Abstract on the topic:

Plague

Plan:

Introduction

• 1. History
  • 1.1 The emergence of the plague
  • 1.2 Plague in Sumero-Akkadian mythology
  • 1.3 Plague in the Bible
  • 1.4 Plague epidemics in historical time
  • 1.5 Plague as a biological weapon
  • 1.6 Current state
  • 1.7 Forecast
• 2 Infection
• 3 Symptoms
  • 3.1 Clinical picture
  • 3.2 Diagnosis
• 4 Treatment (briefly)
• 5 Treatment (detail)
• 6 In literature
• 7 In cinema
Notes

• 9 Scientific literature

Introduction

Plague(lat. pestis - infection) - an acute natural focal infectious disease of the group of quarantine infections, occurring with an exceptionally severe general condition, fever, damage to the lymph nodes, lungs and other internal organs, often with the development of sepsis. The disease is characterized by high mortality and extremely high infectiousness.

The causative agent is the plague bacillus (lat. Yersinia pestis), discovered in 1894 simultaneously by two scientists: the Frenchman Alexandre Yersin and the Japanese Kitazato Shibasaburo.

The incubation period lasts from several hours to 3-6 days. The most common forms of plague are bubonic and pneumonic. Mortality in the bubonic form of the plague reached 95%, in the case of pulmonary - 98-99%. Currently at proper treatment mortality is 5-10%

The well-known plague epidemics, which claimed millions of lives, left a deep mark on the history of mankind.

1. History

1.1. The emergence of the plague

Some researchers have suggested that the plague occurred about 1500-2000 years ago as a result of a pseudotuberculosis mutation ( Yersinia pseudotuberculosus), shortly before the first known pandemics of human plague. At the same time, most of the scientific community considers the plague pathogen to be a much more ancient microorganism.

From the book Daniel M. - The Secret Paths of the Bearers of Death. - M. Progress, 1990, c.101 ISBN 5-01-002041-6:

Plague arose on Earth before man appeared, and its origins must be sought in distant geological epochs, when the great-grandfathers of modern rodents began to appear, about 50 million years ago in the Oligocene. At that time there were already genera of fleas similar to those living today, as evidenced by the remains of fossil insects in amber.

The ancestral home of the plague is the endless steppes and deserts of Central Asia, where this disease developed and maintained among local species of gerbils, marmots and ground squirrels. Another ancient center of the plague was the Central African savannas and North African deserts and semi-deserts. And although some authors stubbornly defended the opinion that the plague was brought to the North American mainland during its colonization by whites, recently there is more and more evidence that it penetrated into the Western Hemisphere even in distant geological epochs through Siberia and Alaska and was an important regulator of populations. steppe rodents in North America since the Pleistocene.

In these parts of the world - and especially in Asia - the first epidemics of the plague arose among people. Initially, obviously, these were local epidemics and their size was limited by the fact that vast areas were inhabited by a relatively small number of people, moreover, they had practically no contact with each other. Real tragedies began when the population and the level of its material development rose to a higher level.

M. V. Supotnitsky in his monograph cites evidence of plague epidemics starting from 1200 BC. e.

1.2. Plague in Sumero-Akkadian mythology

When writing this section, materials from the book by Daniel M. - The Secret Paths of the Death Bearers were used. - M. Progress, 1990, c.105 ISBN 5-01-002041-6

The most ancient literary evidence of plague epidemics belongs to the epic of Gilgamesh, the semi-legendary ruler of the city of Uruk, folk hero, whose exploits and adventures are described in an epic poem in the Assyro-Babylonian language. The twelfth tile (the epic is written in cuneiform on clay tiles) depicts Gilgamesh's despair after the death of his friend Enkidu. Crushed by the loss of a friend and gloomy news from underworld, Gilgamesh in Uruk again faced the evidence of death. The city was visited by the god of war and pestilence Erra, from whom there was no escape. The dead lay in houses, the dead lay in wide streets and squares, the dead swam in the waters of the Euphrates. In the face of all these horrors, Gilgamesh turned to the god Shamash ... “There's nothing to be done, Gilgamesh,” the god Shamash replied. “You are a hero and a ruler! But man's days are numbered. And the king will also lie down and never get up again. And Gilgamesh, shocked by the monstrous consequences of the plague, went in search of the secret of immortality. After long wanderings, he met Utnapishti, who survived the worldwide Babylonian-Assyrian flood (and the gods granted him eternal life), and described the horrors of the plague to him in these words: “My people of Uruk are dying, the dead are lying in the squares, the dead are floating in the waters of the Euphrates!” Probably, these references to the plague do not refer to one particular epidemic, they summarize the experience of previous generations of people.

1.3. Plague in the Bible

When writing this section, materials from the book by Daniel M. - The Secret Paths of the Death Bearers were used. - M. Progress, 1990, c.102 ISBN 5-01-002041-6

The Bible is one of the oldest sources that has come down to us, in which the occurrence of a plague epidemic is noted. The first book of Kings (chapter 5) describes the war between the Israelites and the Philistines. The Israelis are haunted by military setbacks. Having lost the battle, the Israelites, in order to raise their spirits, bring to their camp the ark of the covenant of the Lord - a cupboard with sacred relics. But this does not help them - the Philistines again win, seize the ark and deliver it with great triumph to the city of Ashdod. There they place the ark at the feet of the statue of their god Dagon. And soon a terrible blow falls on the city of Azot and its entire environs: a disease breaks out among people, growths-ulcers appear in their inguinal region, and Azotians die from this disease. Those who survived are firmly convinced that this disease is God's punishment, and they seek to get rid of the ark of the Lord and send it to another province of the Philistines - to the city of Gath. But the history of this terrible disease is completely repeated in Gath. Here is how it is literally stated in the ninth verse: "After they sent it (the ark), the hand of the Lord was on the city - a very great horror, and the Lord struck the inhabitants of the city, from small to large, and growths appeared on them." The Philistines did not calm down and for the third time they transported the trophy of war, and with it the plague, to the city of Ascalon. Then all the rulers of the Philistines gathered there - the kings of the five cities of the Philistines - and they decided to return the ark to the Israelites, because they realized that this was the only way to prevent the spread of the disease. And chapter 5 ends with a description of the atmosphere that reigned in the doomed city. "And those that did not die were smitten with growths, so that the cry of the city ascended to the heavens." Chapter 6 depicts a council of all the rulers of the Philistines, to which priests and soothsayers were called. They advised to bring a guilt offering to God - to put gifts in the ark before returning it to the Israelites. “According to the number of the rulers of the Philistines, five growths of gold and five mice of gold, devastating the earth; for there is one punishment for all of you, and for your rulers.” This biblical tradition is interesting in many ways: it contains a hidden message about an epidemic that most likely covered all five cities of the Philistines. We could talk about the bubonic plague, which affected people from young to old and was accompanied by the appearance of painful growths in the groin - buboes. The most remarkable thing is that the Philistine priests, apparently, connected this disease with the presence of rodents: hence the golden statues of mice "destroying the earth."

There is another passage in the Bible that is believed to be a record certifying another case of the plague. The Fourth Book of Kings (chapter 19, verses 35 and 36) tells of the campaign of the Assyrian king Sennacherib, who decided to devastate Jerusalem. A huge army surrounded the city, but did not take it. And soon Sennacherib withdrew without a fight with the remnants of the army, which was greatly weakened by the plague: 185,000 soldiers died overnight.

1.4. Plague epidemics in historical time

The most famous is the so-called "Justinian Plague" (551-580), which originated in the Eastern Roman Empire and swept the entire Middle East. More than 20 million people died from this epidemic. In the X century there was a big plague epidemic in Europe, in particular, in Poland and Kievan Rus. In 1090, over 10,000 people died from the plague in Kyiv in two weeks. In the 12th century, plagues broke out several times among the Crusaders. In the 13th century, there were several outbreaks of plague in Poland and Rus'.

In the 14th century, a terrible epidemic of the "Black Death", brought from East China, passed through Europe. In 1348, almost 15 million people died from it, which accounted for a quarter of the entire population of Europe. By 1352, 25 million people had died in Europe, a third of the population. .

In 1346 the plague was brought to the Crimea, and in 1351 to Poland and Rus'. Subsequently, outbreaks of plague were noted in Russia in 1603, 1654, 1738-1740 and 1769. An epidemic of bubonic plague swept through London in 1664-1665, killing more than 20% of the city's population. Individual cases of infection with bubonic plague are recorded at the present time.

Up to thirty-four million people of the population of Europe died from the plague 1347-1351

In the Middle Ages, the unsanitary conditions that prevailed in the cities contributed to the spread of the plague. There was no sewerage, and all the garbage flowed right along the streets, which served as an ideal environment for the rats to live. Alberti described Siena in this way, which “loses a lot ... due to the lack of cesspools. That is why the whole city emits a stench not only during the first and last night watch, when the vessels with accumulated impurities are poured out of the windows, but also at other hours it is disgusting and heavily polluted. In addition, in many places, cats were declared the cause of the plague, allegedly being servants of the devil and infecting people. Mass extermination of cats led to an even greater increase in the number of rats.

The most common cause of infection is the bites of fleas that previously lived on infected rats.

1.5. Plague as a biological weapon

A ceramic bomb containing plague-infected material - a flea colony

The use of the plague agent as a biological weapon has deep historical roots. In particular, events in ancient China and medieval Europe showed the use of the corpses of infected animals (horses and cows), human bodies by the Huns, Turks and Mongols to contaminate water sources and water supply systems. There are historical records of cases of ejection of infected material during the siege of some cities.

During World War II, Japanese armed forces samples of biological weapons were developed, designed for the mass dumping of a specially prepared carrier of the plague - infected fleas. When developing samples of biological weapons, Special Detachment 731, headed by General Ishii Shiro, deliberately infected civilians and prisoners of China, Korea and Manchuria for further medical research and experiments, studying the prospects for the use of biological agents as weapons of mass destruction. (English) The group has developed a plague strain that is 60 times more virulent than the original plague strain, a kind of absolute effective weapon mass destruction with natural natural distribution. Various aerial bombs and projectiles have been developed to drop and disperse infected carriers, such as bombs to infect the ground, aerosol bombs, and fragmentation projectiles that affect human tissue. Ceramic bombs were popular, taking into account the peculiarities of the use of living organisms - fleas and the need to maintain their activity and viability under discharge conditions, for which special life support conditions were created (in particular, oxygen was pumped).

1.6. Current state

Every year, the number of plague cases is about 2.5 thousand people, and without a tendency to decrease.

According to available data, according to the World Health Organization, from 1989 to 2004, about forty thousand cases were recorded in 24 countries, and the mortality rate was about seven percent of the number of cases. In a number of countries in Asia (Kazakhstan, China, Mongolia and Vietnam), Africa (Tanzania and Madagascar), the Western Hemisphere (USA, Peru), cases of human infection are recorded almost annually.

At the same time, cases of plague have not been recorded on the territory of Russia since 1979, although annually on the territory of natural foci (with a total area of ​​​​more than 253 thousand sq. km) over 20 thousand people are at risk of infection.

In Russia, from 2001 to 2006, 752 strains of the plague pathogen were recorded. At the moment, the most active natural foci are located in the territories Astrakhan region, Kabardino-Balkarian and Karachay-Cherkess republics, the republics of Altai, Dagestan, Kalmykia, Tuva. Of particular concern is the lack of systematic monitoring of the activity of outbreaks located in the Ingush and Chechen Republics.

For Russia, the situation is complicated by the annual detection of new cases in the states adjacent to Russia (Kazakhstan, Mongolia, China), the importation of a specific plague carrier, fleas, through transport and trade flows from the countries of Southeast Asia Xenopsylla cheopis.

At the same time, in 2001-2003, 7 cases of plague were registered in the Republic of Kazakhstan (with one death), in Mongolia - 23 (3 deaths), in China in 2001-2002, 109 people fell ill (9 deaths). The forecast of the epizootic and epidemic situation in the natural foci of the Republic of Kazakhstan, China and Mongolia adjacent to the Russian Federation remains unfavorable.

In the summer of 2009, the city of Ziketan was quarantined in the Hainan-Tibet Autonomous Region, as an outbreak of pneumonic plague was detected in it, from which several people died.

1.7. Forecast

In the conditions of modern therapy, mortality in the bubonic form does not exceed 5-10%, but in other forms, the recovery rate is quite high if treatment is started early. In some cases, a transient septic form of the disease is possible, which is poorly amenable to intravital diagnosis and treatment (“fulminant form of plague”).

2. Infection

The flea xenopsylla cheopis is the main plague vector, SEM image

The causative agent of plague is resistant to low temperatures, well preserved in sputum, but at a temperature of 55 ° C it dies within 10-15 minutes, and when boiled, almost immediately. It enters the body through the skin (with a flea bite, usually Xenopsylla cheopis), mucous membranes of the respiratory tract, digestive tract, conjunctiva.

