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Copyright SCIENCE ARTWORK/SCIENCE PHOTO LIBRARY

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Pneumonic Plague is an infectious disease that negatively affects the respiratory system of infected individuals and it is caused by inhalation of the bacterium Y. pestis, also known as, Yersinia pestis.

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Where was pneumonic plague first detected?

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Where was pneumonic plague first detected?

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The history of pneumonic plague is difficult to pinpoint and is mostly lumped together with its counterpart, bubonic Plague, which has been around for thousands of years; both forms of plague can occur simultaneously.

A study from 2020 hypothesized that the first possible instance of plague occurred in India around 540 CE. However, the most detrimental and well-known plague pandemic (the Black Death) occurred across Europe and started in 1347.

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What was the suspected infectious agent?

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What was the suspected infectious agent?

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By 1894, the development of modern medicine and education provided the path and research necessary to begin to suspect that plague was caused by bacteria and in 1898, this theory was even further supported by biologist Paul-Louis Simond who connected the transmission of the plague bacteria to rodents-- in the case of bubonic plague.

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Plague is most commonly referred to as a zoonotic disease.

Zoonotic disease: an infectious disease that can spread from non-human animals to humans, vice versa.

However, this is not true in regards to pneumonic Plague, which is only transmitted from human-to-human via infected respiratory droplets; classifying it as an airborne disease.

Airborne disease: a bacteria or virus that is spread due to the exhalation and/or inhalation of respiratory aerosols via actions such as coughing, sneezing, and laughing.

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Focusing on a more recent endemic of pneumonic Plague that occurred in Madagascar in 2015, which started in Moramanga and spread to Beravina, Ambilona, and Ambatohoranana.

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This outbreak occurred over a two-week period.

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Approximately how many people were infected?

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Approximately how many people were infected?

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14 people were infected; 10 of which died shortly thereafter. All of the infected individuals experienced illness and plague symptoms such as dyspnea, chest pain, and cough. It was later discovered that roughly 35 more individuals were carrying the F1 antibody, which is the plague antibody. These individuals did not experience symptoms or death.

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-Virulence references the level of harm a pathogen can cause its host organism; or a pathogen's ability to cause disease.

In regards to Yersinia pestis (the causative agent of pneumonic Plague), it is a HIGHLY virulent pathogen. When it infects an individual it causes severe respiratory distress; is highly transmissible; and *untreated* individuals have a mortality rate of nearly 100%.

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No, the virulence of pneumonic Plague remains the same in Modern times and is just as virulent as it was hundreds of years ago. Y. pestis is classified as a "Tier 1 Select Agent by the [CDC], and a Category A Priority Pathogen by the [NIH]," and because of its high virulence, it still has the potential to lead to endemics on the continents of Asia, Africa, North and South America, and Europe.

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How was the plague handled by the health care community?

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How was the plague handled by the health care community?

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Well, over the course of the last hundred years or so, the plague (bubonic, septicemic, and pneumonic) has become less common with the CDC stating that there are roughly 1000-2000 cases per year-- worldwide. However, with such a long history of causing epidemics and having high virulence, the plague has helped with innovation within the medical field; an example being the Plague Doctor's in 17th century Europe, which was one of the first instances of PPE being used to protect medical professionals against pathogens. In more recent decades, the health care community is very educated and well-versed in plague epidemiology, pathogenicity, and microbiology; with doctors and nurses being highly trained in recognizing signs and symptoms of the plague.

When diagnosed with plague, patients are treated with antibiotics and typically isolated from others, especially if it's pneumonic plague.

Scientists are also working on the development of a "genetic-based" vaccine in response to Y. pestis bioterrorism incidents.

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What medical advances were used in combating the plague?

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What medical advances were used in combating the plague?

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In, Medieval times, face coverings and/or masks helped prevent the "poisonous air" or "killing mists" from being inhaled. This is a simple thing, but one of the most important advances in the prevention of the spread of airborne pathogens. Eventually, quarantine was also supported by some physicians in the 19th century; to prevent the spread of the plague.

The plague also led to a lot of questions and doubts surrounding medical dogma and the Galenic system of medicine, and really helped foster a new era of medical ethics and practices; with more focus on human anatomy and cleanliness. This led to European hospitals implementing standards of cleanliness and being used as a base for the isolation of sick patients, much like modern hospitals.

Eventually, with the discovery of microorganisms and the development of modern medicine, doctor's were able to treat plague patients with antibiotics by the 1930s.

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Were any new technologies applied to the plague? What were they?

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Were any new technologies applied to the plague? What were they?

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Overall, new technology was not applied to the plague until antibiotics were introduced in the 20th century. This coincides with the invention of the microscope and the use of it to discover microorganisms, including Y. pestis via culture in 1894, which allowed for medical professionals to accurately diagnose plague patients.

Additionally, in modern times, we are able to use rapid diagnostic tests (RDTs) to detect Y. pestis-specific antigens in patients in a quick manner.

