyrgyzstan and the cities of Central Asia to Khorezm. The disease reached Kaffa simultaneously via the northern route in 1346 and spread to the rest of the Mediterranean world and beyond in 1347. Recent research has identified the southern course of the disease via Iran to Azerbaijan as well. aDNA research has shown that the same bacterium was responsible for the mass burials in Burana (near Issıq Köl, Kyrgyzstan) and Volga Bulgaria as in medieval Europe. This has implications for the study of the history of the entire territory of Kazakhstan. This study concludes that archeologists should be looking for evidence of mass burials in depopulated urban centers dating from the late 1330s-1340s to corroborate this research and to find ancient samples of the bacterium Yersinia pestis

Lives versus livelihoods in the middle ages: The impact of the plague on trade over 400 years

To what extent did outbreaks of bubonic plague disrupt trade? We estimate the impact of epidemics on trade between regional wheat markets over four centuries — from the Black Death in the 14th century, until the medieval form of the plague became extinct in the 17th century. Using a gravity model, we find that outbreaks had a statistically significant, but relatively modest, impact on local variations in wheat prices. The results provide quantitative evidence on the extent to which epidemics disrupted markets and trade in pre-industrial Europe.

Reading John of Ephesus via Procopius of Caesarea?

Abstract The purpose of this article is to revisit the comparison between the accounts of the Justinianic plague of 541–750 CE, the first recorded pandemic of bubonic plague, by John of Ephesus and Procopius of Caesarea, as done by the scholar of Byzantine history, Anthony Kaldellis, in a 2007 publication. In the article, I critique some of Kaldellis’s main points of comparison, and then by approaching plague as a discourse (in the Foucaultian sense), I attempt to provide a more nuanced reading and comparison of the individual accounts, and of ancient plague discourse more generally.

Bubonic plague: can the size of buboes be accurately and consistently measured with a digital calliper?

IntroductionConducting clinical research on treatments for emerging infectious diseases is often complicated by methodological challenges, such as the identification of appropriate outcome measures to assess treatment response and the lack of validated instruments available to measure patient outcomes. In bubonic plague, some studies have assessed bubo size as an indicator of treatment success, a measure widely assumed to be indicative of recovery. Evaluating this outcome however is challenging as there is no validated method for measuring bubo size. The aim of this study is to assess the accuracy and inter- and intra-rater agreement of artificial bubo measurements using a digital calliper to understand whether a calliper is an appropriate measurement instrument to assess this outcome.MethodsStudy technicians measured 14 artificial buboes made from silicone overlaid with artificial silicone skin sheets over the course of two training sessions. Each artificial bubo was measured by each study technician once per training session, following a Standard Operating Procedure. The objectives of this study are to (i) evaluate the accuracy of individual measurements against the true size of the artificial bubo when using a digital calliper, (ii) understand whether the characteristics of the artificial bubo influence measurement accuracy and (iii) evaluate inter- and intra-rater measurement agreement.ResultsIn total, 14 artificial buboes ranging from 52.7 to 121.6 mm in size were measured by 57 raters, generating 698 measurements recorded across two training sessions. Raters generally over-estimated the size of the artificial bubo. The median percentage difference between the measured and actual bubo size was 13%. Measurement accuracy and intra-rater agreement decreased as the size of the bubo decreased. Three quarters of all measurements had a maximum of 25% difference from another measurement of the same artificial bubo. Inter-rater agreement did not vary with density, size or presence of oedema of the artificial bubo.ConclusionsThe results of this study demonstrate the challenges for both individual and multiple raters to repeatedly generate consistent and accurate measurements of the same artificial buboes with a digital calliper.

Assessing the effectiveness of intervention to prevent plague through community and animal-based survey.

Bubonic plague, transmitted by infected flea bites, is the most common form of plague and, left untreated, can progress to the pneumonic form, which is highly contagious. Surveillance focusing on reservoir and vector is considered to be the main approach to prevent plague. Common rodent control methods include the use of rodenticide and snap traps but, in a plague context, the dispersal of fleas from killed animals may pose a serious health threat. Therefore, there is a need for strategies which address reservoir and vector control. The aim of this study was to assess the effects of combination of reservoir and vector control through community-based surveillance. Activities were implemented by local previously trained community agents in two active plague foci in Madagascar. Kartman bait stations containing rodenticide and insecticide were placed indoors while live traps were set outdoors. Small mammals were identified and killed with their fleas. Effectiveness of control measures was evaluated by comparison of plague incidence two years before and after intervention using data on reported human cases of plague from the Central Laboratory of Plague. A total of 4,302 small mammals were captured, with the predominance of the black rat Rattus rattus. Our results found a reduction in plague incidence in the treated site for at least two years after treatment. Community-based interventions played an important role in reducing contact between humans-rodents-fleas. Our study confirms the importance of animal surveillance during the low plague transmission season. The combination of reservoir and vector control with community involvement may be effective at reducing the risks of plague spillover to humans. The strategy of using Kartman bait stations indoors with live traps outdoors can be used to refine proactive plague prevention, however, due to the potential development of resistance to pesticides in flea and rat populations, overuse should be considered.

