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July 6, 2017

The 'Black Death' is alive and well—albeit rare—in New Mexico

Daily Briefing

The plague—commonly thought of as an antiquated disease from the Middle Ages—has again infected several people in New Mexico, proving that while the disease may be less prominent than it used it to be, it is no less serious.

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According to the New York Times, two new cases of plague have been reported in New Mexico, bringing the total number of reported cases for the area to three so far this year.

What is plague?

According to the Times, the plague comes in three forms: bubonic, pneumonic, and septicemic. Each version of the plague is spread by the Yersinia pestis bacterium (transmitted to humans by fleas found on rodents), and all three versions share some general symptoms, such as fever, chills, and weakness.

The bubonic plague is perhaps the best-known version of the disease, the Times reports, as it's the one that killed millions of people hundreds of years ago. Symptoms of bubonic plague include swollen and painful lymph nodes that appear suddenly in the groin or armpits.

Meanwhile, the pneumonic plague manifests itself in the form of rapid and very severe pneumonia. According to the Times, it is the only version of the plague that can be spread from human-to-human through the air. 

The third form of plague, septicemic plague, attacks the blood cells and can cause skin and other tissue to turn black and die, especially on the hands and feet. This version, according to the Times, is typically caused by a flea bite or if someone handles an infected animal.

A dangerous disease

Although far less common than it was in the Middle Ages, the plague remains quite dangerous, the Times reports.

Paul Ettestad, the public health veterinarian for New Mexico, explained that while the disease is treatable with certain antibiotics, it has to be identified and treated quickly. According to the World Health Organization (WHO), 50 to 60 percent of bubonic plague cases are fatal if not caught and treated promptly. And WHO said the other versions of the plague—pneumonic and septicemic plague—are almost "invariably fatal," with just a few people surviving such a diagnosis.

While improvements in sanitation and living conditions have stemmed cases of the plague, it has not been eradicated. Overall, between 2000 and 2009, the American Society for Tropical Medicine and Hygiene (ASTMH) reported 21,725 cases of plague worldwide, with 1,612 of those being fatal. The majority of the cases identified since the 1990s have been in Africa, specifically in Congo and Madagascar. In the United States, according to ASTMH, 56 cases were reported, of which seven were fatal.

Pritish Tosh, an infectious disease physician and researcher at Mayo Clinic, explained that plague is difficult to eradicate because it comes from animals, rather than from humans alone. "When there is a zoonotic disease, or its coming from animals, there is a reservoir that is going to exist unless you get rid of that reservoir," he said, and that would mean completely eradicating the animals that carry the plague.

Persistent US cases

Most of the cases in the United States occur in the western United States, such as Arizona, California, Colorado, Nevada, New Mexico, and Oregon, according to CDC. It's been especially prevalent in New Mexico, with four cases and one death in 2015, and four more cases—non fatal—reported in 2016. And state officials just last month reported two more cases, bringing the total for this year up to three.

According to Ettestad, New Mexico's environment is a major factor as to why the disease remains so stubbornly persistent. He explained that vegetation common in the state, such as pinyon and juniper trees, house "a wide diversity of rodents and fleas," which means that plague-carrying fleas have a lot of options when it comes to finding a host.

For instance, Ettestad said many people in the state "have rock squirrels in their yard, and when they die, their fleas are very good at biting people." He added, "We have had a number of people who got plague after they were bitten by a flea that their dog or cat brought in the house."

How to ward off the plague

But while the disease might be sticking around for the foreseeable future, there are precautions you can take to prevent infection, CDC said. For instance, you can reduce rodent habitats around the home, treat pets for fleas, and wear bug spray when camping, especially in areas where contact with fleas is likely. And if you show symptoms while visiting or residing in an area where the plague is found, you should check with your doctor as soon as possible, according to medical professionals (Stack, New York Times, 6/27; Bowerman, USA Today, 6/28).

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