Disease pestThe Plague (v. lat. pestis = plague) is a highly contagious disease caused by the bacterium Yersinia pestis is caused. It is originally a zoonosis of rodents (groundhogs, rats, squirrels), in whose populations it can be enzootic. Hence the term "silvanic plague" (from the lat. silva "forest") in the case of people directly infected by them.
In several major pandemics, this disease repeatedly affected significant portions of the world's population, having a lasting impact on human history. The course of European history was marked above all by a major pandemic in 14. Century. However, since at that time any means for an exact diagnosis of the disease as well as clearly usable eyewitness reports were still missing, it is not proven beyond doubt that at that time it was the plague in the actual sense (Yersinia pestis as pathogens) acted. This pandemic is the subject of a separate article entitled Black Death.
Table of Contents
One distinguishes four manifestations of the plague: Bubonic plague also Bubonic Plague called (lat. bubo "bump"), Plaguepsis, pneumonic plague as well as the abortive plague. During pandemics all forms of the disease occur, but most often bubonic plague and pneumonic plague. Without treatment, bubonic plague almost always develops into plague sepsis, which leads to pneumonic plague.
In the case of bubonic plague, infection usually occurs through the bite of a rat flea, which carries the pathogen as an intermediate host. By changing hosts, the bacterium is transferred from an infected to a previously healthy food victim after it has multiplied in the flea.
As a stationary parasite, the rat flea is actually closely bound to its host animal. It infects humans only when it can no longer find a suitable host. Therefore, at least the bubonic plague was always preceded by mass rat deaths.
Incubation period is a few hours to seven days. The symptoms are fever, headache and pain in the limbs, strong feeling of illness and drowsiness. Later, there are disturbances of consciousness. The name bubonic plague comes from the severely swollen, very painful bumps on the neck, armpits and groin that result from infection of the lymph nodes and lymph vessels in the area of the flea bite. These bumps can reach a diameter of up to ten centimeters. Are blue-black in color due to internal bleeding in the lymph nodes. The ulcers disintegrate after they are fused with pus.
Bubonic plague as such is not fatal, and the bumps can heal on their own. Surgical intervention (splitting the bumps) is contraindicated because of the inevitable spread of the bacteria via the bloodstream to other organs that this entails. However, in 25% to 50% of untreated patients, the bacteria spread via the bloodstream (hematogenous dissemination), resulting in plague sepsis and also infestation of other organs (secondary plague), z. B. to pneumonic plague or a spread of the pathogens with extensive skin bleeding. These forms lead untreated in 90-100 % of the cases to the death.
The bubonic plague spreads more slowly in winter than in summer, because the vector flea goes into cold torpor at temperatures below 12°C. The epidemic peak of this type of plague always coincided with the reproductive season of fleas in autumn.
Plague sepsis is caused by the bacteria entering the bloodstream from their place of multiplication. This can happen by infection from the outside, for example via open wounds, but can also be a complication from the other two severe courses, for example by the plague buboes bursting inwards. The pathogens in the blood spread throughout the body with the bloodstream. The infection causes high fever, chills, headache and a general malaise, later extensive skin and organ bleeding. Plague sepsis is practically always fatal if left untreated, usually after 36 hours at the latest.
Today, the mortality can be significantly reduced by treatment with antibiotics.
When the pathogens enter the lungs via the bloodstream in the course of bubonic plague pestis, it is called secondary pneumonic plague. However, if it is transmitted from person to person by droplet infection, we speak of primary pneumonic plague.
Pneumonic plague is more severe than bubonic plague because the defense barriers of the lymph nodes are bypassed by direct infection of the lungs. It begins with shortness of breath, coughing, blue coloration of the lips and black-bloody sputum, which is coughed up extremely painfully. This develops into pulmonary edema with circulatory failure, which leads to death after two to five days if untreated.
The incubation period is only one to two days, and the mortality rate here is 95%.