According to the main carrier, natural foci of plague are divided into ground squirrels, marmots, gerbils, voles and pikas. In addition to wild rodents, the epizootic process sometimes includes the so-called synanthropic rodents (in particular, rats and mice), as well as some wild animals (hares, foxes), which are the object of hunting. Of domestic animals, camels are sick with plague.

In a natural focus, infection usually occurs through the bite of a flea that previously fed on a sick rodent; the likelihood of infection increases significantly when synanthropic rodents are included in the epizootic. Infection also occurs during the hunting of rodents and their further processing. Mass diseases of people occur when a sick camel is cut, skinned, cut, processed. An infected person, depending on the form of the disease, in turn, can be a plague transmitter by airborne droplets or through the bite of certain flea species.

Fleas are a specific carrier of the plague pathogen. This is due to the peculiarities of the structure of the digestive system of fleas: in front of the stomach, the esophagus of the flea forms a thickening - goiter. When bitten by an infected animal (rat), the plague bacterium settles in the goiter of the flea and begins to multiply intensively, completely clogging it. Blood cannot enter the stomach, so such a flea is constantly tormented by a feeling of hunger. She moves from host to host in the hope of getting her portion of blood and manages to infect a sufficiently large number of people before she dies (such fleas live no more than ten days).

When a person is bitten by plague-infected fleas, a papule or pustule filled with hemorrhagic contents (skin form) may appear at the site of the bite. Then the process spreads through the lymphatic vessels without the manifestation of lymphangitis. The reproduction of bacteria in the macrophages of the lymph nodes leads to their sharp increase, fusion and the formation of a conglomerate (bubonic form). Further generalization of the infection, which is not strictly necessary, especially under the conditions of modern antibiotic therapy, can lead to the development of a septic form, accompanied by damage to almost all internal organs. However, from an epidemiological point of view essential role play "screenings" of infection in the lung tissue with the development of the pulmonary form of the disease. Since the development of plague pneumonia, a sick person himself becomes a source of infection, but at the same time, a pulmonary form of the disease is already transmitted from person to person - an extremely dangerous, with a very rapid course.

3. Symptoms

The bubonic form of the plague is characterized by the appearance of sharply painful conglomerates, most often inguinal lymph nodes on one side. The incubation period is 2-6 days (less often 1-12 days). Within a few days, the size of the conglomerate increases, the skin over it may become hyperemic. At the same time, there is an increase in other groups of lymph nodes - secondary buboes. The lymph nodes of the primary focus undergo softening, when they are punctured, purulent or hemorrhagic contents are obtained, the microscopic analysis of which reveals a large number of gram-negative rods with bipolar staining. In the absence of antibiotic therapy, suppurated lymph nodes are opened. Then there is a gradual healing of fistulas. The severity of the patient's condition gradually increases by the 4th-5th day, the temperature may be elevated, sometimes a high fever appears immediately, but at first the condition of the patients often remains generally satisfactory. This explains the fact that a person with bubonic plague can fly from one part of the world to another, considering himself healthy.

However, at any time, the bubonic form of the plague can cause a generalization of the process and go into a secondary septic or secondary pulmonary form. In these cases, the condition of the patients very quickly becomes extremely severe. Symptoms of intoxication increase by the hour. The temperature after a severe chill rises to high febrile numbers. All signs of sepsis are noted: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, up to its loss, sometimes excitement (the patient rushes about in bed), insomnia. With the development of pneumonia, cyanosis increases, a cough appears with the separation of foamy bloody sputum containing a huge amount of plague rods. It is this sputum that becomes the source of infection from person to person with the development of now primary pneumonic plague.

Septic and pulmonary forms of plague proceed, like any severe sepsis, with manifestations of the syndrome of disseminated intravascular coagulation: small hemorrhages on the skin may appear, bleeding from the gastrointestinal tract (vomiting bloody masses, melena), severe tachycardia, rapid and requiring correction ( dopamine) drop blood pressure. Auscultatory - a picture of bilateral focal pneumonia.

3.1. Clinical picture

The clinical picture of the primary septic or primary pulmonary form is not fundamentally different from the secondary forms, but the primary forms often have a shorter incubation period - up to several hours.

3.2. Diagnosis

The most important role in the diagnosis in modern conditions is played by the epidemiological history. Arrival from plague-endemic areas (Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, Karakalpakia, etc.), or from anti-plague stations of a patient with the above described signs of the bubonic form or with signs of the most severe - with hemorrhages and bloody sputum - pneumonia with severe lymphadenopathy is a sufficiently serious argument for the doctor of the first contact to take all measures for the localization of the alleged plague and its accurate diagnosis. It should be emphasized that in the conditions of modern drug prevention the likelihood of illness in personnel who have been in contact with a coughing plague patient for some time is very small. Currently, there are no cases of primary pneumonic plague (that is, cases of infection from person to person) among medical personnel. Establishing an accurate diagnosis must be carried out with the help of bacteriological studies. The material for them is the punctate of a festering lymph node, sputum, blood of the patient, discharge from fistulas and ulcers.

Laboratory diagnostics is carried out using a fluorescent specific antiserum, which stains smears of discharge from ulcers, punctate of lymph nodes, culture obtained on blood agar.

4. Treatment (briefly)

In the Middle Ages, the plague was practically not treated, the actions were reduced mainly to cutting or cauterizing plague buboes. No one knew the true cause of the disease, so there was no idea how to treat it. Doctors tried the most bizarre remedies. The composition of one such drug included a mixture of 10-year-old molasses, finely chopped snakes, wine, and 60 other components. According to another method, the patient in turn had to sleep on the left side, then on the right. Since the 13th century, they have been trying to limit the plague epidemic with the help of quarantines.

The first vaccine against plague was created at the beginning of the 20th century by Vladimir Khavkin.

The treatment of plague patients is currently reduced to the use of antibiotics, sulfonamides and therapeutic anti-plague serum. Prevention of possible foci of the disease consists in carrying out special quarantine measures in port cities, deratization of all ships that go on international flights, the creation of special anti-plague institutions in the steppe areas where rodents are found, the identification of plague epizootics among rodents and the fight against them. Outbreaks of the disease are still found in some countries in Asia, Africa and South America.

5. Treatment (detail)

If a plague is suspected, the sanitary-epidemiological station of the district is immediately notified about it. The notification is filled in by the doctor who suspected the infection, and its forwarding is provided by the head physician of the institution where such a patient was found.

The patient should be immediately hospitalized in the box of the infectious diseases hospital. A doctor or an average medical worker of a medical institution, upon detecting a patient or suspected of having plague, is obliged to stop further admission of patients and prohibit entry and exit from the medical institution. Remaining in the office, ward, the medical worker must inform the chief doctor in a way accessible to him about the identification of the patient and demand anti-plague suits and disinfectants.

In cases of admission of a patient with lung damage, before putting on a full anti-plague suit, a medical worker is obliged to treat the mucous membranes of the eyes, mouth and nose with a solution of streptomycin. In the absence of a cough, you can limit yourself to treating your hands with a disinfectant solution. After taking measures to separate the sick person from healthy people in a medical institution or at home, a list of people who had contact with the patient is compiled, indicating the last name, first name, patronymic, age, place of work, profession, home address.

Until the arrival of a consultant from the anti-plague institution, the health worker remains in the outbreak. The issue of its isolation is decided in each case individually. The consultant takes the material for bacteriological examination, after which specific treatment of the patient with antibiotics can begin.

When a patient is detected on a train, plane, ship, airport, railway station, the actions of medical workers remain the same, although organizational measures will be different. It is important to emphasize that the separation of a suspicious patient from others should begin immediately after his identification.

The head physician of the institution, having received a message about the identification of a patient suspicious of the plague, takes measures to stop communication between the hospital departments, the floors of the clinic, prohibits exit from the building where the patient was found. At the same time, it organizes the transmission of an emergency message to a higher organization and an anti-plague institution. The form of information can be arbitrary with the obligatory presentation of the following data: surname, name, patronymic, age of the patient, place of residence, profession and place of work, date of detection, time of onset of the disease, objective data, preliminary diagnosis, primary measures taken to localize the outbreak, position and the name of the physician who diagnosed the patient. Simultaneously with the information, the manager requests consultants and the necessary assistance.

However, in some situations it may be more appropriate to hospitalize (until an accurate diagnosis is established) in the institution where the patient is located at the time of the assumption that he has the plague. Therapeutic measures are inseparable from the prevention of infection of personnel, who should immediately put on 3-layer gauze masks, shoe covers, a scarf of 2 layers of gauze that completely covers the hair, and goggles to prevent sputum splashes on the mucous membrane of the eyes. According to the Russian Federation rules, personnel must wear an anti-plague suit or use anti-infective protection similar in properties special means. All staff who have been in contact with the patient remain to provide further assistance to him. A special medical post isolates the compartment where the patient and the personnel treating him are located from contact with other people. The isolated compartment should include a toilet and a treatment room. All staff receive immediate prophylactic antibiotic treatment throughout the days they spend in isolation.

Plague treatment is complex and includes the use of etiotropic, pathogenetic and symptomatic agents. Streptomycin antibiotics are most effective for treating plague: streptomycin, dihydrostreptomycin, pasomycin. In this case, streptomycin is most widely used. In the bubonic form of the plague, the patient is injected intramuscularly with streptomycin 3-4 times a day (daily dose of 3 g), tetracycline antibiotics (vibromycin, morphocycline) intravenously at 4 g / day. In case of intoxication, saline solutions, hemodez are administered intravenously. The drop in blood pressure in the bubonic form in itself should be regarded as a sign of a generalization of the process, a sign of sepsis; in this case, there is a need for resuscitation, the introduction of dopamine, the establishment of a permanent catheter. In pneumonic and septic forms of plague, the dose of streptomycin is increased to 4-5 g / day, and tetracycline - up to 6 g. In forms resistant to streptomycin, levomycetin succinate can be administered up to 6-8 g / v. When the condition improves, the dose of antibiotics is reduced: streptomycin - up to 2 g / day until the temperature normalizes, but for at least 3 days, tetracyclines - up to 2 g / day daily inside, chloramphenicol - up to 3 g / day, in total 20-25 g. Biseptol is also used with great success in the treatment of plague.

With a pulmonary, septic form, the development of hemorrhage, they immediately begin to stop the syndrome of disseminated intravascular coagulation: plasmapheresis is performed (intermittent plasmapheresis in plastic bags can be carried out on any centrifuge with special or air cooling with a capacity of its glasses of 0.5 l or more) in the volume of the removed plasma 1-1.5 l when replacing the same amount of fresh frozen plasma. In the presence of hemorrhagic syndrome, daily injections of fresh frozen plasma should not be less than 2 liters. Before stopping the most acute manifestations of sepsis, plasmapheresis is carried out daily. The disappearance of signs of hemorrhagic syndrome, stabilization of blood pressure, usually in sepsis, are grounds for stopping plasmapheresis sessions. At the same time, the effect of plasmapheresis in the acute period of the disease is observed almost immediately, signs of intoxication decrease, the need for dopamine to stabilize blood pressure decreases, muscle pain subsides, shortness of breath decreases.

In the team of medical personnel providing treatment for a patient with a pneumonic or septic form of plague, there should be an intensive care specialist.

6. In Literature

• Giovanni Boccaccio, The Decameron (1352 - 1354). The heroes of the work leave Florence infected with the disease, establishing a primitive quarantine.
• Daniel Defoe, Diary of a Plague City. based on real facts narrative of the Great London Epidemic of 1665.
• Rolland, Romain, "Nikolka Peach".
• Camus, Albert, The Plague 1947).
• Poe, Edgar Mask of the Red Death.
• Unset, Sigrid, Christine, daughter of Lavrans
• Pushkin A.S. "Feast in Time of Plague".
• Twain, Mark, "A Connecticut Yankee in King Arthur's Court".
• London, Jack, "The Scarlet Plague".

7. In cinema

• Flesh and Blood (directed by Paul Verhoeven) (1985). The action takes place during the Italian wars. A diseased dog is used as a bacteriological weapon.

