Bubonic plague annual deaths globally 1907-1953

Even in 2021, bubonic plague continues to exist in nature, and there are generally a few thousand human cases per year. Going back to the beginning of the 20th century, it is estimated that there were roughly one million cases per year in 1907. Within two decades, this number had fallen below one fifth of this level to 170,000 cases per year in the 1920s, and in the 1940s it was just over 20,000 per year. By the mid-20th century, it had fallen below 5,000 cases per year, but the rapid decrease in cases observed in the first half of the 1900s did not continue through the second half of the century. Even in 2019, there was one case of plague recorded in the United States.

How infection occurs

Yersinia pestis is the bacteria that causes the plague virus, and it is most commonly spread by rats and their fleas. The disease survives by fleas infecting rats, which in turn infect other fleas; the majority of rats survive the disease, which facilitates its spread; this is known as the "enzootic cycle ". Interestingly, the disease is usually fatal for the fleas, as it blocks their "stomachs" and causes them to starve; as the fleas get hungrier, they attempt to feed on more hosts, spreading the disease more rapidly. When the rats die, the parasitic fleas then search for a new host, which means that other animals (particularly mammals) are susceptible to this virus. While rat fleas can not survive on other hosts for very long, they can infect other (including human) fleas with the virus. The most common way for humans to contract the plague however, is when a rat flea bites its human host; during this process the flea simultaneously regurgitates Yersinia pestis bacteria into the wound, and this causes bubonic plague. Humans can then spread the disease among one another by coming into contact with the infected tissue or fluids of an infected person, or from the transfer of fleas.

Continued existence of the plague

Plague is extremely difficult to eradicate in nature, as rodent communities in the wild provide natural reservoirs for the disease to spread. In previous centuries, rats had much more frequent contact with humans for a variety of reasons; houses were more often made of wood (which made infestations easier), public spaces were much dirtier, and the presence of rats was tolerated more. As the understanding of epidemiology grew in the 20th century, this greatly reduced the frequency of plague in human populations. Unlike human diseases such as smallpox, which was eradicated through vaccination and other medical advancements, basic sanitation and the extermination of rats have been the driving force behind the decline of plague.