Most people think the plague is a ghost. It’s that terrifying, ink-black blot on history books, something that ended back when people still thought "miasma" or bad smells caused your lungs to melt. You see the beaked masks of medieval doctors and you think, man, I'm glad that's over. But it isn't. Not even close.
If you’re asking does the plague still exist, the answer is a very blunt yes. It never actually left. It just changed its PR strategy. Every year, somewhere between 300 and several thousand people still catch Yersinia pestis, the bacterium that wiped out nearly half of Europe in the 1300s. It’s still here, hiding in the dirt and the fur of small mammals, waiting for a chance to hop back into the human population.
It’s weirdly persistent.
You might find it in the scrublands of New Mexico or the high plateaus of Madagascar. It’s not a relic. It’s a living, breathing biological reality that modern medicine manages to keep in a cage, mostly. But the cage has bars, and sometimes things slip through.
Where the Plague Lives in 2026
We tend to associate the plague with filth and ancient cities, but today, it’s mostly a rural issue. In the United States, the "plague belt" is basically the Southwest. Think Arizona, California, Colorado, and New Mexico. It lives in prairie dogs. It lives in ground squirrels. If you’re hiking in the Grand Canyon and you see a sign telling you not to feed the squirrels, they aren’t just worried about the squirrel’s diet. They’re worried about flea-borne pathogens.
The World Health Organization (WHO) keeps a pretty tight eye on this. Madagascar is currently the most affected country on Earth. They deal with outbreaks almost every year, usually during the "plague season" between September and April. It’s a mix of ecological factors and social ones. When people live in close proximity to rodents because of grain storage or poor sanitation, the risk spikes.
It isn't just one thing, either.
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You’ve got Bubonic plague, which is the one everyone knows. That’s the "buboes" version—painful, swollen lymph nodes that turn black. Then there’s Septicemic plague, where the bacteria multiply in the blood. That one is nasty because it can cause your fingers and toes to go gangrenous and turn black while you're still alive. Finally, there’s Pneumonic plague. That’s the scary one. It’s the only version that can spread person-to-person through the air. One cough, and you’ve passed it on.
The American Context
In the U.S., we see maybe 5 to 15 cases a year. It’s rare, sure. But it’s consistent. In 2024, a person in Oregon actually caught it from their pet cat. Cats are super susceptible to plague because they hunt the rodents that carry the fleas. They get sick, they cough on their owners, and suddenly a suburban household is dealing with a medieval nightmare. It sounds like a movie plot, but it’s just biology.
Why Haven't We Killed It Yet?
You’d think with all our technology, we could just wipe Yersinia pestis off the map. We did it with Smallpox. Why not this?
Basically, it's the "reservoir" problem. Smallpox only lived in humans. If you vaccinate enough humans, the virus has nowhere to go and it dies out. Plague is different. It lives in the wild. You can’t vaccinate every flea on every rat, prairie dog, and marmot on the planet. The bacterium survives in the soil and in these animal populations. It’s part of the ecosystem now.
According to researchers like Dr. Anne Schuchat, formerly of the CDC, the plague is what we call an "enzootic" disease. It simmers in the background of animal populations. Every now and then, there’s an "epizootic" event—a massive die-off of the animals. When the hosts die, the fleas get hungry. They look for the next warm body. If that’s you or your dog, you're in trouble.
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Honestly, we are just lucky that Yersinia pestis hasn't developed widespread resistance to antibiotics yet. Right now, if you catch it and get to a hospital quickly, you’ll probably be fine. Streptomycin, gentamicin, or doxycycline usually do the trick. But if you wait? If you think it’s just a weird flu? The mortality rate for untreated bubonic plague is around 30% to 60%. For the pneumonic version? It’s almost always fatal without immediate treatment.
The Madagascar Situation: A Modern Warning
If you want to understand how the plague behaves in the modern world, look at the 2017 outbreak in Madagascar. It was different from previous years. Usually, it stays in the rural highlands. In 2017, it hit the capital city, Antananarivo.
