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Plague

Infectious Diseases · NLM MeSH · updated 2026-10-29 · version 1

Citations verified against PubMedNot yet clinician-reviewed10 referencesApproximately 4 min read

An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites.

Table of Contents

1. Definition2. Research landscape3. Reading the evidence4. Open-access studies5. Key reviews6. References7. About this article

Definition and research guide

This page combines a MeSH definition, publication statistics and selected research abstracts. It is a starting point for reading the literature, not a medical textbook or a systematic evidence review.

Content available: 4 complete abstracts (826 words), 10 references. Full article text is not stored or reproduced here; follow the PMID, DOI or PMC links to read the original sources and their access terms.

Definition

An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form.

Definition: NLM Medical Subject Headings (MeSH) scope note (Public domain (U.S. National Library of Medicine); attribution requested). View the MeSH record.

Also known as: Yersinia pestis Infection; Pneumonic Plague; Bubonic Plague; Meningeal Plague; Pulmonic Plague; Septicemic Plague; Black Death; Black Plague.

Where it fits in the MeSH classification

Broader topics
Yersinia Infections; Vector Borne Diseases

Related concepts

  • Yersinia Pestis

Research landscape

PubMed indexes 5,828 records tagged with the MeSH heading “Plague” (counts retrieved 2026-10-29). 655 of them (11.2%) were published from 2020 onward, and the busiest period so far is through 1999 with 2,929 records.

Reviews account for 458 records (7.9%) and meta-analyses for 1. Randomized controlled trials number 4 (0.1%) as a share of all records on the topic. Randomized trials make up only a small share of this literature, so much of what is known comes from laboratory, observational or descriptive work.

PubMed records by publication periodthrough 1999: 2,929 records; 2000-2009: 1,073 records; 2010-2019: 1,171 records; 2020 onward: 655 records2,929through 19991,0732000-20091,1712010-20196552020 onward
Records in PubMed indexed with this heading, by publication period. Real counts from NCBI E-utilities; the final period covers only part of the current year. Volume reflects how much has been published, not how strong the evidence is.
Show the data
PeriodRecords
through 19992,929
2000-20091,073
2010-20191,171
2020 onward655
Share of records by publication typeReviews: 7.9 percent; Meta-analyses: 0.0 percent; Randomized controlled trials: 0.1 percentReviews7.9% (458)Meta-analyses0.0% (1)Randomized controlled trials0.1% (4)
Share of all PubMed records on this heading that carry each publication type. Types overlap with other records, so the shares do not sum to 100%.
Publication-type chart data
Publication types among 5,828 PubMed records
TypeRecordsShare
Reviews4587.9%
Meta-analyses10.0%
Randomized controlled trials40.1%

Method: PubMed query "Plague"[MeSH Terms] with publication-type and date filters, retrieved 2026-10-29.

Reading the evidence in infectious diseases

Infectious disease evidence combines microbiology, epidemiology and clinical trials. Laboratory studies identify pathogens and how they cause harm; surveillance and outbreak investigations describe who is affected and how infection spreads; trials establish whether treatments and vaccines work. Results depend on place and time, because pathogens evolve and resistance patterns and population immunity change. Check when and where the data were collected, how cases were defined and how up to date the evidence is.

Evidence from open-access studies

These open-access studies come from PubMed’s best-match results for this heading (papers whose main topic it is), ranked here by citation count, with one recent addition. Each abstract is reproduced in full under its recorded open licence so that you can read the authors’ own words. They illustrate the literature; they are not a systematic summary of it. Citation counts measure attention, not reliability or clinical benefit.

Study comparison — selected abstracts, not a systematic review
Study / authorsYearSource label / designEurope PMC citationsLicence / source
Yersinia pestis and plague: an updated view on evolution, virulence determinants, immune subversion, vaccination, and diagnostics
Demeure CE, Dussurget O, Mas Fiol G, Le Guern AS, Savin C, Pizarro-Cerdá J
2019Review article
Design not recorded in structured metadata
150cc by
PMID 30940874 · DOI · PMC6760536
Phylogeography of the second plague pandemic revealed through analysis of historical Yersinia pestis genomes
Spyrou MA, Keller M, Tukhbatova RI, Scheib CL, Nelson EA, Andrades Valtueña A, et al.
2019Research article
Design not recorded in structured metadata
97cc by
PMID 31578321 · DOI · PMC6775055
Ancient Yersinia pestis genomes from across Western Europe reveal early diversification during the First Pandemic (541-750)
Keller M, Spyrou MA, Scheib CL, Neumann GU, Kröpelin A, Haas-Gebhard B, et al.
2019Research article
Design not recorded in structured metadata
73cc by
PMID 31164419 · DOI · PMC6589673
Lethal plague outbreaks in Lake Baikal hunter-gatherers 5,500 years ago
Macleod R, Seersholm FV, De Sanctis B, Lieverse A, Timpson A, Schulting R, et al.
2026Research article
Design not recorded in structured metadata
2cc by
PMID 42310115 · DOI · PMC13275307