Abortive plague is the harmless variant of plague. It usually manifests itself only in a mild fever. Slight swelling of the lymph glands. After overcoming infection, antibodies were formed, which ensure long-lasting immunity against all forms of the disease.
"On the morning of 16. April, Bernard Rieux, a doctor, stepped out of his apartment and stumbled across a dead rat in the middle of the hallway (…) That same evening, he saw a fat rat emerge from the darkness of the hallway, with damp fur and an unsteady gait. The animal stopped, seemed to seek its balance, turned on the doctor, stopped again, spun in a circle with a low cry, and finally fell to the ground, blood gushing from its half-opened lips …"
With these lines, the French Nobel Prize winner Albert Camus introduces his novel The Plague, published in 1947 and set in Oran. Although Camus' work is fictional, he aptly describes the great rat die-off that tends to precede a plague epidemic. Fleas, but especially the rat flea Xenopsylla cheopsis Play crucial role in transmission of plague pathogen to humans.
Fleas are parasites that parasitize on the outside of their host, but occasionally harbor parasites inside themselves and can infect their host with this parasite. The plague bacterium is such a parasite. If the rat flea moves from an infected rodent – for example the Norway rat or the house rat – to another host after its death, it is able to infect this host with the plague bacterium. The rat flea prefers rats as a new host, for which the plague is just as deadly as for humans. However, if there is a lack of rats, the rat flea also takes on humans as new hosts and then also infects them with the plague bacterium (zoonosis). This situation arises especially when many rats die due to the plague.
The question of which other flea species besides the rat flea are involved in the transmission of plague has been controversial among natural scientists and medical historians since the 1950s. In the meantime, there is agreement that about 30 flea species are conceivable as carriers of plague bacteria, including the human flea (Pulex irritans). Moreover, the plague bacterium can survive for extended periods without an animal host – for example, in soil, dust, feces or animal carcasses – and from there infect disease victims. In addition to this indirect infection by means of the flea as intermediate host, however, there can also be a direct infection on infected rodents or humans via open wounds and saliva. If the pathogen enters the pulmonary bloodstream in humans, secondary pneumonic plague develops with highly infectious bloody sputum. Anyone who has contact with a patient suffering from it can be directly infected with this so-called primary pneumonic plague. Once the plague bacterium has jumped from a rodent population to humans, direct infection very quickly becomes the main route of infection. As few as 100 to 200 inhaled pathogens are enough to cause infection.
Also predators that have eaten infected rats can transmit bacteria and fleas. Domestic cats also contract the plague, but this is not known from dogs. These ways of transmission are rare in normal cases, but play a role in the context of larger pandemics.
Wild rodent populations as a refuge for the plague bacterium
Plague bacteria are still found in wild rodent populations today – such as prairie dogs, ground squirrels and marmots. These populations are the natural reservoirs of the plague bacterium, from which domestic rodents such as rats are occasionally infected.
While no infected animal populations are known in Europe and Australia, such populations occur in the Caucasus, Russia, Southeast Asia, the People's Republic of China, Mongolia, South and East Africa, Central and South America, as well as in the southwestern USA.
The pathogen reached North America via a merchant ship during a plague epidemic that raged in Southeast Asia from 1894 onwards. Although very few people in North America contracted plague, the pathogen infected the American squirrel population. Occasionally, therefore, there are still animal-to-human transmissions in North America today. It is usually hunters who contract the disease from a rodent; Norman F. However, Cantor also points to a North American case from the 1980s in which a woman ran over a squirrel with a lawn mower and contracted the plague in the process.
The plague outbreak in the Indian city of Surat in 1994 therefore confirms the statement that Camus already made in 1947 towards the end of his novel The Plague Does:
"As Rieux listened to the cries of joy that rose from the city, he remembered that this gaiety was constantly threatened. For he knew what was unknown to this happy crowd and what was in the books: That the plague bacillus never dies out or disappears, but can lie dormant for decades in the furniture and the linen, that it waits patiently in the rooms, the cellars, the suitcases, the handkerchiefs and the bundles of old papers, and that perhaps the day will come when, to the misfortune and instruction of man, the plague will awaken its rats and send them out again (…)" 
Worldwide, the World Health Organization (WHO) registers about 1000 to 3000 cases of plague per year, mostly in the form of smaller, localized epidemics. In Europe, the last documented plague outbreak occurred during World War II. It is amed that the plague no longer exists in Europe at present.
