The plague: 1,000 yearly infections, from medieval millions to Madagascar and Congo

The plague, which killed an estimated 75 to 200 million people in Europe between 1347 and 1353, still causes about 1,000 infections annually today, primarily in Madagascar and Congo, with a recent suspected fatal case in Russia. The disease has three main forms: pneumonic, bubonic, and septicemic. Pneumonic plague spreads via respiratory droplets, while bubonic plague enters through flea bites and affects lymph nodes. Transmission between humans requires close contact with a severely ill person, making it far less contagious than COVID-19. There is no vaccine for plague, but effective antibiotics can significantly reduce mortality risk. Infection can also occur through contact with infected animals or their products, though this is mainly limited to regions where the disease is known to be endemic.