<p><span style="font-weight: 400;">The infection spread in those outbreaks</span><a href="https://www.smithsonianmag.com/smart-news/ancient-teeth-push-back-origins-bubonic-plague-180969304/"> <span style="font-weight: 400;">exactly as it did in the Middle Ages</span></a><span style="font-weight: 400;">, and as it did to the recent Idahoan victim: via fleas who infect rodents. In medieval Europe, the culprits were rats. In the modern United States, they’re fluffy rats. That’s right, ground squirrels (a group that includes chipmunks) are the suspected vector in the Idaho case. They’ve been known as carriers as far back as 1924, and Los Angeles health officials credit their rodent eradication program as the key to limiting that outbreak’s infections. As part of that effort, virtually all of the city’s ground squirrels were exterminated.</span></p><p><span style="font-weight: 400;">Rodents spread the disease via fleas carrying the </span><i><span style="font-weight: 400;">Yersinia pestis</span></i><span style="font-weight: 400;"> bacteria, and rodents carrying that bacteria have been found all over the Western US, particularly in the Four Corners region. At least one case of the disease is reported there every year, and some years more than 10 cases have been recorded. </span></p><p><span style="font-weight: 400;">Around the world, though, bubonic plague remains even more common. Madagascar is particularly affected, with dozens of cases annually. During a </span><a href="https://www.independent.co.uk/news/world/africa/madagascar-palgue-latest-update-death-toll-africa-crisis-outbreak-a8072246.html"><span style="font-weight: 400;">2017 outbreak there</span></a><span style="font-weight: 400;">, officials asked native Malagasy to </span><a href="https://thesocialedgen.wpengine.com/science/health/famadihana-funerary-ritual-madagascar-plague/"><span style="font-weight: 400;">halt their sacred funerary rite</span></a><span style="font-weight: 400;">, Famadihana, due to worries that the tradition of exhumation and ancestor worship may be causing new infections. </span></p><p><span style="font-weight: 400;">One reason that the plague is so widespread in Madagascar is that the disease’s early symptoms closely resemble malaria’s early symptoms, which is also endemic, and not nearly as contagious between humans as the bubonic plague is. The 2017 outbreak ultimately infected 2,348 and killed 202 people.</span><span style="font-weight: 400;"></span></p><p><span style="font-weight: 400;"></span></p><p><span style="font-weight: 400;">That outbreak survival ratio is fairly standard with modern antibiotic treatments: 90% of treated patients recover. Left untreated, however, the death rate still reaches the medieval levels of 30-90%.</span></p><p><span style="font-weight: 400;">The teenaged victim in Idaho, whose identity has been protected, is reportedly recovering well following his own treatment. But of course the treatment is most effective when the disease is caught early, so anyone in contact with rodents in the Western US is encouraged to be familiar with the bubonic plague’s symptoms: chills, general malaise,</span><span style="font-weight: 400;"> high fever (>39 </span><a href="https://en.wikipedia.org/wiki/Celsius"><span style="font-weight: 400;">°C</span></a><span style="font-weight: 400;">/102.2 </span><a href="https://en.wikipedia.org/wiki/Fahrenheit"><span style="font-weight: 400;">°F</span></a><span style="font-weight: 400;">), and muscle cramps all typically occur before the characteristic </span><a href="https://en.wikipedia.org/wiki/Bubo"><span style="font-weight: 400;">bubo</span></a><span style="font-weight: 400;">.</span></p><p></p><p><span style="font-weight: 400;">While surviving bubonic plague might make for some interesting cocktail chatter, it never hurts to play it safe, and maybe not feed the squirrels in the Pacific Northwest this year.</span></p>
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