Diagnosis and therapy today
Diagnosis is made by detecting the pathogens in the blood, in the secretions of the buboes or, in the case of pneumonic plague, in the sputum. Antibodies can be detected from the tenth day of illness onwards.
Today, the plague is treated with antibiotics, and if detected early, there is a good chance of a cure. Active agents used include streptomycin and chloramphenicol as well as combinations of tetracyclines and sulfonamides. Streptomycin can only be administered intramuscularly. Chloramphenicol is highly effective, but because of its side effects it is considered only as a reserve drug.
In addition, vaccinations are available, but they only provide immunity for three to six months, and only for bubonic plague, not for pneumonic plague. However, the authors Eberhard-Metzger and Ries point out the poor tolerability of these vaccinations. The World Health Organization therefore recommends vaccination only to at-risk groups, which include farmers, farm workers and hunters in regions where infected rodent populations are common, for example.
Other measures to contain a plague epidemic include improved sanitation, rat control, and preventing the transport of rats on ships. After the death of the rats, the fleas change their host, so people have to be protected from the fleas with insecticides.
Quarantine and mandatory reporting
Plague, along with hemorrhagic fever (Ebola, Lassa u. A.) in Germany to the two quarantine diseases according to § 30 Infection Protection Act. Patients suffering from such diseases have to be screened in special infection wards. Cross-national quarantine regulations for ship, air, train or motor vehicle traffic are laid down in the international sanitary regulations of 1971. A hint of plague, the disease of or death from plague must be reported by name in Germany under the Infection Protection Act, even if suspected. Reports are forwarded by health departments to the state health authority and the Robert Koch Institute. In accordance with international agreements, the Robert Koch Institute reports them to the World Health Organization.
The plague pathogen as a biological weapon
The plague pathogen is listed by the World Health Organization as one of the twelve most dangerous biological warfare agents. To this so-called dirty dozen include, in addition to the pathogens of the plague, those of anthrax and tularemia, as well as smallpox, Ebola and Marburg viruses.
The first historically documented use of plague as a biological weapon took place in the Genoese port city of Kaffa in 1346, when the Tartar leader Khan Djam Bek had plague corpses thrown over the walls of the city and the besieged fled to Italy to escape the plague.
During the second Sino-Japanese War, the Japanese army set up a biological Unit 731 prison camp near Harbin in Manchuria, the Japanese army produced weapons containing plague-infected fleas, the use of which caused local outbreaks of plague in the Republic of China from 1940 to 1942. When the Japanese army destroyed the production facilities at the end of the war in 1945, rats infected with plague were released and caused an epidemic in Heilongjiang and Jilin provinces with more than 20.000 fatalities from.
At the time of the Cold War, Russian scientists (in the Russian institute BIOPREPARAT, headed by Dr. Ken Alibek) the Directorate 15 with the use of plague pathogens as a biological weapon. As the former Russian biological weapons researcher Alibek reported, Russia succeeded in the late 1980s in transforming the plague into a sprayable form and making it resistant to antibiotics.
In Germany, the Robert Koch Institute was concerned with the dangers of biological warfare. There was also the Federal Biosafety Information Center (IBBS) established. How great the danger of an attack with biological warfare agents actually is is disputed. The IBBS does not advise vaccination against the plague in Germany. This recommendation applies to the population as a whole as well as to risk groups.
Plague, smallpox and anthrax
The outbreak of major epidemics is already reported in the Bible: The "plague" belongs to the plagues that afflict Egypt, and it also triggers the mass death of the Philistines, who had seized the Jewish Ark of the Covenant. Historians cite a variety of possible causes. The spectrum ranges from Ebola-like diseases, smallpox, a cow-borne anthrax infection to gonorrhea. As far as the ways of infection and the symptoms are concerned, besides smallpox, spotted fever, cholera, typhoid fever and measles are more likely to be considered as alternatives to the plague.
