Plague, Pneumonic Plague & Prevention Guide
Plague is one of the most feared infectious diseases in history, but many people don't realize that plague still exists today—or that all of its major forms are caused by the same bacterium, Yersinia pestis.
Recent events in Siberia have brought new attention to the disease after a 28-year-old laboratory worker at Russia's Irkutsk Anti-Plague Research Institute died from an unexplained form of pneumonia. The death prompted an investigation into possible pneumonic plague and precautionary monitoring or quarantine of approximately 200 contacts. Russian authorities subsequently reported that no plague cases had been confirmed among her contacts, and the World Health Organization currently considers the risk to the general population low. The laboratory worker's exact cause of death has not publicly been confirmed as plague. Reuters
Regardless of what investigators ultimately determine in this case, the incident is a useful reminder that plague hasn't disappeared. Understanding what causes it—and how it spreads—is far more useful than fearing it.
What Is Plague?
Plague is an infectious disease caused by the bacterium Yersinia pestis.
The bacterium naturally circulates among certain wild animals and their fleas. Humans can become infected through infected flea bites, contact with infected animals or tissues, and—in the case of pneumonic plague—exposure to infectious respiratory particles from an infected person. World Health Organization
There are three major forms of plague, but they're all caused by the same bacterium.
Bubonic Plague
Bubonic plague is the most common form. It typically develops after the bite of an infected flea.
The bacteria travel to the lymph nodes, which can become extremely swollen and painful. These swollen lymph nodes are called buboes, which is where the term “bubonic plague” comes from.
Septicemic Plague
Septicemic plague occurs when Yersinia pestis multiplies in the bloodstream.
It can develop independently or as a complication of another form of plague. Because the infection is circulating through the blood, septicemic plague can become extremely serious very quickly.
Pneumonic Plague
Pneumonic plague occurs when Yersinia pestis infects the lungs.
This distinction is important: pneumonia itself isn't plague. Many different bacteria, viruses and other conditions can cause pneumonia. Pneumonia caused by Yersinia pestis is pneumonic plague.
Unlike ordinary bubonic plague, pneumonic plague can spread from person to person through infectious respiratory particles during close contact. It is the most dangerous form from a person-to-person transmission standpoint. World Health Organization
Can Plague Be Treated Today?
Fortunately, we're no longer living in the Middle Ages.
Plague is a bacterial infection, and antibiotics are effective when treatment begins promptly. Pneumonic plague can progress extremely rapidly, making immediate medical evaluation important whenever exposure is suspected and compatible symptoms develop. World Health Organization
Nasal sprays, supplements and home remedies should never be substituted for antibiotics or professional medical care in a suspected plague infection.
What Can Kill the Bacterium That Causes Plague?
Because scientists know the organism responsible for plague, researchers can study what inactivates Yersinia pestis outside the body.
That's where several familiar antimicrobial compounds become interesting.
Hydrogen Peroxide
Hydrogen peroxide has broad antimicrobial properties.
Laboratory research has specifically investigated Yersinia pestis and found that vaporized hydrogen peroxide can effectively inactivate the organism on contaminated surfaces and materials.
That doesn't mean a hydrogen peroxide nasal product prevents or treats plague. The concentration, method of application and environment in laboratory disinfection research are completely different from nasal use.
Hydrogen peroxide has nevertheless attracted separate research interest as an ingredient in specially formulated nasal and oral cleansing preparations.
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Povidone-Iodine
Iodine compounds have been used as antiseptics for generations, and Yersinia pestis is known to be susceptible to iodine disinfectants.
Povidone-iodine, or PVP-I, is a controlled iodine complex that has also been investigated separately in human research involving nasal sprays and nasal irrigation.
Again, antimicrobial activity against a bacterium should not be confused with evidence that an iodine nasal product prevents plague.
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Hypochlorous Acid (HOCl)
Hypochlorous acid is another interesting antimicrobial compound. HOCl is naturally generated by immune cells as part of the body's response to microorganisms and has broad activity against many bacteria.
Research supports HOCl's general antibacterial activity, although evidence involving one organism or laboratory condition shouldn't automatically be extrapolated to every bacterium or to disease prevention inside the human body.
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Can Nasal Cleansing Prevent Plague?
There is no established clinical evidence that nasal rinsing or nasal sprays prevent plague.
Nasal cleansing does, however, provide a physical way of washing mucus, allergens, dust and other environmental material from the nasal passages and can be part of an everyday nasal-hygiene routine.
This is why nasal irrigation has been studied independently using saline and ingredients such as xylitol, povidone-iodine and other compounds.
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How Can You Protect Yourself From Plague?
The appropriate precautions depend upon the type of exposure.
For bubonic plague, prevention focuses heavily on avoiding infected fleas and potentially infected animals. Don't handle sick or dead wild animals in areas where plague is circulating, and use appropriate insect protection where plague-infected fleas are a concern.
For pneumonic plague, avoiding close contact with an infected person is especially important. WHO advises avoiding close exposure to someone coughing when pneumonic plague is circulating and reducing time in crowded environments during an outbreak. Properly used masks can also help reduce respiratory-droplet transmission in appropriate circumstances. World Health Organization
Other sensible infection-control practices include:
- Wash hands regularly with soap and water.
- Avoid touching potentially infected animals or tissues.
- Avoid close contact with people known or suspected to have pneumonic plague.
- Follow public-health instructions during a confirmed outbreak.
- Maintain good general health through adequate sleep, nutrition and hydration.
- Seek medical care immediately following a known exposure or if concerning symptoms develop.
WHO specifically recommends routine hand washing and standard infection-control precautions during plague outbreaks. World Health Organization
Don't Panic—Understand the Science
The word “plague” understandably sounds terrifying because of its history. But today's situation is dramatically different from the Black Death.
Scientists know exactly what causes plague. We understand how the bacterium spreads, know many of the conditions that can inactivate it, and have effective antibiotic treatments when infection is recognized promptly.
The best defense is accurate information, sensible hygiene, appropriate infection-control practices and prompt medical treatment when genuine exposure occurs.
Nasal hygiene can be one component of an everyday wellness routine—but it should complement, rather than replace, proven public-health and medical measures.