Notes

1. Plague - For doctors, students, patients
2. Achtman M, Zurth K, Morelli G, Torrea G, Guiyoule A, Carniel E. Yersinia pestis, the cause of plague, is a recently emerged clone of Yersinia pseudotuberculosis. Proc Natl Acad Sci U S A. 1999 Nov 23;96(24):14043-8. - www.ncbi.nlm.nih.gov/pubmed/10570195
3. From the book Daniel M. Secret Paths of Death Bearers. - M. Progress, 1990, p.105
4. Old Testament / First Kings / Chapter 5 - www.ubrus.org/bible-pages/?part_id=9&page_id=5
5. Old Testament / First Book of Kings / Chapter 6 - www.ubrus.org/bible-pages/?part_id=9&page_id=6
6. Old Testament / 2 Kings / Chapter 19 - www.ubrus.org/bible-pages/?part_id=12&page_id=19
7. Europe's Plagues Came From China, Study Finds - www.nytimes.com/2010/11/01/health/01plague.html?_r=1&ref=science . // The New York Times, 10/31/2010
8. B. Bayer, W. Birstein et al. History of Humanity 2002 ISBN 5-17-012785-5
9. Alberti Leon Battista. Ten books on architecture. T. II. M., 1937, p. 130
10. Material on use as a biological weapon from the English Wiki
11. Essays on the history of the plague (about biological weapons) - supotnitskiy.webspecialist.ru/images/book3-34-1.gif
12. 1 2 Letter of the Ministry of Health of the Russian Federation dated April 22, 2004 N 2510/3173-04-27 "On the Prevention of Plague"
13. 1 2 Order territorial administration Rospotrebnadzor for the Ministry of Defense dated 02.05.2006 N 100 "On the organization and implementation of measures for the prevention of plague in the Moscow region"
14. Qinghai reports second death from pneumonic plague - russian.people.com.cn/31516/6717104.html, People's Daily(August 3, 2009).
15. China fears pneumonic plague - www.bbc.co.uk/russian/international/2009/08/090802_china_plague.shtml
16. M. V. Supotnitsky "Black Death" - the mechanism of a pandemic catastrophe - supotnitskiy.ru/stat/stat8.htm

9. Scientific literature

• - www.it-med.ru/library/ch/chuma_1.htm Domaradsky I. V. Plague. - M., 1998.
• - www.plosone.org/article/info:doi/10.1371/journal.pone.0006000 Li Y, Cui Y, Hauck Y, Platonov ME, Dai E, Song Y, Guo Z, Pourcel C, Dentovskaya SV, Anisimov AP, Yang R, Vergnaud G. Genotyping and phylogenetic analysis of Yersinia pestis by MLVA: insights into the worldwide expansion of Central Asia plague foci. PLOS One. 2009 Jun 22;4(6):e6000.
• - jmm.sgmjournals.org/cgi/content/full/55/11/1461 Anisimov AP, Amoako KK. Treatment of plague: promising alternatives to antibiotics. J Med Microbiol. 2006 Nov;55(Pt 11):1461-75. review.
• Zhukov-Verezhnikov N. N., Diagnosis of plague and cholera, M., 1944
• Supotnitsky M.V., Supotnitskaya N.S. Essays on the history of the plague: In 2 books. - supotnitskiy.ru/book/book3.htm M.: Vuzovskaya kniga, 2006. ISBN 5-9502-0093-4 (book 1), ISBN 5-9502-0094-2 (book 2), ISBN 5-9502 -0061-6. This is the only book that describes all the plague epidemics from antiquity to the present day.
• Daniel M. - Secret Paths of Death Bearers. - Progress, 1990. ISBN 5-01-002041-6
• V. V. Suntsov, N. I. Suntsova. Plague. Origin and evolution of the epizootic system (environmental, geographical and social aspects). UDC 579.843.95-036.21:576.12. ISBN 5-87317-312-5. Moscow: KMK Publishing House, 2006. - 247 p - macroevolution.narod.ru/suntsov.htm
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Plague is an infectious disease caused by the bacterium Yersinia pestis. Depending on the presence of a lung infection or sanitary conditions, plague can be spread through the air, transmitted by direct contact, or very rarely through contaminated cooked food. The symptoms of plague depend on the concentrated areas of infection: bubonic plague appears in the lymph nodes, septicemic plague in the blood vessels, and pneumonic plague in the lungs. Plague is curable if found on early stage. Plague is still a relatively common disease in some remote parts of the world. Until June 2007, plague was one of three epidemic diseases specifically reported to the World Health Organization (the other two being cholera and yellow fever). The bacterium is named after the French-Swiss bacteriologist Alexandre Yersin.

It is believed that the massive plague pandemics that swept across Eurasia were associated with very high level mortality and major cultural changes. The largest of these was the Plague of Justinian of 541-542, the Black Death of 1340, which continued at intervals during the second plague pandemic, and the third pandemic, which began in 1855 and has been considered inactive since 1959. The term "plague" is currently applied to any severe inflammation of a lymph node resulting from a Y. pestis infection. Historically, the medical use of the term "plague" has been applied to a pandemic of infection in general. The word "plague" is often associated with bubonic plague, but this type of plague is just one of its manifestations. Other names such as the Black Plague and the Black Death have been used to describe the disease; the latter term is currently used mainly by scientists to describe the second, and most devastating, pandemic of the disease. The word "plague" is believed to be derived from the Latin words plāga ("blow, wound") and plangere (to strike), cf. German Plage ("infection").

Cause

Transmission of Y. pestis to an uninfected individual is possible in any of the following ways.

Airborne transmission – coughing or sneezing on another person

Direct physical contact - touching an infected person, including sexual contact

Indirect contact - usually by touching contaminated soil or a contaminated surface

Airborne transmission - if the microorganism can remain in the air for a long time

The fecal-oral route of transmission - usually from contaminated food or water sources - is carried by insects or other animals.

The plague bacillus circulates in the body of animal carriers of the infection, especially in rodents, in natural foci of infection located on all continents except Australia. Natural foci of plague are located in a wide belt of tropical and subtropical latitudes and warm regions of temperate latitudes around the globe, between the parallels of 55 degrees north latitude and 40 degrees south latitude. Contrary to popular belief, rats were not directly involved in starting the spread of bubonic plague. Basically, this disease through fleas (Xenopsylla cheopis) infected rats, because of which the rats themselves became the first victims of the plague. In humans, infection occurs when a person is bitten by a flea that has been infected by biting a rodent that has itself been infected by the bite of a disease-carrying flea. The bacteria multiply inside the flea, sticking together to form a plug that blocks the flea's stomach and causes it to starve. The flea then bites the host and continues to feed, even being unable to suppress its hunger, and consequently regurgitates blood contaminated with bacteria back into the wound from the bite. The bubonic plague bacteria infects a new victim, and the flea eventually starves to death. Serious outbreaks of plague are usually triggered by other outbreaks in rodents, or by an increase in the rodent population. In 1894, two bacteriologists, Alexandre Yersin of France and Kitasato Shibasaburo of Japan, independently isolated the bacterium in Hong Kong responsible for the third pandemic. Although both investigators reported their results, a series of confusing and conflicting claims by Shibasaburo eventually led Yersin to be recognized as the organism's primary discoverer. Yersin named the bacterium Pasteurella pestis after the Pasteur Institute where he worked, but in 1967 the bacterium was transferred to a new genus and renamed Yersinia pestis, after Yersin. Yersin also noted that rat plague was observed not only during plague epidemics, but often preceded such epidemics in humans, and that many locals considered plague to be a disease of rats: villagers in China and India claimed that the death of a large number of rats entailed outbreaks of the plague. In 1898, the French scientist Paul-Louis Simon (who also came to China to fight the third pandemic) established the rat-flea vector that controls the disease. He noted that sick people should not be in close contact with each other, so as not to acquire the disease. In Yunnan Province, China, residents fled their homes as soon as they saw dead rats, and in Formosa, Taiwan, residents believed that contact with dead rats was associated with an increased risk of plague. These observations led the scientist to suspect that the flea might be an intermediate factor in the transmission of plague, as humans only acquired the plague when they were in contact with recently deceased rats that died less than 24 hours ago. In a classic experiment, Simon demonstrated how a healthy rat died of plague after infected fleas jumped on it from rats that had recently died of plague.

Pathology

Bubonic plague

When a flea bites a person and contaminates the wound with blood, the plague-transmitting bacteria are transferred into the tissue. Y. pestis can reproduce inside a cell, so even if the cells are phagocytosed, they can still survive. Once in the body, the bacteria can enter the lymphatic system, which pumps out interstitial fluid. Plague bacteria secrete several toxins, one of which is known to cause life-threatening beta-adrenergic blockade. Y. pestis spreads through the lymphatic system of an infected person until it reaches a lymph node, where it stimulates severe hemorrhagic inflammation that leads to lymph node enlargement. Enlarged lymph nodes are the cause of the characteristic "bubo" associated with this disease. If the lymph node is congested, the infection can pass into the bloodstream, causing secondary septicemic plague, and if the lungs are seeded, this can cause secondary pneumonic plague.

septic plague

The lymphatic system eventually flows into the blood, so plague bacteria can enter the bloodstream and end up in almost any part of the body. In the case of septicemic plague, bacterial endotoxins cause disseminated intravascular coagulation (DIC), resulting in small clots throughout the body and possibly ischemic necrosis (tissue death due to lack of circulation/perfusion to that tissue) from clots. DIC depletes the body's clotting resources and the body can no longer control bleeding. Consequently, bleeding into the skin and other organs occurs, which can cause a red and/or black spotted rash and hemoptysis/hemesis (coughing/vomiting blood). There are bumps on the skin that look like several insect bites; they are usually red in color, and sometimes white in the center. Left untreated, septicemic plague is usually fatal. Early antibiotic treatment reduces the mortality rate by between 4 and 15 percent. People who die from this form of plague often die on the same day that symptoms first appear.

Pneumonic plague

The pneumonic form of plague arises from a lung infection. It causes coughing and sneezing, and thus produces airborne droplets that contain bacterial cells that can infect someone if they are inhaled. The incubation period for pneumonic plague is short, usually two to four days, but sometimes only a few hours. The initial signs are indistinguishable from several other respiratory diseases; they include headache, weakness, and hemoptysis or hematemesis (spitting or vomiting of blood). The course of the disease is fast; if not diagnosed and treated soon enough, usually within hours, the patient dies within one to six days; in untreated cases, the mortality rate is nearly 100%.

pharyngeal plague

Meningeal plague

This form of plague occurs when bacteria cross the blood-brain barrier, resulting in infectious meningitis.

Other clinical forms

Several other rare manifestations of plague exist, including asymptomatic plague and abortive plague. Cellular skin plague sometimes results in infections of the skin and soft tissues, often around the site of a flea bite.

Treatment

The first person to invent and test a vaccine against bubonic plague in 1897 was Vladimir Khavkin, a doctor who worked in Bombay, India. When diagnosed early, various forms of plague tend to be highly responsive to antibiotic therapy. Commonly used antibiotics include streptomycin, chloramphenicol, and tetracycline. Among the newer generation of antibiotics, gentamicin and doxycycline have proven effective in the monotherapy treatment of plague. The plague bacterium can develop drug resistance and become a serious health threat again. One case of a drug-resistant form of the bacterium was discovered in Madagascar in 1995. Another outbreak in Madagascar was reported in November 2014.

Plague vaccine

Since human plague is rare in most parts of the world, routine vaccination is only needed for people who are particularly exposed to high risk infection, or people living in areas with enzootic plague occurring on a regular basis with predictable rates in populations and specific areas, such as the western United States. Most travelers to countries with known recent cases are not even vaccinated, especially if their trip is limited to urban areas with modern hotels. The Centers for Disease Control, therefore, recommends vaccination only for: (1) all laboratory and field workers who work with antimicrobial resistant Y. pestis; (2) people involved in aerosol experiments with Y. pestis; and (3) people involved in field operations in enzootic plague areas where avoidance of exposure is not possible (eg, in some disaster areas). A systematic review of the Cochrane Collaboration did not find any studies of sufficient quality to make any claim about the effectiveness of the vaccine.

Epidemiology

Epidemic in Surat, India, 1994

In 1994, pneumonic plague broke out in Surat, India, killing 52 people and causing a major internal migration of about 300,000 residents who fled for fear of quarantine. The combination of heavy monsoon rains and clogged sewers led to massive flooding linked to unsanitary conditions and animal carcasses strewn across the streets. This situation is believed to have precipitated the epidemic. There was widespread fear that the sudden flight of people from this area could spread the epidemic to other parts of India and the world, but this scenario was averted, probably as a result of an effective response by India's public health authorities. Some countries, especially in the neighboring Gulf region, have taken the step of canceling some flights and imposing a short-term ban on shipments from India. Much like the Black Death that swept across medieval Europe, there are still some unanswered questions about the 1994 Surat epidemic. The first questions about whether this was an epidemic of the plague arose because the Indian health authorities were unable to cultivate the plague bacillus, but this may be due to the poor quality of laboratory procedures. However, there are several lines of evidence suggesting that this was a plague epidemic: blood tests for Yersinia were positive, the number of individuals showing antibodies against Yersinia, and the clinical symptoms displayed by the sick were consistent with the plague.

