You have just spent a weekend hiking in New Mexico. At work on Monday, you get a terrible headache and fever and leave early. The following morning, you are a wreck: your entire body is aching, you feel dizzy and disoriented, and cannot keep your breakfast down. Your diagnosis is a bad case of the flu, and you visit the doctor for some medication. But instead of getting a shot and prescription for chicken soup, your doctor examines you and rushes you off to the hospital. The truth is far from a bad cold. You are in fact, the latest victim of one of the most devastating diseases in human history: bubonic plague.
If this story sounds fantastic, think again: Although it has kept a low profile, the disease that killed almost half of Europe in the Middle ages is alive and well in the world. Isolated pockets of plague have been continually reported on almost every continent. In the last ten years, over 160 humans have contracted bubonic plague in the United States, resulting in 23 fatalities. Most of these cases were contracted through contact with wild squirrels in the Western U.S., primarily in California, New Mexico, Colorado, and Arizona. Epidemiologists at the Center for Disease Control in Fort Collins, Colorado are keeping a wary eye on human plague, continuing to educate the public about the dangers of this centuries-old disease.
Bubonic plague is caused by the bacterium Yersinia pestis, and is usually transmitted by the bite of a flea who has fed on an infected animal. In the Western United States, Ground Squirrels are the primary carriers, but people have become infected from animals as varied as antelope and house cats. People can also contract plague through exposure to body fluids of infected animals, placing hunters and naturalists at particular risk. There is no way of positively identifying an infected animal outside of a laboratory.
The early symptoms of bubonic plague look deceptively like a bad cold. It starts with annoying headaches and fever up to a week after the initial infection. The disease then progresses rapidly, inducing vomiting, muscle pain, and delirium. Lymph nodes near the site of the bite begin to swell up, forming buboes, from which the disease gets its name. Death is almost certain if not treated within a day of the onset of symptoms.
The most terrifying form of plague is not spread by fleas, but man. If left untreated, the disease spreads throughout the body and can infect the lungs. Pneumonic plague can be transmitted by coughing infected droplets into the air, posing the greatest danger to the population at large. In this form, it has already adapted itself to the human body, and the onset of the disease is much more rapid, and the symptoms are more severe. Pneumonic plague is believed to be responsible for the famous Black Plague that killed an estimated 75 million people in fourteenth century Europe.
The rarity of plague is in itself one of its greatest dangers. If diagnosed in time, treatment with antibiotics is very effective in curing the disease. Because the incidence is so low, however, both the public as well as the medical community are not aware of the symptoms or treatment. "It is difficult to get the medical community to take seriously a disease that only has a few cases a year," notes Dr. Allan Barnes, Chief of the Plague Section of the Bacterial Zoonoses Branch of the Center for Infectious Diseases in Fort Collins, Colorado. "But the possibility of an outbreak of pneumonic plague always exists. The medical community, especially in the Western United States, needs to be aware of what to look for and how to treat it." The majority of cases occur in children and young adults under twenty, because that is the age group most likely to be spending time outdoors and having contact with an infected animal.
Thankfully, the specter of another massive epidemic of the Black Death is relatively remote. Rats and their fleas are the most effective transmitters of the disease, and people of the Middle Ages in Europe paid little attention to them. But education and changing attitudes towards personal hygiene have reduced the population of rats in inner cities. "People in developed countries have been educated for generations about the hazards of rats. They just don't tolerate them any more," says Barnes. In addition, national and international health organizations are quietly monitoring plague outbreaks to make sure that they do not become epidemic.
As we survey the world around us, we have progressed far since the Middle Ages. But it is still a little humbling to realize that as we move into the twenty-first century, the fourteenth still haunts us.
--Kevin Self
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