The plague, known historically for devastating Europe during the Middle Ages, remains a lethal disease today. According to the Robert Koch Institute (RKI), Germany's government agency for disease control and prevention, approximately 3,000 cases of plague were reported worldwide between 2010 and 2015, resulting in over 500 deaths.

The most affected regions currently include the Democratic Republic of the Congo, Uganda, and particularly Madagascar, where the last major outbreak occurred in 2017. Several hundred new cases are reported annually in Madagascar alone. In contrast, Europe has not seen cases of flea-borne plague since 1945, with the last reports coming from France and Italy.

Holger Scholz, molecular biologist and head of the Consultant Laboratory for Yersinia Pestis at the RKI's Center for Biological Threats and Special Pathogens, attributes the low occurrence in Europe to the fact that rodents infected with the plague pathogen no longer frequently enter human homes. He also noted that rats, especially black rats, are generally not the primary reservoir animals. The US Centers for Disease Control and Prevention (CDC) identifies other reservoir animals, including certain rat species like the pack rat and rodents from the squirrel family such as the tarbagan marmot.

A recent case involved Paul Gaylord, who initially experienced flu-like symptoms after being bitten by his ill cat. Initially treated for cat scratch fever, his condition deteriorated, leading to intensive care and coma. This highlights the challenge in early diagnosis, as "the first patients dying because they aren't properly diagnosed at first and therefore cannot be treated in time," according to experts.

Patients with pneumonic plague have a narrow window for treatment, typically surviving only 48 hours after symptom onset without intervention. However, modern methods allow health professionals to determine whether a strain is naturally occurring or manipulated, and new treatments have improved the ability to combat the disease.

Despite its historical reputation, the plague remains a present and serious health threat in certain regions today.

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