Other modern cases

On August 31, 1984, the Centers for Disease Control and Prevention (CDC) reported a case of pneumonic plague in Claremont, California. The CDC believes the patient, a veterinarian, contracted the distemper from a stray cat. Because the cat was not available for autopsy, this cannot be confirmed. From 1995 to 1998, annual plague outbreaks were observed in Mahajanga, Madagascar. Plague was confirmed in the United States from 9 western states during 1995. Currently, 5 to 15 people in the United States are estimated to get plague each year, usually in the western states. Mice are considered to be the reservoir of the disease. In the US, about half of all plague deaths since 1970 have occurred in New Mexico. In 2006, there were 2 plague deaths in the state, the first deaths in 12 years. In February 2002, a small outbreak of pneumonic plague occurred in the Shimla region of Himachal Pradesh in northern India. In the fall of 2002, a couple in New Mexico became infected shortly before a visit to New York. Both men were treated with antibiotics, but the man required amputation of both legs to fully recover, due to a lack of blood flow to his legs, cut off by bacteria. On April 19, 2006, CNN News and other news outlets reported a case of plague in Los Angeles, California involving Nirvana laboratory technician Kowlessar, the first case in that city since 1984. In May 2006, KSL Newsradio reported a case of plague in dead field mice and chipmunks in Natural Bridges National Wildlife Refuge, located about 40 miles (64 km) west of Blending in San Juan County, Utah. In May 2006, the Arizona media reported a case of distemper in a cat. One hundred deaths due to pneumonic plague were reported in the Ituri region in eastern Democratic Republic of the Congo in June 2006. Plague control proved difficult due to the ongoing conflict. In September 2006, it was reported that three mice infected with the plague bacillus had apparently disappeared from a laboratory owned by the Public Health Research Institute, located on the campus of the University of Medicine and Dentistry of New Jersey, which conducts research to combat bioterrorism. for the US government. On May 16, 2007, an 8-year-old capuchin monkey died of bubonic plague at the Denver Zoo. Five squirrels and a rabbit were also found dead at the zoo and given positive result for the disease. On June 5, 2007, in Torrance County, New Mexico, a 58-year-old woman developed bubonic plague, which evolved into pneumonic plague. November 2, 2007 by Eric Yorke, a 37-year-old wildlife biologist with a conservation program national parks Mountain Lion and the Foundation for the Conservation of Cats, was found dead in his home in national park Grand Canyon. On October 27, Yorke performed an autopsy on a mountain lion that probably died of illness, and three days later Yorke reported flu-like symptoms and took time off from work due to illness. He was treated at a local clinic but was not diagnosed with any serious illness. His death caused a little panic, officials it was said that he probably died from the plague or exposure to hantaviruses, and 49 people who came into contact with York were given aggressive antibiotic treatment. None of them got sick. Autopsy results released on November 9 confirmed the presence of Y. pestis in his body, confirming plague as the probable cause of his death. In January 2008, at least 18 people died of bubonic plague in Madagascar. On June 16, 2009, the Libyan authorities reported an outbreak of bubonic plague in Tobruk, Libya. 16-18 cases were reported, including one death. On August 2, 2009, the Chinese authorities quarantined the town of Ziketan, in Xinghai County, Hainan Tibet Autonomous Prefecture, China's Qinghai Province (Northwest China) after an outbreak of pneumonic plague. On September 13, 2009, Dr. Malcolm Casadaban died after accidental laboratory exposure to a weakened strain of the plague bacterium. This was due to his undiagnosed hereditary hemochromatosis (iron overload). He was assistant professor of molecular genetics and cell biology and microbiology at the University of Chicago. On July 1, 2010, eight cases of bubonic plague were reported in humans in the Chicama region of Peru. One 32-year-old man was injured, as well as three boys and four girls aged 8 to 14. 425 homes were fumigated and 1,210 guinea pigs, 232 dogs, 128 cats and 73 rabbits were treated for fleas in an attempt to stop the epidemic. On May 3, 2012, a ground squirrel trapped at the popular Palomar Mountain Campground in San Diego, California tested positive for distemper bacteria during routine testing. On June 2, 2012, a man in Crook County, Oregon, while trying to save a cat that had choked on a mouse, was bitten and contracted septicemic plague. On July 16, 2013, a squirrel caught at an Angeles National Wildlife Refuge testbed positive for plague, prompting the closure of the campground while researchers tested other squirrels and took action against plague fleas. On August 26, 2013, Temir Isakunov, a teenager, died of bubonic plague in northern Kyrgyzstan. In December 2013, an epidemic of pneumonic plague was reported in 5 of the 112 districts of Madagascar, which was allegedly caused by large bush fires, forcing rats to flee to the cities. On July 13, 2014, a Colorado man was diagnosed with pneumonic plague. On July 22, 2014, Yumen City, China was placed under lockdown and 151 people were quarantined after one man died of bubonic plague. On November 21, 2014, the World Health Organization reported 40 deaths and 80 others on the island of Madagascar, with the first known case in the outbreak believed to have occurred in late August 2014.

Story

Antiquity

Y. pestis plasmids have been found in archaeological specimens from the teeth of seven Bronze Age individuals 5000 years ago (3000 BC), the Afanasevo culture at Afanasevo in Siberia, the Battle Ax culture in Estonia, the Sintashta culture in Russia, the Unetitsa culture in Poland and the Andronovo culture in Siberia. Y. pestis existed in Eurasia during the Bronze Age. The age of the common ancestor of all Y. pestis is estimated to be 5783 years before present. Mouse Yersinia toxin (YMT) allows bacteria to infect fleas, which can then transmit bubonic plague. Early versions of Y. pestis do not have the YMT gene, which was only found in 951 calibrated specimens dating back to BC. The Amarna archive and Mursili II's plague prayers describe an outbreak among the Hittites, although some contemporary sources state that it may have been tularemia. The first book of Kings describes a possible outbreak of plague in Philistia, and the Septuagint version says that it was caused by "the devastation of mice." In the second year of the Peloponnesian War (430 BC), Thucydides described an epidemic that was said to have started in Ethiopia, passed through Egypt and Libya, and then reached the Greek world. During the plague of Athens, the city lost perhaps a third of its population, including Pericles. Modern historians disagree as to whether plague was a critical factor in population loss during the war. Although this epidemic has long been considered an outbreak of plague, many modern scholars believe that typhoid, smallpox, or measles are more appropriate for descriptions given by survivors. A recent study of DNA found in the dental pulp of plague victims suggests that typhus was in fact involved. In the first century AD, Rufus of Ephesus, a Greek anatomist, described an outbreak of plague in Libya, Egypt, and Syria. He notes that the Alexandrian physicians Dioscorides and Posidonius described symptoms including acute fever, pain, agitation, and delirium. Under the knees, around the elbows, and "in the usual places" the patients developed buboes - large, hard and not festering. The death toll among those infected was very high. Rufus also wrote that similar buboes were described by Dionysius Curtus, who may have practiced medicine in Alexandria in the third century BC. If this is correct, the eastern Mediterranean world may have been familiar with the bubonic plague at such an early stage. In the second century, the Antonine Plague, named after the surname of Marcus Aurelius Antoninus, swept the world. The disease is also known as the Plague of Galen, who knew about it firsthand. There is speculation that in reality this disease could be smallpox. Galen was in Rome when, in 166 AD. this epidemic started. Galen was also present in the winter of 168-69. during an outbreak among troops of soldiers stationed in Aquileia; he had experience with the epidemic, calling it "very long" and describing the symptoms of the disease and his methods of treating it. Unfortunately, his notes are very brief and scattered among several sources. According to Barthold Georg Niebuhr, “This contagion raged with incredible force, taking with it countless victims. Ancient world never recovered from the blow inflicted by the plague during the reign of M. Aurelius. The death rate from the plague was 7-10 percent; outbreak in 165(6)-168 claimed the lives of 3.5 to 5 million people. Otto Sik believes that more than half of the population of the empire died. J. F. Gilliam believes that the Antonine Plague probably caused more deaths than any other epidemic from the time of the empire until the middle of the 3rd century.

Medieval and post-medieval pandemics

Local plague outbreaks are grouped into three plague pandemics, with the result that the respective start and end dates for some pandemic outbreaks are still subject to debate. According to Joseph P. Byrne of Belmont University, these pandemics were: The first plague pandemic from 541 to ~750 AD, spreading from Egypt to the Mediterranean (beginning with the Plague of Justinian) and northwestern Europe. Second plague pandemic from ~1345 to ~1840, spreading from Central Asia to the Mediterranean and Europe (beginning with the Black Death), and probably spreading to China as well. The third plague pandemic from 1866 to the 1960s that spread from China around the world, particularly to India and the West Coast of the United States. However, the Black Death of the late Middle Ages is sometimes seen not as the beginning of the second, but as the end of the first pandemic - in this case, the beginning of the second pandemic would be in 1361; also not constant are the end dates of the second pandemic in the literature, e.g. ~1890 instead of ~1840.

First Pandemic: The Early Middle Ages

Plague of Justinian in 541-542 AD is the first known epidemic to be described. It marks the first recorded pattern of bubonic plague. This disease is believed to have originated in China. It then spread to Africa, from where the huge city of Constantinople imported large quantities of grain, mostly from Egypt, to feed its citizens. Grain ships were a source of infection for the city, and populations of rats and fleas inhabited the massive state granaries. At the peak of the epidemic, according to Procopius, it killed 10,000 people daily in Constantinople. The real number was more likely around 5,000 per day. The plague ultimately may have killed 40% of the city's inhabitants. The plague claimed the lives of up to a quarter of the population of the eastern Mediterranean. In 588 AD a second major wave of plague spread across the Mediterranean into what is now France. It is estimated that the Plague of Justinian killed about 100 million people worldwide. This epidemic cut the population of Europe by about half between 541 and 700. In addition, the plague may have contributed to the success of the Arab conquests. An outbreak of plague in 560 AD was described in 790 AD. The source says that the plague caused "swollen glands ... in the form of a nut or date" in the groin area "and in other rather delicate places, followed by an unbearable fever." While the swelling in this description is identified by some as buboes, there is some controversy as to whether this pandemic should be attributed to the bubonic plague, Yersinia Pestis, known in modern times.

Second pandemic: 14th century to 19th century

From 1347 to 1351, the Black Death, a massive and deadly pandemic originating in China, spread along the Silk Road and swept through Asia, Europe and Africa. This epidemic may have reduced the world's population from 450 million to 350-375 million. China has lost about half of its population, from about 123 million to about 65 million; Europe has lost about 1/3 of its population, from about 75 million to 50 million people; and in Africa about 1/8 of the population died, from about 80 million to 70 million (death rates tend to correlate with population density, so Africa, being less dense overall, had the most low level mortality). The Black Death has been associated with the highest number of deaths of any known non-viral epidemic. Although no precise statistics are available, it is believed that 1.4 million people died in England (a third of the 4.2 million people who lived in England), while an even larger percentage of the population was probably wiped out in Italy. On the other hand, populations in the northeast of Germany, the Czech Republic, Poland and Hungary are likely to have been less affected, and there are no death estimates in Russia or the Balkans. It is possible that Russia was not so affected due to the very cold climate and large size, which made it less closely in contact with the infection. The plague repeatedly returned to Europe and the Mediterranean during the 14th to 17th centuries. According to Biraben, the plague was present in Europe every year between 1346 and 1671. The second pandemic spread in 1360-1363; 1374; 1400; 1438-1439; 1456-1457; 1464-1466; 1481-1485; 1500-1503; 1518-1531; 1544-1548; 1563-1566; 1573-1588; 1596-1599; 1602-1611; 1623-1640; 1644-1654; and 1664-1667; subsequent outbreaks, although severe, marked a weakening of outbreaks over most of Europe (18th century) and North Africa(19th century). In the words of Geoffrey Parker, "France lost nearly a million men in the plague of 1628-31." In England, in the absence of a census, historians offer a range of data on the population before the epidemic, reaching between 4 and 7 million people in 1300, and after the epidemic, 2 million. By the end of 1350, the Black Death subsided, but it never completely disappeared from England. Over the next few hundred years, further outbreaks occurred in 1361-62, 1369, 1379-83, 1389-93 and during the first half of the 15th century. An outbreak in 1471 claimed the lives of 10-15% of the population, and the death rate from the plague of 1479-80. could reach 20%. The most common outbreaks in Tudor and Stuart England began in 1498, 1535, 1543, 1563, 1589, 1603, 1625 and 1636 and ended with the Great Plague of London in 1665. In 1466, 40,000 people died of the plague in Paris. During the 16th and 17th centuries, the plague swept through Paris for almost every third year. The Black Death ravaged Europe for three years and then continued in Russia, where the disease broke out about once every five or six years from 1350 to 1490. Plague epidemics ravaged London in 1563, 1593, 1603, 1625, 1636 and 1665, reducing its population by 10-30% in those years. Over 10% of the population of Amsterdam died in 1623-1625, and again in 1635-1636, 1655 and 1664. In Venice between 1361 and 1528 there were 22 outbreaks of the plague. The plague of 1576-1577 killed 50,000 people in Venice, almost a third of the population. Later outbreaks in central Europe included the Italian plague of 1629-1631, which is associated with troop movements during the Thirty Years' War, and the great plague in Vienna in 1679. Over 60% of the population in Norway died between 1348 and 1350. The last outbreak of the plague devastated Oslo in 1654. In the first half of the 17th century, the Great Plague of Milan claimed the lives of 1.7 million people in Italy, or about 14% of the population. In 1656, a plague killed about half of Naples' 300,000 inhabitants. More than 1.25 million deaths are associated with the extreme spread of plague in 17th century Spain. The plague of 1649 probably halved the population of Seville. In 1709-1713, the plague after the Great Northern war(1700-1721, Sweden against Russia and allies) killed about 100,000 people in Sweden and 300,000 people in Prussia. The plague killed two-thirds of the inhabitants of Helsinki, and a third of the population of Stockholm. The last major epidemic in Western Europe occurred in 1720 in Marseille, in Central Europe the last major outbreaks occurred during the Great Northern War, and in Eastern Europe during the Russian plague of 1770-72. The Black Death ravaged much of the Islamic world. Plague was present in some region of the Islamic world almost every year between 1500 and 1850. The plague hit the cities of North Africa several times. Algiers lost 30,000-50,000 men in 1620-21, and again in 1654-57, 1665, 1691 and 1740-42. The plague remained an important factor in Ottoman society until the second quarter of the 19th century. Between 1701 and 1750, 37 major and minor epidemics were recorded in Constantinople, and 31 epidemics between 1751 and 1800. Baghdad was hit hard by the plague and two-thirds of its population was wiped out.