There were over 2,000 cases.
The majority were pneumonic. That’s the version that travels through the air. This was a massive wake-up call for global health officials because it showed how quickly an ancient disease could paralyze a modern city. Schools closed. Public gatherings were banned. People wore masks not because of a new virus, but because of a bacterium that’s been around for millennia.
It's a reminder that does the plague still exist isn't just a trivia question. It's a public health reality. The 2017 event was eventually contained through massive coordination between the Malagasy government and the WHO, but it proved that urban plague is not just a thing of the past.
Climate Change and the Rat Factor
Climate change is starting to mess with plague distributions too. Warmer winters mean more rodents survive. More rodents mean more fleas. In places like the Tibetan Plateau, researchers have found that shifting weather patterns are changing how marmots interact with people, potentially increasing the risk of "spillover" events.
Identifying the Modern Plague
You aren't going to see a guy in a cloak ringing a bell. Modern plague looks like a lot of other things at first.
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- Sudden fever and chills.
- Extreme exhaustion.
- A headache that feels like a hammer.
- Painful, swollen lumps (usually in the groin, armpit, or neck).
If you’ve been hiking in the West or traveling in high-risk areas and you feel like you’ve been hit by a truck, you tell the doctor where you were. That’s the key. Doctors in New York or Chicago aren't looking for the plague. They’ll test you for the flu or COVID-19. You have to mention the "prairie dog" factor.
In 2020, a person in California tested positive for the plague—the first case in that state in five years. They lived in South Lake Tahoe. It wasn't some remote wilderness; it was a popular vacation spot. They recovered, but only because the medical team was on the lookout.
What You Can Actually Do
Since the plague still exists, you need to be smart, especially if you live in or travel to the Western United States, parts of Africa, or Central Asia. This isn't about panic; it's about basic "don't be a victim" logic.
First, stop touching wildlife. Seriously. That squirrel looking for a handout might be carrying more than just a desire for nuts. If you see a bunch of dead rodents in an area, leave. Don't let your dog sniff them. In fact, if you live in a plague-prone area, keep your pets on flea-prevention meds year-round. A flea from a dead rabbit can jump onto your dog, and then your dog jumps onto your bed. That's the transmission chain.
Second, handle your environment. If you have a woodpile near your house, you have a rodent hotel. Move it. If you have tall grass against your foundation, you're inviting the reservoir species to live in your walls.
Lastly, understand that we have the tools to beat this, but only if we're fast. If you get a sudden, unexplained fever after being outdoors in the Southwest, get to a clinic. Mention the plague. It feels dramatic, like you're roleplaying a medieval peasant, but it's the kind of drama that keeps you out of a statistics column.
The Future of Yersinia Pestis
We are currently seeing a lot of research into a plague vaccine. We used to have one, but it wasn't great and had nasty side effects. Today, scientists are working on mRNA versions—the same tech used for COVID—to create something that could protect high-risk populations.
But for now, the status quo remains. The plague is a permanent resident of our planet. It’s a "low-frequency, high-consequence" pathogen. It doesn't want to kill us all; it just wants to survive in its rodent hosts. We just happen to get in the way sometimes.
Practical Next Steps for Safety:
- Clear the Perimeter: If you live in the Western U.S., remove rock piles, clutter, and woodpiles from near your home to discourage rodents.
- Pet Protection: Use vet-approved flea control on cats and dogs. Cats are particularly high-risk for transmitting the disease to humans.
- Hiker Awareness: Stay on trails and never touch or feed wild animals. If you see a dead animal, do not approach it.
- Symptom Vigilance: If you develop a high fever and swollen glands after being in a rural area, seek medical attention immediately and explicitly mention your travel history. Early antibiotic treatment is the difference between a quick recovery and a life-threatening emergency.