Ultimately, the word Plague from the latin pestis and, like the Greek loimos nothing else than "pestilence. It also stands for misfortune, ruin, perishable person or thing, monster, fiend, torment, suffering, famine. Classical texts, from the ancient Near Eastern Epic of Gilgamesh (c. 1800 a.c.), from the Aeneid to the Iliad to the Bible, therefore refer to all major epidemics as plague. Historians are of the opinion that the epidemics were actually triggered by the plague pathogens mentioned below.
Antiquity to early Middle Ages
The great plague in ancient Greece
An archaeological site excavated in the years 430-426 b. Chr. The epidemic raging in Athens has attracted the interest of historians and physicians for many years. Among other things Attic plague and – in a misunderstood transcription of the Latin pestis (pestilence) – also called "The Plague of Thucydides". For a long time, many scholars amed that this was either the plague itself or smallpox. However, that this plague was caused by plague agents is now strongly doubted, as Thukykides did not describe the typical characteristics such as plague bumps and blackish spots on the skin. Since the symptoms described do not fit any disease known today, historians and physicians have long discussed other pathogens – now a total of 29 – as possible triggers.
New excavations in 1994/95 under the direction of archaeologist Effie Baziotopoulou-Valavani and subsequent investigation by Manolis Papagrigorakis and collaborators in 2005 identified the pathogen Salmonella enterica serovar Typhi by DNA studies.
Whatever the cause, in Athens the epidemic led to a dramatic decline in population and a breakdown in the social fabric, with fatal economic consequences and military and political decline – quite comparable to the effects of later, clearly documented plague epidemics.
The plague in the Roman Empire
The Roman Empire was also hit several times by major epidemics. The first was the so-called Antonine Plague at the time of Emperor Marcus Aurelius (161-180), which was spread by soldiers returning from the Parthian Wars in 166. Whether this epidemic was the plague, however, is also unclear. Plague waves with profound effects on the Roman Empire occurred especially in the period between 250 (Cyprian plague) and 650 n. Chr. at.
The so-called Justinian Plague at the time of Emperor Justinian (527-565), which broke out in Constantinople in 542, possibly contributed to the failure of the Restauratio imperii and is considered the largest ancient plague epidemic in Europe or. First plague pandemic. It first broke out in the Orient, from where it spread rapidly throughout the Mediterranean region. 
On the basis of the detailed descriptions of the late antique historian Prokopios, most researchers ame that this epidemic was in fact the bubonic plague, which perhaps occurred together with other diseases. In 544 Justinian, who had been ill himself but had survived, announced the end of the plague epidemic. However, it broke out again in 557, returned again in 570, and continued until the middle of the 8th century. Century in approximately twelve-year rhythm again and again in appearance. Around 770, the plague disappeared for more than five centuries.
From the early Middle Ages until the outbreak of the so-called Black Death in the second half of 14. In the middle of the sixteenth century, Europe seems to have been largely spared from the plague.
The "Black Death" – the medieval plague epidemics
Main article: Black Death
The epidemic had apparently been in the 30s of the 14. It broke out in Central Asia in the middle of the sixteenth century. Spread along the trade routes towards Europe as well. In 1347 it reached Kaffa in the Crimea. Kaffa, today's Feodosiya, was a Genoese trading city closely integrated into the Genoese trade network, which extended over the entire Mediterranean region. Spread by ships, the disease reached the coastal cities of Constantinople, Cairo and the Sicilian city of Messina in the same year. Around All Saints' Day 1347 the epidemic had already reached Marseille and the Rhône valley, in March 1348 Toulouse, in May the first victims fell ill in Paris, in August the first died of the plague in Avignon. Germany, Norway, Sweden and England were reached by the plague in 1349. It is estimated that about 20 to 25 million people, about a third of the population of Europe at the time, perished as a result of the Black Death. For Germany, the number of plague deaths is estimated at about 10 percent of the population  . About the number of victims in Asia. Africa there are no serious data. However, any figures should be treated with caution, as contemporary sources tended to overstate the number of dead in order to emphasize the horror and ruthlessness of this pandemic.