Lastly, vaccine technology is currently being used to develop a vaccine for all plague varieties; and in 1999, scientists were able to develop a "formalin-killed whole cell vaccine" that was effective in protection against bubonic plague.

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How was the disease handled by the leadership and/or governmental bodies?

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How was the disease handled by the leadership and/or governmental bodies?

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It is hard to determine how pneumonic plague has been handled by leadership, as it is such an ancient, widespread disease; with no specific countries in which it is persistently prevalent; however, overall, it is prevalent in third-world countries and almost non-existent in first-world countries like the United States.

In the instance of a pneumonic plague outbreak in another country, that has the potential to be imported into the U.S., out government would inact 3 steps in response to such a threat: surveillance, evaluation, and implementation of control measures. This would include sending epidemiologists to the country of origin, to increase surveillance and gather data; which could lead to travel advisories for international travels, and increased surveillance at domestic airports. Additionally, if the threat is great, state health authorities would be notified and would be advised to institute prompt diagnoses and treatment for individuals who are suspected to be infected. Quarantine may also be required.

The CDC may also feel more imminent pressure to create a vaccine.

These are all steps that would be taken by U.S. leadership in the instance of a pneumonic plague outbreak.

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Were any innovative initiatives used in combating the disease?

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Were any innovative initiatives used in combating the disease?

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Yes, plague or the Black Death in Europe in the 14th century led to authorities discovering the importance of sanitation, especially in public spaces, as well as, the effectiveness of quarantining infected individuals; both of which were very innovative approaches at the time.

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What could leadership have done better in response to this disease?

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What could leadership have done better in response to this disease?

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During the Black Death, leadership in Europe did the best they could with the limited knowledge they had of the human body and microorganisms--- which weren't discovered yet; and since then, with the discovery of microorganisms and pathogens like Y. pestis, and the development of antibiotics, governmental entities have responded to plague outbreaks in an effective manner.

I would have to say that in terms of what leadership could do better when it comes to pneumonic plague, is to have an effective vaccine created to prevent epidemics and to have a better/higher budget allocated to the plague research division at the CDC. This would allow for more room for scientists to specialize in plague research; granting us a better chance at developing a successful vaccine.

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Beyond the physical effect, what was the societal and sociological impact of this disease?

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Beyond the physical effect, what was the societal and sociological impact of this disease?

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Going back to the plague epidemic of Europe in the 14th century, where the most prominent effects of the plague on society took place, we can understand that there were many societal and sociological impacts on the population. To start, the plague led many people to abandon their families and their friends, and to flee the cities. Funerals ceased and people were unable to give their loved ones proper burials. Additionally, faith in God and devotion to religion decreased drastically due to the failure of prayer and the deaths of most clergymen.

The price of goods were also inflated, and since it was very difficult for businesses to find workers-- due to the sheer amount of deaths from the plague, the wealthy had to provide higher wages to peasants in order to keep up with demand and the cost of living. All of this meant that people could not gather and/or celebrate special occasions or grieve properly.

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Most notably, the distinctions of class began to blur, as peasants were being paid more and serfs were no longer constrained to a singular master. So, the upper class relied on extravagant fashion to define their societal/economic status. Eventually, peasants were confident enough in their status to riot and revolt against the aristocracy; which created the basis for the Renaissance and Reformation.

Additionally, hospitals were no longer reserved for the nobility, as they catered to the whole.

The plague also affected the arts, and began an era of very morbid and pessimistic paintings, sculptures, and music.

Lastly, with the lack of religious devotions and general pessimism about in society, people stopped having children; to avoid loss, save money, and decrease stress.

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Did society learn from the physical effect of the disease?

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Did society learn from the physical effect of the disease?

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As a whole, no. European society was essentially clueless to the cause of the plague until the end and while numerous "treatments" were performed by "experts," they never led to a cure; which "naturally" led to less inquisition by society, and to more persecution of anyone who had a skin disease like psoriasis or acne... or if they were Jewish.

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What was the most revealing aspect you learned about your disease?

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What was the most revealing aspect you learned about your disease?

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The fact that pneumonic plague is still prevalent and extremely virulent, and that the causative agent Y. pestis could be used for bioterrorism. This just depicted how dangerous the disease is, and I previously only associated it with the Black Death and did not understand that it still causes epidemics.

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What did you learn about your disease that surprised you?

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What did you learn about your disease that surprised you?

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I think the lack of development for a successful vaccine for pneumonic plague, surprised me. Mostly because we've had nearly 100 years to create one. However, it is clearly a powerful disease that we have yet to crack; but scientists are getting closer to the answer.

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What did you come across in your research that should've been a part of the Padlet assignment?

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What did you come across in your research that should've been a part of the Padlet assignment?

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Well, in my research, I came across information about Y. pestis being a potential bioweapon and the question that could be asked for other disease options: "Can your disease be used for bioterrorism?" Which would help spread more awareness of bioterrorism incidents and could lead to students researching the terminology and further understanding what to do if they ever find themselves in such a situation.