The nature of the Black Death

In the early 20th century, following the identification by Yersen and Shibasaburō of the plague bacterium that caused the Asian bubonic plague (Third Pandemic) in the late 19th and early 20th century, most scientists and historians became convinced that the Black Death was strongly associated with the presence of more contagious pneumonic and septic variants of the disease, which increased the growth of infection and spread the disease deep into the interior of the continents. Some modern researchers argue that the disease was more likely viral, pointing to the absence of rats in parts of Europe that were badly affected by epidemics, and to the opinion of people at the time that the disease was spread by direct contact with an infected person. According to the stories of the time, the Black Death was highly contagious, unlike the bubonic plague of the 19th and early 20th century. Samuel K. Cohn made a comprehensive attempt to disprove the bubonic plague theory. The researchers proposed a mathematical model based on the changing demographics of Europe from 1000 to 1800, demonstrating how the plague epidemics from 1347 to 1670 could provide selection that raised the mutation rate to the level seen today, which prevents HIV from entering macrophages and CD4+ T cells that carry the mutation (the average frequency of this allele is 10% in European populations). It is assumed that one original mutation appeared more than 2500 years ago, and that constant epidemics of hemorrhagic fever erupted during the early classical civilizations. However, there is evidence that two previously unknown clades (variant strains) of Y. pestis were responsible for the Black Death. A multinational team conducted new surveys that used both ancient DNA assays and protein-specific detection methods to search for Y. pestis-specific DNA and protein in human skeletons from widespread mass graves in northern, central, and southern Europe that have been archeologically associated with the Black Death and subsequent outbreaks. The authors concluded that this study, together with previous analyzes from the south of France and Germany, "...allows the debate about the etiology of the Black Death to be ended, and unequivocally demonstrates that Y. pestis was the causative agent of the plague that ravaged Europe in the Middle Ages." The study also identified two previously unknown but related strains of Y. pestis that have been associated with various medieval mass graves. They have been recognized as the ancestors of modern isolates of the Y. pestis "Orientalis" and "Medievalis" strains, suggesting that these variant strains (now considered extinct) may have entered Europe in two waves. Surveys of plague graves remaining in France and England show that the first variant entered Europe via the port of Marseille around November 1347 and spread through France over the next two years, eventually reaching England in the spring of 1349, where it spread. throughout the country in three consecutive epidemics. Surveys of plague graves left in the Dutch city of Bergen op Zoom showed the presence of a second genotype of Y. pestis, which is different from that in Britain and France, and this second strain was believed to be responsible for the pandemic that spread through Holland. Belgium and Luxembourg since 1350. This discovery means that Bergen-op-zoom (and possibly other regions in the south of the Netherlands) did not directly become infected from England or France around 1349, and the researchers suggested that a second wave of plague infection, different from the one that occurred in England and France may have reached the Low Countries from Norway, the Hanseatic cities or other regions.

Third pandemic: 19th and 20th centuries

The Third Pandemic began in the Chinese province of Yunnan in 1855, spreading the plague to every inhabited continent and eventually causing the death of over 12 million people in India and China. The analysis shows that the waves of this pandemic may come from two different sources. The first source is mainly bubonic plague, which spread throughout the world through ocean trade, transport of infected people, rats, and cargo that harbored fleas. The second, more virulent strain was mainly pulmonary in nature, with strong infection from person to person. This strain was largely restricted to Manchuria and Mongolia. Researchers during the "Third Pandemic" identified plague vectors and plague bacteria, leading over time to modern treatments. The plague hit Russia in 1877-1889, and it happened in the countryside near the Ural Mountains and the Caspian Sea. Efforts to maintain hygiene and isolate patients have reduced the spread of the disease, and the disease has claimed the lives of only 420 people in the region. It is important to note that the Vetlyanka region is close to the population of the steppe marmot, a small rodent considered to be a very dangerous reservoir of plague. The last significant outbreak of plague in Russia occurred in Siberia in 1910 after a sudden increase in demand for marmot pelts (a substitute for sable) that increased the price of the pelts by 400 percent. Traditional hunters did not hunt sick marmots, and it was forbidden to eat the fat from under the marmot's shoulder (where the axillary lymph gland is located, in which the plague often developed), so outbreaks tended to be limited to individuals. Rising prices, however, attracted thousands of Chinese hunters from Manchuria, who not only caught sick animals, but also ate their fat, which is considered a delicacy. The plague spread from the hunting grounds to the end of the Chinese East railway and on the highway behind it for 2700 km. The plague lasted 7 months and killed 60,000 people. The bubonic plague continued to circulate through various ports throughout the world for the next fifty years; however, the disease was predominantly distributed in Southeast Asia. An epidemic in Hong Kong in 1894 was associated with a particularly high mortality rate of 90%. As early as 1897, the medical authorities of the European powers organized a conference in Venice in search of a way to contain the plague in Europe. In 1896, the plague in Mumbai struck the city of Bombay (Mumbai). In December 1899, the disease reached the Hawaiian Islands, and the decision of the Board of Health to initiate controlled burnings of individual buildings in Honolulu's Chinatown resulted in an uncontrolled fire that led to the unintentional burning of much of Chinatown on January 20, 1900. Shortly thereafter, the plague reached the continental United States, initiating the plague of 1900-1904. in San Francisco. The plague persisted in Hawaii on the outer islands of Maui and Hawaii (The Big Island) until it was finally eradicated in 1959. Although the outbreak that began in China in 1855 is traditionally known as the Third Pandemic, it remains unclear what was whether major outbreaks of bubonic plague are less than or greater than three. Most modern outbreaks of bubonic plague in humans were preceded by a strikingly high mortality rate in rats, but this phenomenon is missing from the descriptions of some earlier epidemics, especially the Black Death. Buboes or swelling in the groin, which are especially characteristic of bubonic plague, are also a characteristic feature of other diseases. Research conducted by a group of biologists from the Pasteur Institute in Paris and the Johannes Gutenberg University in Mainz in Germany, by analyzing DNA and proteins from plague graves, published in October 2010, report that, without a doubt, all "three major epidemics" were caused, by at least two previously unknown strains of Yersinia Pestis and originated in China. A team of medical geneticists, led by Mark Achtman at University College Cork in Ireland, reconstructed the genealogical tree of this bacterium and in the online edition of Nature Genetics on October 31, 2010, scientists concluded that all three large waves of plague originated in China.

Plague as a biological weapon

The plague was used as a biological weapon. Historical evidence from ancient China and medieval Europe demonstrates the use of contaminated animal carcasses such as cows or horses and human corpses by the Huns, Mongols, Turks, and other peoples to pollute enemy water sources. General Ho Qibin of the Han Dynasty died from such contamination while participating in military operations against the Huns. Plague victims were also catapulted into cities under siege. In 1347, Genoese-owned Kaffa, a large trading center on the Crimean peninsula, was under siege by an army of Mongol Golden Horde warriors under the command of Janibek. After a long siege during which the Mongol army reportedly suffered from the disease, the Mongols decided to use the infected corpses as a biological weapon. The corpses were catapulted outside the city walls, infecting the inhabitants. Genoese merchants fled, carrying the plague (Black Death) with their ships to the south of Europe, from where it quickly spread throughout the world. During World War II, a plague broke out in the Japanese army due to a large number of fleas. During the Japanese occupation of Manchuria, Unit 731 intentionally infected Chinese, Korean, and Manchu civilians and prisoners of war with the plague germ. These people, who were called "maruta" or "logs", were then studied by dissection, others by vivisection while they were still conscious. Members of the bloc, such as Shiro Ishii, were exonerated from the Tokyo Tribunal by Douglas MacArthur, but 12 of them were prosecuted in trials in the Khabarovsk Military Courts in 1949, during which some confessed to spreading bubonic plague within a radius of 36 km around the city of Changde. Ishii bombs, containing live mice and fleas, with very low explosive loads to deliver weaponized microbes, overcame the problem of killing infected animals and insects with an explosive device by using a ceramic, rather than metal, warhead housing. Although there are no records of the actual use of ceramic shells, prototypes exist and were presumably used in experiments during World War II. After World War II, agents for the military use of pneumonic plague were developed in the United States and the Soviet Union. Experiments included various delivery methods, vacuum drying, bacterial sizing, development of antibiotic resistant strains, association of bacteria with other diseases (such as diphtheria), and genetic engineering. Scientists working on biological weapons programs in the USSR stated that Soviet Union made powerful efforts in this direction, and that large stocks of plague germs were produced. Information about many Soviet projects largely absent. Aerosol pneumonic plague remains the most serious threat. Plague can be easily treated with antibiotics, which are stocked in some countries, such as the United States, in case of such an attack.

Wheelis M. (2002). "Biological warfare at the 1346 siege of Caffa". Emerg Infect Dis (Center for Disease Control) 8(9): 971–5. doi:10.3201/eid0809.010536. PMC 2732530. PMID 12194776

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Plague. Briefly about the disease

Plague (lat. pestis) is an acute natural focal infectious disease of the group of quarantine infections, occurring with an exceptionally severe general condition, fever, damage to the lymph nodes, lungs and other internal organs, often with the development of sepsis. The disease is characterized by high mortality.

The causative agent is plague wand, discovered in 1894 at the same time by the Frenchman Yersin and the Japanese Kitasato.

The incubation period lasts from several hours to 3-6 days. The most common forms of plague are bubonic and pneumonic. Mortality in bubonic plague ranges from 27 to 90%, in pulmonary - almost 100%.

The well-known plague epidemics, which claimed millions of lives, left a deep mark on the history of mankind.

plague infectious disease

The emergence of the plague

Plague arose on Earth before man appeared, and its origins must be sought in distant geological epochs, when the great-grandfathers of modern rodents began to appear - about 50 million years ago. Then there were already species of fleas similar to those living today, as evidenced by the remains of fossil animals in amber. The ancestral home of the plague is the endless steppes and deserts of Central Asia, where this disease developed and maintained among local species of gerbils, marmots and ground squirrels. Another ancient center of the plague was the Central African savannas and North African deserts and semi-deserts. Most likely, it penetrated into the Western Hemisphere even in distant geological epochs through Siberia and Alaska. In these parts of the world - and especially in Asia - the first epidemics of the plague arose among people. Initially, these were local epidemics and their size was limited by the fact that vast areas were inhabited by a relatively small number of people, moreover, they had practically no contact with each other. Real tragedies began when the population and the level of its material development rose to a higher level.

Plague epidemics in our era

The most famous is the so-called "Justinian plague" (551-580), which originated in the Eastern Roman Empire and swept the entire Middle East. More than 20 million people died from this epidemic. In the X century there was a big plague epidemic in Europe, in particular, in Poland and Kievan Rus. In 1090, over 10,000 people died from the plague in Kyiv in two weeks. In the 12th century, plagues broke out several times among the Crusaders. In the 13th century, there were several outbreaks of plague in Poland and Rus'. In the 14th century, a terrible epidemic of the "Black Death", brought from Eastern China, passed through Europe. In 1348, almost 15 million people died from it, which accounted for a quarter of the entire population of Europe. In 1346 the plague was brought to the Crimea, and in 1351 to Poland and Rus'. Later outbreaks in Russia were marked by outbreaks of plague in 1603, 1654, 1738 - 1740 and 1769. An epidemic of bubonic plague swept through London in 1664-1665, killing more than 20% of the city's population. Separate cases of infection are recorded at the present time.