Yersinia pestis and plague: an updated view on evolution, virulence determinants, immune subversion, vaccination, and diagnostics [1]

Review article Demeure CE, Dussurget O, Mas Fiol G, Le Guern AS, Savin C, Pizarro-Cerdá J · · 2019 · cited 150 times (Europe PMC)

Abstract reading summary — source excerpts
Opening excerpt
Plague is a vector-borne disease caused by Yersinia pestis.
Closing excerpt
pestis evolution, virulence factor function, bacterial strategies to subvert mammalian innate immune responses, vaccination, and problems associated with pneumonic plague diagnosis.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (192 words)

Plague is a vector-borne disease caused by Yersinia pestis. Transmitted by fleas from rodent reservoirs, Y. pestis emerged <6000 years ago from an enteric bacterial ancestor through events of gene gain and genome reduction. It is a highly remarkable model for the understanding of pathogenic bacteria evolution, and a major concern for public health as highlighted by recent human outbreaks. A complex set of virulence determinants, including the Yersinia outer-membrane proteins (Yops), the broad-range protease Pla, pathogen-associated molecular patterns (PAMPs), and iron capture systems play critical roles in the molecular strategies that Y. pestis employs to subvert the human immune system, allowing unrestricted bacterial replication in lymph nodes (bubonic plague) and in lungs (pneumonic plague). Some of these immunogenic proteins as well as the capsular antigen F1 are exploited for diagnostic purposes, which are critical in the context of the rapid onset of death in the absence of antibiotic treatment (less than a week for bubonic plague and <48 h for pneumonic plague). Here, we review recent research advances on Y. pestis evolution, virulence factor function, bacterial strategies to subvert mammalian innate immune responses, vaccination, and problems associated with pneumonic plague diagnosis.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 30940874 · DOI · PMC6760536

Phylogeography of the second plague pandemic revealed through analysis of historical Yersinia pestis genomes [2]

Research article Spyrou MA, Keller M, Tukhbatova RI, Scheib CL, Nelson EA, Andrades Valtueña A, et al. · · 2019 · cited 97 times (Europe PMC)

Abstract reading summary — source excerpts
Opening excerpt
The second plague pandemic, caused by Yersinia pestis, devastated Europe and the nearby regions between the 14th and 18th centuries AD.
Closing excerpt
pestis during both events.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (150 words)

The second plague pandemic, caused by Yersinia pestis, devastated Europe and the nearby regions between the 14th and 18th centuries AD. Here we analyse human remains from ten European archaeological sites spanning this period and reconstruct 34 ancient Y. pestis genomes. Our data support an initial entry of the bacterium through eastern Europe, the absence of genetic diversity during the Black Death, and low within-outbreak diversity thereafter. Analysis of post-Black Death genomes shows the diversification of a Y. pestis lineage into multiple genetically distinct clades that may have given rise to more than one disease reservoir in, or close to, Europe. In addition, we show the loss of a genomic region that includes virulence-related genes in strains associated with late stages of the pandemic. The deletion was also identified in genomes connected with the first plague pandemic (541-750 AD), suggesting a comparable evolutionary trajectory of Y. pestis during both events.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 31578321 · DOI · PMC6775055

Ancient Yersinia pestis genomes from across Western Europe reveal early diversification during the First Pandemic (541-750) [3]

Research article Keller M, Spyrou MA, Scheib CL, Neumann GU, Kröpelin A, Haas-Gebhard B, et al. · · 2019 · cited 73 times (Europe PMC)

Abstract reading summary — source excerpts
Opening excerpt
The first historically documented pandemic caused by Yersinia pestis began as the Justinianic Plague in 541 within the Roman Empire and continued as the so-called First Pandemic until 750.
Closing excerpt
We identified a deletion of a 45-kb genomic region in the most recent First Pandemic strains affecting two virulence factors, intriguingly overlapping with a deletion found in 17th- to 18th-century genomes of the Second Pandemic.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (251 words)