The Black Death did not ravage Europe evenly, but left a few areas almost untouched. Large parts of Poland, Belgium, and southern Germany, for example, were spared from this first wave of plague. Milan also escaped the ravages of the plague, while in Florence four-fifths of the citizens died. In the introduction to his collection of novellas Decamerone Boccaccio impressively describes the devastating effects of the epidemic:
"Thus, anyone who would have walked through the city – especially in the morning – could have seen countless corpses lying around. Then they sent for stretchers or, lacking them, laid their dead on a bare board. It also happened that on one stretcher two or three were carried away, and not once, but many times could have been counted, where the same stretcher carried the bodies of the man and the woman or two and three brothers and the father and his child." 
Many of the people perceived the plague as a punishment from God. Religious movements arose spontaneously in the wake of or in anticipation of the plague: one of the most conspicuous was the movement of the flagellants, who, as penance for their own sins as well as those of society, flagellated themselves in public processions and preached repentance and conversion in the cities. They saw themselves as direct mediators between heaven. Earth – without the intervention of ecclesiastical authorities. Pope Clement VI. therefore forbade public self-flagellations as early as 1348, without, however, being able to enforce this prohibition.
Already at the beginning of 1348 the rumor had arisen that the plague was spread by well poisoning. In Holy Week, Jews were persecuted for the first time in Provence because of the plague; the accusation that they dripped poison into fountains and springs, thus spreading the plague, is found a little later in the sources. In Savoy in the fall of 1348, Jewish defendants pleaded guilty to such offenses under torture. The confessions spread rapidly and formed the basis for a wave of Jewish pogroms, especially in Alsace, Switzerland, and Germany. Not infrequently, the Jews were caught between the fronts of older conflicts, such as in Strasbourg. The situation of the Jewish minority in the empire was extremely precarious due to the disputes between the houses of the Wittelsbach and the Luxembourgers.
After the subsiding of a first wave of pogroms around March 1349, this large-scale situation was responsible for the beginning of a second wave: In the struggle for the loyalty of individual cities (Frankfurt am Main, Nuremberg), Charles IV. the Jews at the mercy of the interests of the urban ruling groups. The often claimed responsibility of the flagellants for the Jewish pogroms can be proven in the rarest cases, most likely for Cologne. In most cases it is true that the Jews were murdered before the arrival of the plague. In Bohemia and Austria they were protected by the sovereignty, in Regensburg by the municipality.
In the long run, the plague caused and accelerated a profound change in medieval society due to the massive population collapse, the long-term effects of which were also viewed positively. Thus David Herlihy described the plague as a The hour of the new menThe depopulation allowed a larger percentage of the population access to farms and rewarding jobs. Land that had become unprofitable was abandoned, which in some regions led to villages being abandoned or not repopulated (so-called deserts). The guilds now admitted members who had previously been refused admission, and while the market for agricultural rents collapsed, wages in the cities rose significantly.
Doubts and new findings
The identification of the medieval plagues with the disease caused by Yersinia pestis was and still is doubted several times, for example by the historians David Herlihy, Samuel K. Cohn and Sue Scott, the zoologist Chris Duncan, and the anthropologist James Wood. In particular, the objection that neither the rapid rate of spread at the time nor the historically described signs of the disease corresponded to those to be expected in a bubonic plague is valid. Also, no expected epizootic in domestic rats had been observed at that time.