In the Middle Ages, the unsanitary conditions that prevailed in the cities contributed to the spread of the plague. There was no sewerage, and all the garbage flowed right along the streets, which served as an ideal environment for the rats to live. Alberti described Siena in this way, which “loses a lot ... due to the lack of cesspools. That is why the whole city emits a stench not only during the first and last night watch, when vessels with accumulated sewage pour out of the windows, but also at other hours it is disgusting and heavily polluted ". In addition, in many places, cats were declared the cause of the plague, allegedly being servants of the devil and infecting people. Mass extermination of cats led to an even greater increase in the number of rats. The most common cause of infection is the bites of fleas that previously lived on infected rats.

Plague as a biological weapon

The use of the plague agent as a biological weapon has deep historical roots. In particular, events in China and in medieval Europe showed the use of the corpses of infected animals (cows, horses), human bodies by the Huns, Turks and Mongols to infect water sources and water supply systems. There are historical records of cases of ejection of infected material during the siege of some cities.

During World War II, the Japanese military used elements of biological weapons in the form of a plague agent. From the planes of the Japanese side, a mass drop of a specially prepared carrier of the plague - infected fleas - was carried out. Special Squad 731 produced a deliberate infection of civilians and prisoners of China, Korea and Manchuria for further medical research and experiments, studying the prospects for biological weapons of mass destruction.

Infection

The causative agent of plague is resistant to low temperatures, well preserved in sputum, but at 55 degrees it dies within 10-15 minutes, and when boiled - almost instantly. It enters the body through the skin (with a flea bite), mucous membranes of the respiratory tract, digestive tract, conjunctiva. According to the main carrier, natural foci of plague are divided into ground squirrels, marmots, gerbils, voles and pikas. In addition to wild rodents, rats and mouse-like animals, as well as some wild animals (hares, foxes), which are the object of hunting, are sometimes included in the process. Of domestic animals, camels are sick with plague.

In a natural focus, infection usually occurs through the bite of a flea that previously fed on a sick rodent. Infection also occurs during the hunting of rodents and their further processing.

Mass diseases of people occur when a sick camel is cut, skinned, cut, processed. An infected person, depending on the form of the disease, in turn, can be a plague transmitter by airborne droplets or through the bite of certain flea species.

Fleas are a specific carrier of the plague pathogen. This is due to the peculiarities of the structure of the digestive system of fleas: in front of the stomach, the esophagus of the flea forms a thickening - goiter. When bitten by an infected animal (rat), the plague bacterium settles in the goiter of the flea and begins to multiply intensively, completely clogging the goiter. Blood cannot enter the stomach, so such a flea is constantly tormented by a feeling of hunger.

She moves from host to host in the hope of getting her portion of blood and manages to infect a fairly large number of people before she dies (such fleas live no more than ten days).

When bitten by plague-infected fleas, a person may develop a papule or pustule filled with pus. Then the process spreads through the lymphatic vessels (bubonic form), affecting almost all internal organs.

However, from an epidemiological standpoint, the most important role is played by the “screening out” of the infection in the lung tissue with the development of the pulmonary form of the disease. Since the development of plague pneumonia, a sick person himself becomes a source of infection, but at the same time, a pulmonary form of the disease is transmitted from person to person - an extremely dangerous one, with a very rapid course.

The course of the disease

The bubonic form of the plague is characterized by the appearance of sharply painful ulcers, most often inguinal lymph nodes on one side. The incubation period is 2-6 days (less often 1-12 days). In the absence of antibiotic therapy, the lymph nodes are opened. Then there is a gradual healing of fistulas. The severity of the condition of patients gradually increases by 4-5 days, the temperature may be elevated, sometimes a high fever appears immediately, but at first the condition of patients often remains satisfactory. This explains the fact that a person with bubonic plague can fly from one part of the world to another, considering himself healthy.

However, at any time, the bubonic form of the plague can cause a generalization of the process and go into a secondary septic or secondary pulmonary form. In these cases, the condition of the patients very quickly becomes extremely severe. Symptoms of intoxication increase by the hour. The temperature after the strongest chill rises to high numbers. All signs of sepsis are noted: muscle pain, severe weakness, headache, dizziness, congestion of consciousness, up to its loss, sometimes excitement (the patient rushes about in bed), insomnia. With the development of pneumonia, a cough appears with the separation of frothy bloody sputum, containing a huge amount of plague rods. It is this sputum that becomes the source of infection from person to person with the development of now primary pneumonic plague.

In the Middle Ages, the plague was practically not treated, the actions were mainly reduced to cutting or cauterizing plague buboes. Since the 13th century, they have been trying to limit the plague epidemic with the help of quarantines.

The first vaccine against plague was created at the beginning of the 20th century by Vladimir Khavkin.

The treatment of plague patients is currently reduced to the use of antibiotics, sulfonamides and therapeutic anti-plague serum. Prevention of possible foci of the disease consists in carrying out special quarantine measures in port cities, disarming all ships that sail on international flights, creating special anti-plague institutions in the steppe areas where rodents are found, identifying plague epizootics among rodents and fighting them. Outbreaks of the disease are still found in some countries in Asia, Africa and South America.

If a plague is suspected, the sanitary and epidemiological station of the district is notified about this.

The patient should be immediately hospitalized in the box of the infectious diseases hospital. The isolated compartment should include a toilet and a treatment room. All staff receive immediate prophylactic antibiotic treatment throughout the days they spend in isolation. The head doctor of the institution, having received a message about the identification of a patient suspicious of the plague, takes measures to stop communication between the hospital departments, the floors of the clinic where the patient was found. At the same time, he organizes the transmission of an emergency message to a higher organization and an anti-plague institution. Together with the information, the leader requests consultants and the necessary assistance.

After taking measures to separate the sick person from healthy people in a medical institution or at home, a list of people who had contact with the patient is compiled, indicating their full name, age, place of work, profession, home address.

For the treatment of plague, antibiotics are most effective: streptomycin, pasomycin. With the bubonic form of the plague, the patient is injected intramuscularly with streptomycin 3-4 times a day, tetracycline antibiotics - intravenously. In case of intoxication, saline solutions are administered intravenously. Biseptol is used with great success in the treatment of plague.

Current state

Every year, the number of cases is about 2.5 thousand people, and without a tendency to decrease. For Russia, the situation is complicated by the annual detection of new cases in the states adjacent to Russia (Kazakhstan, Mongolia, China), the importation of a specific plague carrier, fleas, through transport and trade flows from the countries of Southeast Asia.

According to available data, according to the World Health Organization, from 1989 to 2004, about forty thousand cases were recorded in 24 countries, and the mortality rate was about seven percent of the number of cases. In a number of countries in Asia (Kazakhstan, Mongolia, China and Vietnam), Africa (Tanzania and Madagascar), the Western Hemisphere (USA, Peru), cases of human infection are recorded almost annually.

In Russia, from 2001 to 2006, 752 strains of the plague pathogen were recorded. At the moment, the most active natural foci are located in the Astrakhan region, the Kabardino-Balkarian and Karachey-Cherkess republics, the republics of Altai, Dagestan, Kalmykia, and Tyva. Of particular concern is the lack of systematic monitoring of the activity of outbreaks located in the Ingush and Chechen Republics.

At the same time, cases of plague have not been registered in Russia since 1979, although annually over 20 thousand people are at risk of infection in the territory of natural foci (with a total area of ​​more than 253 sq. km.).

Scientific literature

1. "Essays on the history of the plague" Supotnitsky M.V., Supotnitskaya N.S.

2. V. V. Suntsov, N. I. Suntsova Plague. Origin and evolution of the epizotic system.

3. Ganin V. S. War against the "black death": from defense to offensive. "Science and life".

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A few days ago, doctors confirmed a case of bubonic plague in Kyrgyzstan. According to the Republican Center for Quarantine and Especially Dangerous Infections, 15-year-old Temirbek Isakunov contracted a dangerous disease after he ate marmot shish kebab with his friends (who are now being actively searched for by doctors).

Plague doctor. Fragment of an engraving by Paul Furst, 1656

For many, the news that outbreaks of the plague are still possible in our time came as a surprise. In fact, since the time of the great epidemics, the plague has certainly not disappeared anywhere and will not disappear in the near future. And the point here is not at all in the state of medicine in Central Asia(although there are also questions to him in this case), but that the disease persists in natural reservoirs, where it continues to infect its main carriers - marmots, ground squirrels and other rodents. These reservoirs exist all over the world, on all continents, with the possible exception of only Antarctica and Australia. A little less than three thousand cases of bubonic plague are registered annually. It is not possible to destroy these foci, and since one way or another humanity will have to continue to live with the plague on the same planet, it is interesting to understand these complex relationships.

three waves

On a global scale, humanity faced the plague three times: it was the Justinian plague, which raged in the second half of the sixth century during the reign of Justinian in Byzantium, the famous Black Death, which came to Europe in the middle of the XIV century and did not subside for almost three hundred years, and the last, Asian plague that broke out in southern China in 1855. Scientists call these three wars of mankind for survival pandemics, that is, global epidemics that have affected the entire known (to the West) world. At the same time, strictly speaking, the condition of globality was fulfilled only for the third time - during the Asian pandemic. The medieval Black Death did not affect the New World, but the Plague of Justinian (based on what we know from historical sources) did not reach Southeast Asia. However, perhaps the simple fact is that this part of the world lay far beyond the western ecumene of the 5th century.

Scientists trying to figure out the history and origin of the plague are forced to use historical descriptions contemporaries who understood almost nothing in its nature. Before the concept of a bacterial infection, before the agent that caused it, Yersinia pestis, was discovered, "plague" or "pestilence" (plague and pestilence) was the name given to any epidemic disease that led to the death of a large number of people.

One striking example of the unreliability of historical evidence in this sense is the Plague of Athens that broke out on mainland Greece during the Peloponnesian War at the end of the 5th century BC. It is vividly described by the Greek historian Thucydides. The war began when the Spartan-backed Thebans attacked Athens' Boeotian ally, Plataea. The 60,000-strong army of the Peloponnesians, led by Sparta, entered Attica in May 431 BC and began to destroy everything in its path. The inhabitants of the surrounding villages hurried to hide behind the Long Walls, as a result of which the city was overcrowded - many spent the night right under the open sky. Lack of water and unsanitary conditions contributed to the spread of the disease. An epidemic broke out in the city, which claimed the lives of a quarter of the population, that is, approximately 30 thousand people. Pericles himself, the leader of the Athenian army and one of the prominent figures of the Greek Golden Age, became its victim. The name "plague" has been attached to this epidemic in the literature, and many scientists until recently believed that this name correctly reflects its nature.

The Plague of Athens, Nicolas Poussin, 1630. Image:Web Gallery of Art

However, in 2006, Greek microbiologists showed that the epidemic in Periclean Athens was not the plague in its current understanding. Scientists have isolated bacterial DNA from the teeth of several people buried in the ancient cemetery of Keramekos in Athens. It turned out that fragments of the genome of the plague bacillus Yersinia pestis, as well as DNA of the causative agents of typhoid, anthrax and smallpox, were not in them. The cause of the epidemic, apparently, was Salmonella enterica (Typhi), which causes a food infection - it was her DNA that was found in the teeth of Pericles' contemporaries. However, if we are not talking about the exclusion of the plague version, but about the proof of salmonellosis as the only reason epidemic, the data obtained by the authors are still too fragmentary.

Sunset of Europe

The first reliably proven pandemic of Yersinia pestis is the Plague of Justinian, which appeared in the capital of Byzantium in 532 and spread throughout Europe by the end of the 6th century. Historical evidence suggests that the disease came from Africa with a cargo of Egyptian grain, although there is no reliable evidence of this yet. Since the disease spread along trade routes, it is not surprising that Constantinople became its epicenter. It is believed that in 541-542, at the peak of the plague fire, about 40 percent of the population of the capital died. “At this time, few people could be found at work. Most of the people who could be met on the street were those who carried the corpses, ”says the historian Procopius of Caesarea. Justinian I himself died of the plague.

Justinian I, fragment of a mosaic in San Vitale in Ravenna. Photo: The York Project

According to existing estimates, the first pandemic killed 25 million people in Europe, halving its population, and a fantastic 100 million fell victim to the pandemic. At the same time, we should not forget that the population of the Earth today is completely incomparable with the number in the 6th century, and besides, the first pandemic affected, as we know, only the Old World.

