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There are more biological agents out there than we'd like to think about. One of the ones that has always had a fierce reputation is the weapon that uses "the Black Death" as its basis.

In the fourteenth century, the plague was responsible for killing a greater proportion of the world's population than any other disease - or war - in history. As much as we'd like to, we can't avoid this centuries old disease — it's back.

Yersinia pestis. a.k.a. Y pestis, was transmitted all over the globe by the bite of a flea that had fed on an infected rat. A single fleabite potentially transmitted thousands of tiny organisms into the skin of the victim. From the skin, the bug goes to the lymphatic system.

Left: Yersinia pestis under fluorescent staining, 2000x. Source: CDC

In the United States, the mortality rate from Y. pestis is 14% (1 out of 7) for all plague cases.

There are three forms of the plague:

  • Bubonic Plague: The European "Scourge" caused by flea bites, characterized by painfully swollen lymph nodes. Untreated, it progresses to either Pneumonic or Septicemic plague

  • Septicemic Plague: Plague not contained in the lymph system - a blood infection in many different organs, eventually progressing to Pneumonic Plague.

  • Pneumonic Plague: Lung Infections - no vaccine is available. The MOST LIKELY bio-weapon! Untreated, Pneumonic plague is fatal. (Pneumonic Plague may be inhaled directly from the air.)

Why are we concerned about pneumonic plague as a bioweapon? (From CDC)

Yersinia pestis used in an aerosol attack could cause cases of the pneumonic form of plague. One to six days after becoming infected with the bacteria, people would develop pneumonic plague. Once people have the disease, the bacteria can spread to others who have close contact with them. Because of the delay between being exposed to the bacteria and becoming sick, people could travel over a large area before becoming contagious and possibly infecting others. Controlling the disease would then be more difficult.

A bioweapon carrying Y. pestis is possible because the bacterium occurs in nature and could be isolated and grown in quantity in a laboratory. Even so, manufacturing an effective weapon using Y. pestis would require advanced knowledge and technology.

How do people become infected with pneumonic plague?

Pneumonic plague occurs when Yersinia pestis infects the lungs. Transmission can take place if someone breathes in Y. pestis particles, which could happen in an aerosol release during a bioterrorism attack. Pneumonic plague is also transmitted by breathing in Y. pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague. Respiratory droplets are spread most readily by coughing or sneezing. Becoming infected in this way usually requires direct and close (within 6 feet) contact with the ill person or animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs.

How quickly would someone get sick if exposed to plague bacteria through the air?

Someone exposed to Yersinia pestis through the air—either from an intentional aerosol release or from close and direct exposure to someone with plague pneumonia—would become ill within 1 to 6 days.

Can pneumonic plague be treated?

Yes. To prevent a high risk of death, antibiotics should be given within 24 hours of the first symptoms. Several types of antibiotics are effective for curing the disease and for preventing it. Available oral medications are a tetracycline (such as doxycycline) or a fluoroquinolone (such as ciprofloxacin). For injection or intravenous use, streptomycin or gentamicin antibiotics are used. Early in the response to a bioterrorism attack, these drugs would be tested to determine which is most effective against the particular weapon used.

How long can plague bacteria exist in the environment?

Yersinia pestis is easily destroyed by sunlight and drying. Even so, when released into air, the bacterium will survive for up to one hour, depending on conditions.

What should someone do if they suspect they or others have been exposed to plague?

Get immediate medical attention: To prevent illness, a person who has been exposed to pneumonic plague must receive antibiotic treatment without delay. If an exposed person becomes ill, antibiotics must be administered within 24 hours of their first symptoms to reduce the risk of death. Notify authorities: Immediately notify local or state health departments so they can begin to investigate and control the problem right away. If bioterrorism is suspected, the health departments will notify the CDC, FBI, and other appropriate authorities.

Even though the plague is an ancient disease, it is alive and well right here in the United States. As of right now, almost all diagnosed cases are west of the Mississippi River.

Outbreaks in people occur in areas where housing and sanitation conditions are poor. These outbreaks can occur in rural communities or in cities. They are usually associated with infected rats and rat fleas that live in the home.

In the American West, the Prairie Dog has taken over the role of the rats for the transmission of the plague.

There are two main reasons Y. pestis may be used as a bio-terrorism weapon: The first is its ability to cause deadly pneumonia that could go undetected and therefore untreated. The second is once you have contracted pneumonic plague, it can be spread from person to person, making the range of the weapon greater than just the targeted area. In this day and age of air travel, an exposure in Los Angeles could infect people in New York in a matter of hours. The SPEED OF DETECTION IS CRITICAL TO CONTAIN A BIO-TERRORIST ATTACK.

A note for Australians

The plague is NOT found in your country naturally. If plague develops in Australia, someone gave it to you on purpose. A BAD purpose.

Fortunately, making an aerosol version of pneumonic plague is difficult, and takes a lot of time, money and scientific expertise. It is much more difficult to manufacture than anthrax weapons. There have been no "meth lab" type facilities ever discovered. However, some countries who support terrorism have these facilities. What we don't know is if they are using them to manufacture Y. pestis. Assuming the worst - it may still show up as a weapon. Both the US and the Soviet Union produced hundreds of tons of this junk. Thankfully, neither of us used it. In theory, both countries have destroyed their stockpiles. I hope this is true.

Both the United States and the (old) Soviet Union manufactured Y. pestis based weapons during the cold war. Thousands of Soviet scientists were employed in the manufacture of this bacterial weapon. We do not know (at least we're not sure) what these scientists are doing now, after the collapse of the Soviet Union. Rumor has it many are out of work. Out of work bio-terrorism scientists will leap at the opportunity to make "big bucks" and might work for the highest bidder, regardless of the political consequences. This is another of those "Oh Heck - I don't know" scenarios. I hate those, don't you?

One of the many reasons China does not like the Japanese is during WW II, the Japanese tested and used plague-based weapons on mainland China, with disastrous results. We know that thousands of Chinese were killed, but the exact numbers are unknown. The first "plague bombs" consisted of infected fleas dropped by the cannister load over China.

Personal protection for pneumonic plage, like the anthrax weapons, is the use of the N95 (or higher) protective respirators I mentioned in my previous article on anthrax. Unlike anthrax, the use of the N95 respirator will continue to protect you from person-to-person transmittal of the disease. If the use of the plague bacteria has been detected, and you think you might have been exposed - or are living with someone who may have been exposed, get to a doctor for a blood test immediately. Until a doctor either confirms or denies the presence of Y. pestis infection, wear the respirator.


Since Y. pestis has a relatively short life span - and dies naturally in about an hour, cleanup is no more involved than washing suspected contaminated areas with soap and water. However, protective clothing and respirators should be used in case the bacteria's clock isn't working correctly and lives more than one hour. Another serious problem for decontamination is that there (were) scientists working on making the active life span of the Y. pestis bacteria much longer than one hour. Until we are attacked by this plague, we won't know how successful they have been.

If you are concerned about the plague being used as a terror-weapon, one item of concern you should find out about is the availability of large quantities of the antibiotics needed to fight this infection. If a large number of people show up needing antibiotics, an inadequately stocked hospital will quickly run out of the needed antibiotics, directly threatening your survivability. It is important that all medical personnel involved in anti-terrorism planning realize resupply of antibiotics is a mandatory and life-saving measure that must be assured.