Alternatively, the possibility is now discussed that it could have been either anthrax or a slow variant of hemorrhagic fever. An argument for this is also provided by a mutation of the gene CCR5 in humans, in which 32 base pairs are not present. This mutation called CCR5Δ32 is described in ca. 10 % of the European population found, but not in Asia or East Africa. Mathematical models of the spread of this mutation suggest a major selection prere about 700 years ago, the time of the plague in Europe. This mutation could thus have been a genetic survival advantage over the plague agent. Today, this change in the CCR5 gene offers the homozygous carrier limited protection against HIV infection. When inherited from only one parent, it delays the onset of AIDS by an average of three years. Before Yersinia pestis this mutation does not protect against it. The disease known as plague in the Middle Ages may thus have been a hemorrhagic fever transmitted directly from person to person, a viral disease whose best-known form is Ebola fever.
The opposite position is presented in the article Plague epidemics in Norway.
By detecting Yersinia DNA in the dental pulp of people of the 8th century. and of the 14. In the meantime, it is clear that at least these epidemics were caused by plague bacteria. A group of researchers at the University of Marseille led by Didier Raoult, head of the Department of Clinical Microbiology, believes that the clothes louse (Pediculus humanis corporis), which retains plague bacteria in its blood for almost two weeks and excretes the pathogen with its feces for that time, was a decisive factor in transmission. As early as 1665, the Dutch physician Ysbrand van Diemerbrok proved that the plague could be transmitted through infected clothing.
This new theory better explains the speed at which the plague spread, since the European rat flea (Nosopsyllus fasciatus) is very reluctant to jump to humans, and the Indian rat flea (Xenopsylla cheopsis), which also appreciates human blood, was shown to spread long after the Black Death arrived in Europe. Not only rats and the fleas that moved from them to humans by necessity, but also people who traveled with plague-infected clothes fleas in their clothing could infect other people in new areas. The rate of spread estimated at only 20 meters per week for rat-to-rat transmission can therefore no longer be regarded as a limiting factor, but rather the travel speed of humans at that time. This also explains the overcoming of a distance of 3700 km from Naples to Tromsø within three years during the last great epidemic of the Middle Ages.
After infection of a person living in close quarters, the head louse (Pediculus humanis capitis) and the human flea (Pulex irritans) are also possible vectors in the event of a change of host, since both parasites can ingest plague bacteria. Plague bacteria, according to the results of these scientists, can survive in sterilized sand for 6 months, and even much longer in rodent burrows. Thus, the spread of plague can be expected whenever plague-infected rodents or humans are present in an environment with the aforementioned ectoparasites. 
The analysis of the 4000-gene genome leads the researchers to ame that the plague bacterium arose through mutation of the harmless intestinal parasite and soil bacterium Yersinia pseudotubercolosis. A bacterial toxin developed that blocked the electron transport chain in the mitochondria, the power plants of human cells.
15. to 19. Century
After a severe plague epidemic that began in 1347, the disease endemicized: In local epidemics, it struck various areas of Europe at nearly regular intervals over the next three centuries. In the town of St. Gallen, for example, the plague occurred at least fourteen times between 1500 and 1640. After 1580, smallpox outbreaks also occurred in cycles of four to five years, killing mostly younger children.
The plague epidemic of 1555 in Nidda, Hesse, lasted only three weeks and killed 300 people. This was a third of the population of this city. The situation was similar in the small town of Uelzen, which at the beginning of the 16. Century approximately 1200 inhabitants had. Uelzen is one of the cities that already in the 16. In the nineteenth century, the city kept accurate registers of its inhabitants. It is known that in 1566 exactly a quarter of the inhabitants of Uelzen died, namely 295, of whom 279 succumbed to the plague. In 1597 – Uelzen's population had meanwhile grown to about 1600 inhabitants – 554 inhabitants died, 510 of them from the plague.
Further serious epidemics occurred in England in 1665/66, with about 100 cases.000 deaths (see Great Plague of London) and in 1678/79 in Vienna at the time when the so-called dear Augustin Lived. The last plague epidemics hit Europe in the 18. century: From 1709 to 1711, the plague raged in East Prussia; usually 15 died there per year.000 people (out of a population of about 600.000), a total of 230 people died in these three years.000 people killed.
