Human plague: An old scourge that needs new answers

Xavier Vallès*, Nils Chr Stenseth, Christian Demeure, Peter Horby, Paul S. Mead, Oswaldo Cabanillas, Mahery Ratsitorahina, Minoarisoa Rajerison, Voahangy Andrianaivoarimanana, Beza Ramasindrazana, Javier Pizarro-Cerda, Holger C. Scholz, Romain Girod, B. Joseph Hinnebusch, Ines Vigan-Womas, Arnaud Fontanet, David M. Wagner, Sandra Telfer, Yazdan Yazdanpanah, Pablo TortosaGuia Carrara, Jane Deuve, Steven R. Belmain, Eric D’ortenzio, Laurence Baril

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)
3 Downloads (Pure)


Yersinia pestis, the bacterial causative agent of plague, remains an important threat to human health. Plague is a rodent-borne disease that has historically shown an outstanding ability to colonize and persist across different species, habitats, and environments while provoking sporadic cases, outbreaks, and deadly global epidemics among humans. Between September and November 2017, an outbreak of urban pneumonic plague was declared in Madagascar, which refocused the attention of the scientific community on this ancient human scourge. Given recent trends and plague’s resilience to control in the wild, its high fatality rate in humans without early treatment, and its capacity to disrupt social and healthcare systems, human plague should be considered as a neglected threat. A workshop was held in Paris in July 2018 to review current knowledge about plague and to identify the scientific research priorities to eradicate plague as a human threat. It was concluded that an urgent commitment is needed to develop and fund a strong research agenda aiming to fill the current knowledge gaps structured around 4 main axes: (i) an improved understanding of the ecological interactions among the reservoir, vector, pathogen, and environment; (ii) human and societal responses; (iii) improved diagnostic tools and case management; and (iv) vaccine development. These axes should be cross-cutting, translational, and focused on delivering context-specific strategies. Results of this research should feed a global control and prevention strategy within a “One Health” approach.

Original languageEnglish
Article numbere0008251
Number of pages22
JournalPLoS Neglected Tropical Diseases
Issue number8
Publication statusPublished - 27 Aug 2020

Bibliographical note

Funding: The workshop meeting where the contents of this article were developed was hosted by the Institut Pasteur (Paris, France) with financial and organizational support from the Department of International Affairs, the Emerging Disease Epidemiology Unit, the Mathematical Modelling of Infectious Diseases Unit and REACTing-Inserm. Oswaldo Cabanillas’s travel was financed by the Department of International Affairs at the Institut Pasteur (Paris, France). Travel costs for Laurence Baril and Maherisoa Ratsitorahina were financially supported by USAID (Grant n° AID-687-G-13-00003), and for Voahangy Andrianaivoarimanan and Minoarisoa Rajerison by Northern Arizona University (through HDTRA1-11-16-BRCWMD-BAA). Attendance of Steven Belmain was supported by the African Union (Grant AURGII/1/006/2016). Travel and accommodation for Feno Rakotoarimanana, and accommodation for Romain Girod, Beza Ramasindrazana, Voahangy Andrianaivoarimanana, and Minoarisoa Rajerison, were financially supported by the Wellcome Trust/UK Department for International Development (Grant 211309/Z/18/Z) and REACTing-Inserm. All other participants financially supported travel and accommodation through their own institutional funding. The preparation and editing of the manuscript was financially supported by Wellcome Trust/UK Department for International Development (Grant 211309/Z/18/Z).


  • Animals
  • Disease Outbreaks/prevention & control
  • Disease Reservoirs/microbiology
  • Humans
  • Insect Vectors
  • Madagascar/epidemiology
  • Neglected Diseases/epidemiology
  • Plague/epidemiology
  • Rodentia
  • Siphonaptera
  • Yersinia pestis


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