Updated 30 October 2017

SA on alert: what you should know about the 'black death' plague

The World Health Organization recently warned South Africa to be on high alert for the bubonic plague. But what exactly is this?

News24 reported on 25 October that South Africa is one of nine countries warned by the World Health Organization (WHO) to take precautionary measures for the "black death" plague, also known as bubonic plague, which can be treated successfully with antibiotics. 

The other eight countries include the Comoros, Ethiopia, Kenya, Mauritius, Mozambique, France's La Réunion, the Seychelles and Tanzania.

This followed after a recent outbreak in Madagascar in September 2017.

Ever since, the WHO has been concerned that the disease will spread – 124 people died and 1 133 people were infected. 

Read more: Update: Bubonic plague - what is being done in SA?

One of the biggest pandemics in history

The WHO stated that the disease can be treated in the present day with antibiotics, but in the fourteenth century this disease was still responsible for causing 50 million deaths across Europe. 

Bubonic plague – the facts

Bubonic plague is an infection of the lymphatic system, pneumonic plague is an infection of the respiratory system and septicemic plague is an infection in the blood stream.

While bubonic plague is transmitted to humans via fleas living on rats, pneumonic plague is the most virulent and least common form of the plague and can be inhaled and transmitted between humans without involvement of animals or fleas.

It occurs when Yersina pestis bacteria infect the lungs and cause pneumonia and, without treatment, it can kill within 24 hours. 

What are the symptoms?

The symptoms include sudden fevers and chills, headaches, body aches, weakness and shortness of breath, chest pain and cough, sometimes coughing up blood and blood in the sputum.

How is it treated?

Antibiotics are effective in the treatment of plague, and should be started as soon as possible to prevent complications. The antibiotics used for treating plague include tetracyclines (such as doxycycline), fluoroquinolones (such as ciprofloxacin) and amingolycosides (including streptomycin and gentamycin).

History of bubonic plague

The bubonic plague signified real terror in urban communities for hundreds of years. Spread by airborne bacteria or by infected fleas living on rats in unhygienic urban conditions, this disease wiped out two-thirds of the inhabitants of parts of Europe in the 14th century.

The plague returned for centuries, often in the summer months. It is thought that the Great Fire of London in 1666 was largely responsible for ending this scourge in London, as it destroyed many of the favourite haunts of the rats which bore the infected fleas.

But in other areas, including modern urban environments, the Black Plague (aka Black Death) is still a reality – although a lot less terrifying since the advent of antibiotics.

Here are some more facts about this disease

  • The pneumonic plague, which was spread via the coughing of infected people, had a death rate of 100%.
  • In the 14th century it killed almost two-thirds of the inhabitants of northern Europe – mostly within three or four days of the time of infection.
  • In 1347 the inhabitants of Genoa shot burning arrows at a naval vessel returning from war in the Crimea known to have Bubonic plague on board.
  • It spread nevertheless and, in four years, killed 75 million people in Europe, often more than half the population of a given country.
  • It was called the "Black Plague", because of the black discolouration of toes and fingers as a result of coagulation of the blood in these body parts.
  • No one knew then what caused it. However, it turned out that fleas were spreading the plague from infected rats. But for many years people believed that the disease was spread by filthy air. Often household pets or rats were the first to die – they were blamed for this disease, which lead to the killing of many pets as a (useless) preventative measure.
  • The other two types of plague are pneumonic plague (which was also rampant in the 14th century) and septicaemic plague.
  • Bubonic plague is the most common form of plague. It occurs when an infected flea bites a person or, in rare cases, when material contaminated with the Yersinia pestis bacterium enters through a crack in the skin.

    The information in this article originally appeared in a previous article published on Health24.