Fearing an outbreak in Berlin as well, King Frederick I. build a plague house there, from which the Charite emerged. In May 1720 the plague appeared again in Marseille and in Provence and disappeared only in 1722. After another plague epidemic occurred in Moscow in 1771, there were no further plague epidemics in Europe. The extinction of the plague in Europe is associated with the fact that since the 16. In the nineteenth century, the domestic rat was gradually replaced by the Norway rat. Because the Norway rat is more timid than its predecessor, direct contact between humans and animals is less frequent, reducing infection from infected fleas. However, the historian Vasold, who studied the plague extensively, points out that the outbreak in Moscow in 1771 occurred at a time when the Norway rat had long since supplanted the domestic rat.
Another possible explanation is that the plague pathogen changed genetically or that rats became immune to the plague pathogen and did not die after being infected by the flea, so there was no need for the fleas to migrate any more. Also the progress in health care. Improvements in hygiene have contributed to the absence of plague epidemics.
The last pandemic began in the second half of the 19th century. The plague struck Central Asia at the end of the nineteenth century and claimed the lives of some 12 million people worldwide over the next 50 years. During this plague epidemic, the pathogen was identified by the French physician Alexandre Yersin in 1894 and the transmission route was explained.
The plague today
Plague has not been conquered even today: From 1979 to 1992, the World Health Organization (WHO) reported 1451 deaths in 21 countries. In the United States, for example, there were thirteen infections and two deaths in 1992.
The last major plague epidemic occurred in Surat, India, from August to October 1994. WHO counted 6344 suspected and 234 proven cases of plague with 56 deaths. The plague pathogen found there exhibited characteristics never before observed. It was characterized by a weak virulence. Considered a novel strain of the pathogen due to some molecular biological peculiarities.
In February 2005, pneumonic plague spread to Lower Uelle in northwestern Congo. According to WHO reports, there were 61 deaths. The intervention of the organization Doctors Without Borders prevented further spread of the plague. 
According to WHO reports, on 14. June 2006, 100 plague deaths were reported in the Democratic Republic of Congo. The most affected region was the Ituri district with up to 1000 cases per year, both pneumonic and bubonic plague  .
The plague in literature and art
Few other catastrophes shaped collective perceptions of powerlessness, doom, and misfortune as much as the plague's infestation.
The earliest accounts of plague come from ancient authors such as Homer, Thucydides, Lucretius, Procopius of Caesarea, and Ovid. In book VII, 501-613 of his Metamorphoses he reports in great detail about the plague of Aegina
Above all, however, the plague epidemic of the 14. The nineteenth-century has been strongly focused on art. Literature. People bought so-called plague sheets to protect themselves from the plague with the help of the saints depicted on them. Boccaccio wrote his collection of novellas against the background of the plague that raged through Florence in 1348 Il DecameroneSeven ladies and three young men flee from the plague to a country estate in Florence. In a remarkable contrast to the gloom and drama of the plague depictions are the erotic and cheerful stories that the ten Florentines tell each other for entertainment. They find a way out of the catastrophe in a lighter life. The extraordinary situation of the plague gives them the opportunity to question the medieval norms and values in their narratives.
Very often the "Black Death" was depicted on a galloping horse. In Lubeck in 1350, under the impression of the devastating plague epidemic, the painting "Dance of Death" was created in the newly built St. Mary's Church. In the same year Francesco Traini created the murals of the Campo Santo of Pisa. Death here is not a bone man, but an old woman dressed in black, descending on a group of carefree young people with waving hair and a broad-edged sickle in her hand. A masterpiece of sepulchral art that points to the changing image of death in late medieval art is the painting of a deathbed in the late 14th century. The tomb of Cardinal La Grange, built in the middle of the XVII century. The cardinal is depicted as an almost naked, decomposing corpse, and the inscription admonishes all those still alive how void life is: Why do you puff yourself up in your pride?. Dust thou art and dust thou must become, a rotten carcass, the food of worms.