‘Oh, so that’s what it was like!’: The Personal Essay in Hard Times

This article explores characteristics of personal essays, primarily written by American essayists, that appeared in 2020 during the COVID-19 pandemic and protests against racial injustice that erupted around the U.S. It does so against the historical backdrop of essays that were written during other global hard times, particularly the second wave of the bubonic plague epidemic in the 1500s, when Montaigne wrote The Essays, and the 1918 flu pandemic. It notes significant differences in the contemporary responses – for one, an extraordinary level of detail about life in a pandemic – many of which unite around a communal despair over pandemic losses, outrage at racism, and hope for a better future. One of the challenges faced by essayists in public hard times is how to position their personal experiences amid a public calamity. Writers of colour, the author contends, face additional challenges as they navigate the complexities and pressures of representational narratives.

Plaguing Segregations: Paradigms of Rule at The Cape of Good Hope

AbstractPower, while fundamental to sociality, might be exercised with haphazard ferocity or more judiciously in legally constrained ways. Such constraint requires us first to understand how ruling paradigms work, and the effects of their powers, before entertaining suitable forms of legal limitation. Transposing Kuhn’s famous concept, this paper examines a ruling paradigm of biopolitical sovereignty at the Cape of Good Hope through two examples: the 1891 census’ racialized categorizations of the “population”; and a racialized segregation responding to the 1901 bubonic plague. Prefiguring apartheid, both examples indicate how colonial laws authorized discretionary biopowers and yet exempted themselves from monitoring how officials demarcated and governed racialized population groups. The paper touches on the growing maladroitness of positivist ideas about a sovereign “rule of law” in regulating arbitrary biopolitical forces. It concludes by briefly indicating the promise of legal pluralism and Indigenous legalities to check capricious biopowers while pursuing legitimate life-affirming forces.

A self-amplifying RNA vaccine provides protection in a murine model of bubonic plague.

Mice were immunized with a combination of self-amplifying (sa) RNA constructs for the F1 and V antigens of Yersinia pestis at a dose level of 1 μg or 5 μg or with the respective protein sub-units as a reference vaccine. The immunization of outbred OF1 mice on day 0 and day 28 with the lowest dose used (1 μg) of each of the saRNA constructs in lipid nanoparticles protected 5/7 mice against subsequent sub-cutaneous challenge on day 56 with 180 cfu (2.8 MLD) of a 2021 clinical isolate of Y. pestis termed 10-21/S whilst 5/7 mice were protected against 1800cfu (28MLD) of the same bacteria on day 56. By comparison, only 1/8 or 1/7 negative control mice immunized with 10 μg of irrelevant haemagglutin RNA in lipid nanoparticles (LNP) survived the challenge with 2.8 MLD or 28 MLD Y. pestis 10-21/S, respectively. BALB/c mice were also immunized with the same saRNA constructs and responded with the secretion of specific IgG to F1 and V, neutralizing antibodies for the V antigen and developed a recall response to both F1 and V. These data represent the first report of an RNA vaccine approach using self-amplifying technology and encoding both of the essential virulence antigens, providing efficacy against Y. pestis. This saRNA vaccine for plague has the potential for further development, particularly since its amplifying nature can induce immunity with less boosting. It is also amenable to rapid manufacture with simpler downstream processing than protein sub-units, enabling rapid deployment and surge manufacture during disease outbreaks.

Engagement with Traditional Healers for Early Detection of Plague in Uganda.