The Plague of Justinian, which flared up for several years and then subsided, lasted in such waves until the year 700, marking the beginning of the "Dark Ages" of Europe. It was a period of decline in European culture and arts, the destruction of trade relations. At the same time, the population, spared from constant epidemics, gradually grew and by the beginning of the XIV century it had tripled.

When trade with Asia began to re-establish itself and the first trading and financial empires like the Medici, Sforza and their rivals began to appear in Europe, the plague returned to Europe again and this time went much further than in Justinian's time. This pandemic subsequently became known as the Black Death.

"Multiple people die"

It is possible that the plague began to be called the Black Death because of a characteristic symptom - dark circles around the eyes of people who suffered from it, and possibly because of the black spots that appeared on the skin of patients. At the same time, the disease began to be called bubonic plague for the characteristic swelling of the lymph nodes, buboes, which appeared in the first days of the disease.

Be that as it may, we know much more about the second wave of the pandemic than about the plague of the Justinian era. The Black Death came to Europe with merchant ships that landed in Sicily in 1347. From here it spread throughout Europe - up to Greenland, penetrated the northern coast of Africa, reached Arabia.

Here is how Giovanni Boccaccio describes this invasion on the first pages of the Decameron:

“So, since the time of the saving incarnation of the Son of God, one thousand three hundred and forty-eight years have already passed, when a destructive plague visited the glorious Florence, the best city in all of Italy; it arose, perhaps under the influence of heavenly bodies, and perhaps it was sent to us for sins by the right wrath of God, so that we could atone for them, but only a few years before that it appeared in the East and claimed countless lives, and then , constantly moving from place to place and growing to a mind-blowing size, finally reached the West.

The wave of the Black Death swept through Europe in many isolated epidemics followed by periods of relative calm. Epidemics continued for almost 300 years and came to naught only by the end of the 17th century. Interestingly, by this time, the Black Death had managed to do something good in a sense: because of the epidemic of 1665, Isaac Newton had to leave Cambridge and return to his own home, where he created his “Beginnings” in rural seclusion for 18 months of concentrated work. which laid down the principles of all modern science.

Black Death. Illustration from the Toggenburg Bible, 1411.

Despite the absence of maritime communication, the Black Death did not bypass Russia either. It happened almost immediately after the start of the pandemic - in 1349. The plague came, according to Karamzin, through Scandinavia and first spread to Pskov and Novgorod, where about half the population died as a result. Glukhov and Belozersk, according to the chronicler, completely died out. Kostomarov reports that in 1387 in Smolensk "there was such a strong pestilence that only five people remained who left the city and closed the gates behind them."

The Black Death showed the complete helplessness of all medicine of the XIV-XIX centuries, which was recognized even by contemporaries. Plague doctors, whose costume with a black cloak and a nosy mask was immortalized by the Venetian carnival, could not only prevent the spread of the disease, but even simply alleviate the suffering of the patient, using completely ineffective means for this: putting frogs on buboes and, of course, bloodletting. Characteristically, they usually received from the commune at least four times the fee than ordinary honest doctors, although their ranks were replenished with all sorts of adventurers without any education at all (for this they were politely called "empiricists").

Boccaccio and other contemporaries described what they saw in such detail that there is no doubt that the plague caused by Yersinia pestis was the cause of the Black Death:

“... the onset of the disease was marked in both men and women by tumors under the armpits and in the groin, growing to the size of a medium-sized apple or egg - in some people, people called them buboes. In a very short time, malignant buboes appeared and arose in patients and in other places. Later, a new symptom of the above disease was discovered in many: black or blue spots appeared on their hands, on their hips, as well as on other parts of the body ... "

Thanks to modern methods of molecular biology, it has recently been possible not only to show that Yersinia pestis was the cause of the Black Death, but also to study the DNA features of that very ill-fated strain. A recent study showed that all modern varieties of Yersinia pestis are direct descendants of the Black Death itself, and she herself is not so different from them.

Doubts about the identity of the strain arose due to the fact that, according to historical evidence, in the Middle Ages the disease was much more acute and led to greater mortality than now. In addition, buboes used to appear more often in the upper body on the neck and in the armpits, but now in most patients they occur more often in the groin (because vector fleas jump on their feet more easily). Contrary to expectations, animal experiments showed approximately the same virulence of the Black Death strain, and the differences in DNA found were by no means significant.

asian wave

The third, or Asian, wave of the plague began in 1855 in the Chinese province of Yunnan, famous for its tea production. By the end of the century, it reached Hong Kong and Bombay, from where it spread all over the world by steamboats. Even the (extremely ingenious) invention of anti-rat discs, which were mounted on ropes and did not allow flea vectors to enter the ships, was not able to contain the pandemic. In India alone, the Asian plague killed 12.5 million people.

Rat protection discs. Photo: US Navy

Fortunately, by the end of the 19th century, vaccines had already been invented, and microbiology was flourishing. Inspired by the success of the fight against smallpox, in 1894 the Japanese scientist Shibasaburo Kitazato and the Frenchman Alexandre Yersin went to Bombay in search of a cure. Both almost simultaneously managed to detect the microorganism-causative agent of the plague. At the same time, as it turned out later, Kitazato, who at first was widely recognized, actually discovered a commensal (associated) bacterium, and the strain isolated by Yersen turned out to be the true pathogen - it was his name in 1970 that was immortalized in the generic name of the pathogen Yersinia.

Alexandre Yersen, discoverer of the plague wand

Already two years after the discovery, Yersen managed to obtain an anti-plague serum, and subsequently other scientists were able to make a vaccine, and more than one. However, it was impossible to talk about the victory over the plague until Alexander Fleming made the main invention of the 20th century, which turned the life of mankind upside down - we are talking about the discovery of antibiotics. Today, plague is a serious disease, which, if diagnosed on time, can be cured in ten days of a streptomycin course. Those deaths that continue to be recorded in different parts of the world rather paradoxically illustrate the effectiveness of existing therapy. Usually they are the result of the fact that doctors simply cannot recognize the disease, which they met only on the pages of textbooks.

unknown plague

Advances in medicine create a misleading impression that today, if not everything, then almost everything is known about the plague. Upon closer examination, it turns out that this is not the case at all. And the feeling of victory over the disease, if you think in the longer term, is also really deceptive.

First, the question of the very origin of Yersinia pestis remains open. It is known that this bacterium, a relative of E. coli, several tens of thousands of years ago was quite a common enterobacterium that lived in the intestines and caused - in the most severe case - intestinal poisoning like salmonellosis. How exactly this bacterium, Yersinia pseudotuberculosis, became the deadly plague is unclear. Russian microbiologists Viktor and Nina Suntsov from the A.N. Severtsov, Russian Academy of Sciences, developed a complex hypothetical mechanism for this transition, which is related to the characteristics of the wintering of marmots and takes into account climate change, but it is still unclear to what extent it reflects the real process.

Secondly, scientists do not know why the plague entered Europe only in the 6th century AD, and before that it bypassed it. Established trade relations existed much earlier - suffice it to recall the Greek colonies, which in the 7th century BC stretched across the space from Portugal to the Sea of ​​\u200b\u200bAzov. If there really was no plague in those days, then this can be explained either by amazing luck, or (again, incomprehensibly) by the absence of plague in the Greek ecumene.

Thirdly, it is not known why the first and second waves of the plague lasted exactly as long as they lasted, and why they did end. It is not clear how one can explain the apparent absence of epidemics in the Dark Ages and their rarity in the 18th and early 19th centuries.

Yersinia pestis. Photo: PHIL

And, finally, fifthly, it is not clear whether the victory over the plague is final and how many more quiet years are allotted to humanity in this regard. Antibiotics remain the main weapon against plague, and the situation with them in the modern world is becoming more and more threatening. The lack of effective global regulatory bodies, the release of antibiotics into the environment, and the unwillingness of commercial companies to spend money on developing new generations of drugs are steadily depleting the supply of effective drugs. The creation of antibiotics, unlike almost all other pharmaceutical products, is associated with a tragic paradox: each new generation becomes more toxic, less effective and more expensive, while it can only be sold to a few thousand patients infected with resistant strains of infections. All this makes the prospect that future generations will remember the 20th century as a beautiful but brief golden age of humanity.

plague doctor in the middle ages

For more than a hundred years, people have associated plague with a special disease that claims the lives of millions of people. Everyone knows the damaging ability of the causative agent of this disease and its lightning-fast spread. Everyone knows about this disease, it is so rooted in the human mind that everything negative in life is associated with this word.

What is plague and where does the infection come from? Why does it still exist in nature? What is the causative agent of the disease and how is it transmitted? What are the forms of the disease and symptoms? What is the diagnosis and how is the treatment carried out? Thanks to what kind of prevention in our time it is possible to save billions of human lives?

What is plague

Experts say that plague epidemics were mentioned not only in historical reference books, but also in the Bible. Cases of the disease were regularly recorded on all continents. But of greater interest are not epidemics, but pandemics or outbreaks of infection that are widespread throughout almost the entire territory of the country and cover neighboring ones. In the entire history of the existence of people, they counted three.

1. The first outbreak of plague or pandemic occurred in the VI century in Europe and the Middle East. During its existence, the infection has claimed the lives of more than 100 million people.
2. The second case, when the disease covered a significant territory, was noted in Europe, from where it reached from Asia in 1348. At this time, more than 50 million people died, and the pandemic itself is known in history as the "plague - black death." She did not bypass the territory of Russia.
3. The third pandemic raged at the end of the 19th century in the East, mainly in India. An outbreak began in 1894 in Canton and Hong Kong. A large number of deaths have been recorded. Despite all the precautions from the local authorities, the number of deaths exceeded 87 million.

But it was during the third pandemic that it was possible to carefully examine the dead people and identify not only the source of the infection, but also the carrier of the disease. The French scientist Alexandre Yersin found that a person becomes infected from sick rodents. A few decades later, they created an effective vaccine against the plague, although this did not help humanity completely get rid of the disease.

Even in our time, isolated cases of plague are recorded in Russia, Asia, the USA, Peru, and Africa. Every year, doctors discover several dozen cases of the disease in various regions, and the number of deaths ranges from one to 10 people, and this can be considered a victory.

Where is the plague found now?

The centers of infection in our time are not marked in red on the usual tourist map. Therefore, before traveling to other countries, it is better to consult an infectious disease specialist where plague is still found.

According to experts, this disease has not yet been completely eradicated. In which countries can you get plague?

1. Isolated cases of the disease occur in the United States and Peru.
2. Plague in Europe was practically not registered several recent years, but Asia has not been spared by the disease. Before visiting China, Mongolia, Vietnam and even Kazakhstan, it is better to get vaccinated.
3. On the territory of Russia, it is also better to play it safe, because several cases of plague are recorded here every year (in Altai, Tyva, Dagestan) and it borders on countries that are dangerous for infection.
4. Africa is considered a dangerous continent from the point of view of epidemiology, most of today's severe infections can be contracted here. Plague is no exception; isolated cases of the disease have been recorded here over the past few years.
5. There is an infection on individual islands. For example, just two years ago, a plague struck several dozen people in Madagascar.

The last hundred years of plague pandemics have not been observed, but the infection has not been completely eradicated.

It has long been no secret that many of the most dangerous infections, which include the plague, are being used by the military as biological weapons. During the Second World War in Japan, scientists brought out a special type of pathogen. In terms of its ability to infect people, it surpassed natural pathogens tenfold. And no one knows how the war could have ended if Japan had used this weapon.

Although plague pandemics have not been recorded for the last hundred years, it has not been possible to completely eradicate the bacteria that cause the disease. There are natural sources of plague and anthropurgic, that is, natural and artificially created in the process of life.

Why is infection considered especially dangerous? Plague is a disease with a high lethality rate. Until the creation of the vaccine, and this happened in 1926, the mortality rate from various types of plague was at least 95%, that is, only a few survived. Now lethality does not exceed 10%.

plague agent

The causative agent of the infection is yersinia pestis (plague bacillus), a bacterium of the genus Yersinia, which is part of a large family of enterobacteria. To survive in natural conditions This bacterium had to adapt for a long time, which led to the peculiarities of its development and vital activity.

1. Grows on simple available nutrient media.
2. It happens in different shapes - from filiform to spherical.
3. The plague bacillus in its structure contains more than 30 types of antigens that help it survive in the body of the carrier and humans.
4. Resistant to environmental factors, but instantly dies when boiled.
5. The plague bacterium has several pathogenicity factors - these are exo and endotoxins. They lead to damage to organ systems in the human body.
6. You can fight bacteria in the external environment with the help of conventional disinfectants. Antibiotics also kill them.

Plague transmission routes

Not only humans are affected by this disease, there are many other sources of infection in nature. The sluggish variants of the plague pose a great danger, when the affected animal can overwinter, and then infect others.

Plague is a disease with natural foci that affects, in addition to humans and other creatures, for example, domestic animals - camels and cats. They get infected from other animals. To date, more than 300 species of bacterial carriers have been identified.