Probably the first medical dissertation on the plague was written by Johannes Pistorius the Younger, a physician from Nidda: De vera curandae pestis ratione (On the right way to treat the plague), Frankfurt 1568. Christoph Schorer from Memmingen published one of the first German-language manuals on plague prevention in 1666.
In Vienna in 1679, the popular song – which today is often no longer recognized as such – was written O dear Augustine, everything is gone. (cf. Marx Augustin), who contrasted the plague with a gallows humor. In 1722 appeared in London Daniel Defoe's Journal of the Plague Year (in German: The Plague of London). The story was published at a time when a plague outbreak in southern France led to fears of a renewed infestation by this disease, and found a wide readership. For a long time it was considered an eyewitness account of the plague outbreak in 1665. Defoe, however, was still a child of four or five at the time of the outbreak; the narrative, however, depicts the plague outbreak from the point of view of a grown man, who describes the events in a matter-of-fact tone and compassionately and empathetically follows the reactions of his fellow citizens. Together with Robinson Crusoe and Minor Flanders this tale established Daniel Defoe's reputation as the creator of the art form of the realistic novel.
In the I Promessi Sposi Alessandro Manzoni describes the ravages of the plague epidemic in Milan in 1630. His account is based on reports of several contemporary witnesses, namely the Historiae Patriae by the historiographer Giuseppe Ripamonti (1573 – 1643) and the plague chronicle by the physician Alessandro Tadino (Ragguaglio dell'origine et giornali successi della gran peste contagiosa, venefica et malefica, seguita nella città di Milano ..), which had appeared in 1648. Goethe – probably the first German reader of Manzoni's novel (the latter had given him the Promessi Sposi sent to the author immediately after the printing of the third volume in 1827) – noted that the author stands in the plague chapters "as a naked historian" and criticized the "awkward detail" in things of a "disgusting nature". Regardless of this, the mercilessly precise description of the plague in the Promessi Sposi today considered a highlight of Italian prose. – Manzoni's 1829 work also deals with events in Milan during the plague year of 1630 Storia della Colonna Infame.
Edgar Allan Poe created the burlesque tale in 1835 King Pest, in which the title character allegorically embodies the terror of all terrors, but is defeated by two bezeled sailors. Poe's story The mask of the Red Death of 1842 was inspired by his recollection of the Baltimore cholera epidemic he had witnessed in 1831, but shows parallels to other pester narratives. Although a plague (the Red Death, Red Death), Prince Prospero, who has fled to his castle, gives a pompous masquerade ball. The flight from the epidemic into pleasures recalls the frame narrative of Boccaccio's Decamerone, but Poe's story takes a different turn: The Red Death comes "like a thief in the night.", invades the castle in spite of the welded gates and kills the self-important Prospero and the entire festive company.
In the frame novella The Black Spider Jeremias Gotthelf adapted old legends about a deal with the devil into a parable-like tale about the plague in 1843.
Arnold Bocklin created on this subject in 1898 in Italy the picture Plague/Black Death, which is now exhibited in the Kunstmuseum Basel. Bocklin personifies the plague in his painting as a grim reaper riding on a flying monster from which there is no escape. The scythe and skeletal figure hark back to medieval death symbolism.
1921/1922 filmed F.W. Vampire symbolically equated with the plague. represents its figurative-physical personification. Even more clearly this metaphoric is in Werner Herzog's sound film adaptation Nosferatu – Phantom of the Night with Klaus Kinski in the title role elaborated. Ingmar Bergman filmed in 1957 The Seventh Seal (Det sjunde inseglet) with Max von Sydow, the film is set in the 14. Century.
Albert Camus wrote the novel The Plague (fr. La Peste) about a modern-day plague outbreak in the Algerian city of Oran (published 1947). In it, a doctor encounters humanity and solidarity despite the hopelessness and absurdity of the fight against the plague. The plague is often interpreted here as a symbol of Nazism.
Known victims of the plague
The plague succumbed to many millions of people. Among the victims of this disease are u.