In rural Uganda, many people who are ill consult traditional healers prior to visiting the formal healthcare system. Traditional healers provide supportive care for common illnesses, but their care may delay diagnosis and management of illnesses that can increase morbidity and mortality, hinder early detection of epidemic-prone diseases, and increase occupational risk to traditional healers. We conducted open-ended, semi-structured interviews with a convenience sample of 11 traditional healers in the plague-endemic West Nile region of northwestern Uganda to assess their knowledge, practices, and attitudes regarding plague and the local healthcare system. Most were generally knowledgeable about plague transmission and its clinical presentation and expressed willingness to refer patients to the formal healthcare system. We initiated a public health outreach program to further improve engagement between traditional healers and local health centers to foster trust in the formal healthcare system and improve early identification and referral of patients with plaguelike symptoms, which can reflect numerous other infectious and noninfectious conditions. During 2010-2019, 65 traditional healers were involved in the outreach program; 52 traditional healers referred 788 patients to area health centers. The diagnosis was available for 775 patients; malaria (37%) and respiratory tract infections (23%) were the most common diagnoses. One patient had confirmed bubonic plague. Outreach to improve communication and trust between traditional healers and local healthcare settings may result in improved early case detection and intervention not only for plague but also for other serious conditions.

Plague Gives Surprises in the Second Decade of the Twenty-First Century.

From 2010 through 2019, the six leading countries by numbers of human plague cases reported to the WHO were, in order from highest to lowest, Madagascar, Congo, Uganda, Peru, Tanzania, and the United States. From these countries, there was a total of 4,547 cases, of whom 786 (17%) died. Top plague events were four outbreaks of primary pneumonic plague in Madagascar that affected 1,936 persons, including index cases, of whom 137 died. One of the outbreaks was caused by a streptomycin-resistant strain of Yersinia pestis. Person-to-person transmission occurred in a taxi, in households with family caregivers, at burial ceremonies and wakes for victims, and at a hospital where cases were treated. Unique clinical presentations in the United States included a dog owner who acquired pneumonic plague from his sick dog, a boy with septicemic plague who developed complications of osteomyelitis and arthritis that required surgery for bone removal and bone grafting, and a prairie dog handler who acquired bubonic plague from a bite by a sick prairie dog. Efficacy of antibiotics in a model of pneumonic plague in African green monkeys for use in bioterrorism revealed the most effective drugs to be gentamicin, ciprofloxacin, and levofloxacin. A recombinant vaccine containing Fraction 1 antigen and V antigen of Y. pestis designed for first responders during a bioterrorism attack and military personnel was tested for safety and immunogenicity but was not licensed for use by the end of the decade.

Can pandemics be predicted?

Epidemics are global phenomena that need to be prevented in advance to save lives and resources. The objective of the research was to predict in the long term when the next pandemic might occur, and how many deaths it might bring, as well as modeling the pandemics that have struck humanity from 165 AD to the COVID-19 pandemic in 2019. Having a forecast in advance would allow Global Health Organizations, such as PAHO and WHO, to be aware of these predictions, and to take measures in a precise and timely manner, so that this does not happen, and if it does happen, to minimize its consequences as much as possible. The Bubonic Plague has been the Epidemic that has caused the most deaths, with 200 million, where the average value throughout history is 27,792,857; generally, epidemics are below 50 million deaths. In this research, 100% of the cases are explained with zero errors, both for deaths and years of occurrence, where the trend of deaths is increasing, and the model depends on the deaths regressed on 11 events. It was possible to predict the number of deaths, as well as the year of occurrence of possible future global pandemics. Health entities, agencies and bodies (PAHO/WHO) should be aware of these predictions and take measures accordingly.

“For Rats Died in the Street; Men in their Homes:” The Pharmacology of the Human-Rat Relationship in Camus’s The Plague

Animals have always embodied the memory and trauma of troubled times in human history. The alienization of animals in terms of their non-human essence results in their gothification, resulting in irrational fears of animals that represent cultural anxieties and taboos. For instance, rats are the most culturally accepted symbol of the ravages of bubonic plague. Even though scientifically proven otherwise, the rat has become one of the indelible animal constructions of fear, Other-ness and the evil with-out, signifying the harbinger of the poison of untidiness and unsanitariness into an otherwise healthy society. This paper examines the sociopolitical conflicts in Albert Camus’s The Plague through the human-rat relationship. It uses the lens of Jacques Derrida and Bernard Stiegler’s conception of the pharmakon, where the pest becomes the pharmakon (a malign/benign entity) as well as the pharmakos (scapegoat) in a society riddled with the pestilence of cleansing the invasive Otherness. We have argued, through key theories in critical animal studies and the theories of pharmacology in discursive psychopolitics, that the rat becomes the Gothic icon in the narrative, exposing human foibles and affects our perception of chaos and order.