Under natural conditions, the natural carrier of the plague pathogen are:

• gophers;
• marmots;
• gerbils;
• voles and rats;
• Guinea pigs.

In urban environments, the reservoir of bacteria are special types rats and mice:

• pasyuk;
• gray and black rat;
• Alexandrovskaya and Egyptian species of rats.

The carrier of plague in all cases are fleas. Human infection occurs when this arthropod bites, when an infected flea, not finding a suitable animal, bites a person. Just one flea per life cycle can infect up to 10 people or animals. The susceptibility to the disease in humans is high.

How is the plague transmitted?

1. Transmissible or through the bites of an infected animal, mainly fleas. This is the most common way.
2. Contact, which is infected during the cutting of carcasses of sick domestic animals, as a rule, these are camels.
3. Despite the fact that the primacy is given to the transmissible route of transmission of plague bacteria, the alimentary one also plays an important role. A person becomes infected while eating food contaminated with the pathogen.
4. The methods of penetration of bacteria into the human body during plague include the aerogenic route. While coughing or sneezing, a sick person easily infects everyone around them, so they need to be kept in a separate box.

Plague pathogenesis and its classification

How does the causative agent of plague behave in the human body? The first clinical manifestations of the disease depend on the way bacteria enter the body. Therefore, there are different clinical forms of the disease.

Having penetrated into the body, the pathogen with the blood flow penetrates into the nearest lymph nodes, where it remains and safely multiplies. It is here that the first local inflammation of the lymph nodes occurs with the formation of a bubo, due to the fact that blood cells cannot fully destroy bacteria. The defeat of the lymph nodes leads to a decrease in the protective functions of the body, which contributes to the spread of the pathogen in all systems.

In the future, Yersinia affects the lungs. In addition to infection with plague bacteria of the lymph nodes and internal organs, blood poisoning or sepsis occurs. This leads to numerous complications and changes in the heart, lungs, kidneys.

What are the types of plague? Doctors distinguish two main types of the disease:

• pulmonary;
• bubonic.

They are considered the most common variants of the disease, although conditionally, because bacteria do not affect any particular organ, but gradually the entire human body is involved in the inflammatory process. According to the degree of severity, the disease is divided into mild subclinical course, moderate and severe.

plague symptoms

Plague is an acute natural focal infection caused by Yersinia. It is characterized by such clinical signs as severe fever, damage to the lymph nodes and sepsis.

Any form of the disease begins with common symptoms. The incubation period of the plague lasts at least 6 days. The disease is characterized by an acute onset.

The first signs of plague in humans are as follows:

• chills and almost lightning-fast increase in body temperature up to 39–40 ºC;
• severe symptoms of intoxication - headache and muscle pain, weakness;
• dizziness;
• damage to the nervous system of varying severity - from stunning and lethargy to delirium and hallucinations;
• the patient has impaired coordination of movements.

A typical appearance of a sick person is characteristic - a reddened face and conjunctiva, dry lips and a tongue that is enlarged and lined with a white thick coating.

Due to the enlargement of the tongue, the speech of the plague patient becomes illegible. If the infection proceeds in a severe form, the person's face is puffy with a blue tint or bluish, the face has an expression of suffering and horror.

Symptoms of bubonic plague

The name of the disease itself comes from the Arabic word "jumba", which means bean or bubo. That is, it can be assumed that the first clinical sign of the "black death", which our distant ancestors described, was an increase in lymph nodes that resembled the appearance of beans.

How is bubonic plague different from other variants of the disease?

1. A typical clinical symptom of this type of plague is bubo. What does he represent? - this is a pronounced and painful enlargement of the lymph nodes. As a rule, these are single formations, but in very rare cases their number increases to two or more. The plague bubo is more often localized in the axillary, inguinal and cervical region.
2. Even before the appearance of bubo, a sick person develops soreness that is so pronounced that one has to take a forced position of the body to alleviate the condition.
3. Another clinical symptom of bubonic plague is smaller size these formations, the more pain they cause when touched.

How are buboes formed? This is a long process. It all starts with the onset of pain at the site of formation. Then the lymph nodes increase here, they become painful to the touch and soldered with fiber, a bubo is gradually formed. The skin over it is tense, painful and becomes intensely red. Within about 20 days, the bubo resolves or reverses.

There are three options for the further disappearance of the bubo:

• long-term complete resorption;
• opening;
• sclerosis.

In modern conditions, with the right approach to the treatment of the disease, and most importantly, with timely therapy, the number of deaths from bubonic plague does not exceed 7-10%.

Symptoms of pneumonic plague

The second most common variant of the plague is its pneumonic form. This is the most severe variant of the development of the disease. There are 3 main periods of development of pneumonic plague:

• elementary;
• peak period;
• soporous or terminal.

In recent times, it was this type of plague that killed millions of people, because the mortality rate from it is 99%.

The symptoms of pneumonic plague are as follows.

More than 100 years ago, the pneumonic form of plague ended in death in almost 100% of cases! Now the situation has changed, which is undoubtedly due to the correct treatment tactics.

How other forms of plague proceed

In addition to the two classic variants of the course of the plague, there are other forms of the disease. As a rule, this is a complication of the underlying infection, but sometimes they occur as primary independent ones.

1. Primary septic form. The symptoms of this type of plague are slightly different from the two variants described above. The infection develops and proceeds rapidly. The incubation period is shortened and lasts no more than two days. Heat, weakness, delirium and arousal - these are not all signs of a violation of the state. Inflammation of the brain and infectious-toxic shock develops, then coma and death. In general, the disease lasts no more than three days. In relation to this type of disease, the prognosis is unfavorable, recovery almost never occurs.
2. An erased or mild course of the disease is observed with a skin variant of the plague. The pathogen enters the human body through broken skin. At the site of the introduction of the plague pathogen, changes are observed - the formation of necrotic ulcers or the formation of a boil or carbuncle (this is inflammation of the skin and surrounding tissue around the hair with areas of necrosis and pus release). Ulcers heal for a long time and a scar gradually forms. The same changes may appear as secondary in bubonic or pneumonic plague.

Plague diagnosis

The first stage in determining the presence of infection is epidemic. But it is easy to make a diagnosis this way when there are several cases of the disease with the presence of typical clinical symptoms in patients. If the plague has not been seen in a given area for a long time, and the number of cases is calculated in units, the diagnosis is difficult.

In the case of the onset of infection, one of the first steps in determining the disease is bacteriological method. If plague is suspected, work with biological material to detect the pathogen is carried out under special conditions, because the infection spreads easily and quickly in the environment.

Almost any biological material is taken for research:

• sputum;
• blood;
• puncture buboes;
• examine the contents of ulcerative skin lesions;
• urine;
• vomit masses.

Almost everything that the patient secretes can be used for research. Since the plague disease in humans is severe and the person is very susceptible to infection, the material is taken in special clothes, and inoculation on nutrient media in equipped laboratories. Animals infected with bacterial cultures die in 3–5 days. In addition, when using the method of fluorescent antibodies, bacteria glow.

Additionally, serological methods for the study of plague are used: ELISA, RNTGA.

Treatment

Any patient with suspected plague is subject to immediate hospitalization. Even in the case of the development of mild forms of infection, a person is completely isolated from others.

In the distant past, the only method of treating the plague was cauterization and processing of buboes, their removal. In an attempt to get rid of the infection, people used only symptomatic methods, but to no avail. After identifying the pathogen and creating antibacterial drugs, not only the number of patients decreased, but also complications.

What is the treatment for this disease?

1. The basis of treatment is antibiotic therapy, tetracycline antibiotics are used in the appropriate dose. At the very beginning of treatment, the maximum daily doses of drugs are used, with their gradual decrease to the minimum in case of normalization of temperature. Before starting treatment, the sensitivity of the pathogen to antibiotics is determined.
2. An important milestone The treatment for plague in humans is to carry out detoxification. Patients are given saline solutions.
3. Symptomatic treatment is used: diuretics are used in case of fluid retention, hormonal substances are used.
4. Use therapeutic anti-plague serum.
5. Along with the main treatment, supportive therapy is used - heart drugs, vitamins.
6. In addition to antibacterial drugs, local drugs for plague are prescribed. Plague buboes are treated with antibiotics.
7. In the case of the development of a septic form of the disease, plasmapheresis is used daily - this is a complex procedure for cleaning the blood of a sick person.

After the end of treatment, after approximately 6 days, conduct a control study of biological materials.

Plague Prevention

The invention of antibacterial drugs would not solve the problem of the emergence and spread of pandemics. This is just an effective way to cope with an already existing disease and prevent its most formidable complication - death.

So how did you defeat the plague? - after all, isolated cases per year without declared pandemics and the minimum number of deaths after an infection can be considered a victory. An important role belongs to the correct prevention of the disease. And it began the moment the second pandemic arose, back in Europe.

In Venice, after the second wave of the spread of the plague, back in the 14th century, while only a quarter of the population remained in the city, the first quarantine measures were introduced for arrivals. Ships with cargo were kept in the port for 40 days and the crew was monitored to prevent the spread of infection so that it did not enter from other countries. And it worked, no new cases of infection were noted, although the second plague pandemic had already claimed most of the population of Europe.

How is infection prevention carried out today?

1. Even if isolated cases of plague occur in any country, all those arriving from there are isolated and observed for six days. If a person has some signs of the disease, then prophylactic doses of antibacterial drugs are prescribed.
2. The prevention of plague includes the complete isolation of patients with suspected infection. People are not only placed in separate closed boxes, but in most cases they try to isolate the part of the hospital where the patient is located.
3. The State Sanitary and Epidemiological Service plays an important role in preventing the occurrence of infection. They annually control the outbreaks of the plague, take water samples in the area, examine animals that may turn out to be a natural reservoir.
4. In the foci of the development of the disease, the destruction of plague carriers is carried out.
5. Measures to prevent plague in the outbreaks of the disease include sanitary and educational work with the population. They explain the rules of behavior for people in case of another outbreak of infection and where to go first.

But even all of the above was not enough to defeat the disease if the plague vaccine had not been invented. It was from the moment of its creation that the number of cases of the disease has sharply decreased, and there have been no pandemics for more than 100 years.

Vaccination

Today, in addition to general preventive measures, more effective methods are used to combat the plague, which helped to forget about the "black death" for a long time.

In 1926, the Russian biologist V. A. Khavkin invented the world's first plague vaccine. From the moment of its creation and the beginning of universal vaccination in the foci of the appearance of infection, plague epidemics have remained far in the past. Who is vaccinated and how? What are its pros and cons?

Nowadays, a lyophilisate or a live dry vaccine against plague is used, this is a suspension of live bacteria, but a vaccine strain. The drug is diluted immediately before use. It is used against the causative agent of bubonic plague, as well as pulmonary and septic forms. This is a universal vaccine. The drug diluted in a solvent is injected different ways, which depends on the degree of dilution:

• apply it subcutaneously with a needle or needleless method;
• skin;
• intradermally;
• use the plague vaccine even by inhalation.

Prevention of the disease is carried out for adults and children from the age of two.

Indications and contraindications for vaccination

Plague vaccination is done once and it protects for only 6 months. But not every person is vaccinated, certain groups of the population are subject to prevention.

Today, this vaccination is not included as mandatory in the national vaccination calendar, it is done only according to strict indications and only to certain citizens.

Vaccination is given to the following categories of citizens:

• to all who live in epidemically dangerous areas, where the plague occurs in our time;
• health workers whose professional activities are directly related to work in "hot spots", that is, in places where the disease occurs;
• vaccine developers and laboratory workers in contact with bacterial strains;
• prophylactic vaccination is given to people with a high risk of infection, working in the foci of infection - these are geologists, employees of anti-plague institutions, shepherds.

It is impossible to carry out prophylaxis with this drug for children under two years of age, pregnant and lactating women, if a person has already had the first symptoms of plague, and everyone who has had a reaction to a previous vaccine administration. There are practically no reactions and complications to this vaccination. Of the minuses of such prevention, one can note its short effect and the possible development of the disease after vaccination, which is extremely rare.

Can plague occur in vaccinated people? Yes, this also happens if an already sick person is vaccinated or the vaccine turned out to be of poor quality. This type of disease is characterized by a slow course with sluggish symptoms. The incubation period exceeds 10 days. The condition of the patients is satisfactory, so it is almost impossible to suspect the development of the disease. Diagnosis is facilitated with the appearance of a painful bubo, although there is no inflammation of the tissues and lymph nodes around. In the case of delayed treatment or its complete absence, the further development of the disease is fully consistent with its usual classical course.

Plague is currently not a sentence, but another dangerous infection that can be dealt with. And although in the recent past, all people and health workers were afraid of this disease, today, the basis of its treatment is prevention, timely diagnosis and complete isolation of the patient.