The first historically documented pandemic caused by Yersinia pestis began as the Justinianic Plague in 541 within the Roman Empire and continued as the so-called First Pandemic until 750. Although paleogenomic studies have previously identified the causative agent as Y. pestis, little is known about the bacterium's spread, diversity, and genetic history over the course of the pandemic. To elucidate the microevolution of the bacterium during this time period, we screened human remains from 21 sites in Austria, Britain, Germany, France, and Spain for Y. pestis DNA and reconstructed eight genomes. We present a methodological approach assessing single-nucleotide polymorphisms (SNPs) in ancient bacterial genomes, facilitating qualitative analyses of low coverage genomes from a metagenomic background. Phylogenetic analysis on the eight reconstructed genomes reveals the existence of previously undocumented Y. pestis diversity during the sixth to eighth centuries, and provides evidence for the presence of multiple distinct Y. pestis strains in Europe. We offer genetic evidence for the presence of the Justinianic Plague in the British Isles, previously only hypothesized from ambiguous documentary accounts, as well as the parallel occurrence of multiple derived strains in central and southern France, Spain, and southern Germany. Four of the reported strains form a polytomy similar to others seen across the Y. pestis phylogeny, associated with the Second and Third Pandemics. We identified a deletion of a 45-kb genomic region in the most recent First Pandemic strains affecting two virulence factors, intriguingly overlapping with a deletion found in 17th- to 18th-century genomes of the Second Pandemic.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 31164419 · DOI · PMC6589673

Lethal plague outbreaks in Lake Baikal hunter-gatherers 5,500 years ago [4]

Research article Macleod R, Seersholm FV, De Sanctis B, Lieverse A, Timpson A, Schulting R, et al. · · 2026 · cited 2 times (Europe PMC)

Abstract reading summary — source excerpts
Opening excerpt
Plague is among the most devastating diseases in human history1.
Closing excerpt
We contend that the occurrence of outbreaks among mid-Holocene hunter-gatherer communities well outside the sphere of Late Neolithic Europe challenges the notion that higher population densities and lifestyle changes during the Neolithic agricultural transition were prerequisites for plague epidemics.
Interpretation limits
Verbatim excerpts from the authors’ abstract; the closing excerpt may describe a finding, limitation or recommendation. Design, population, effect size and uncertainty have not been independently extracted or appraised. Read the complete abstract and linked paper before interpreting the findings.
Read complete abstract (233 words)

Plague is among the most devastating diseases in human history1. However, early strains of the plague-causing bacterium Yersinia pestis lacked virulence factors that are required for the bubonic form until around 3,800 years ago2,3. Consequently, the morbidity and mortality of early plague strains remain unclear. Here we describe early plague strains that are associated with two phases of outbreaks among mid-Holocene hunter-gatherers near Lake Baikal in southeast Siberia, beginning from about 5,500 years ago. These outbreaks occur across four hunter-gatherer cemeteries, with a 39% detection rate for plague infection. By reconstructing kinship pedigrees, we show that small familial groups were affected, consistent with human-to-human spread of disease, and that the first outbreak occurred within a single generation. The infections appear to have resulted in acute mortality, especially among children (aged 8 to 11 years). We further note functional differences, including in the ypm superantigen locus, which is also present in present day Yersinia pseudotuberculosis. The new strains diverge ancestrally to known Y. pestis and constrain the timing of its emergence, indicating that this happened before approximately 5,700 years ago. These findings show that plague outbreaks happened earlier than previously thought and were indeed lethal. We contend that the occurrence of outbreaks among mid-Holocene hunter-gatherer communities well outside the sphere of Late Neolithic Europe challenges the notion that higher population densities and lifestyle changes during the Neolithic agricultural transition were prerequisites for plague epidemics.

Abstract reproduced from the open-access article under the recorded cc by licence; © the authors. PMID 42310115 · DOI · PMC13275307

Key reviews and meta-analyses

The most cited review-type papers among PubMed’s best-match results for this heading, listed with bibliographic details only. Follow the links for the full text and access terms.

  • Research article Yersinia pestis--etiologic agent of plague [5]
    Perry RD, Fetherston JD · Clin Microbiol Rev · 1997 · cited 1,269 times (Europe PMC)
  • Research article Natural history of plague: perspectives from more than a century of research [6]
    Gage KL, Kosoy MY · Annu Rev Entomol · 2005 · cited 434 times (Europe PMC)
  • Research article Plague: past, present, and future [7]
    Stenseth NC, Atshabar BB, Begon M, Belmain SR, Bertherat E, Carniel E, et al. · PLoS Med · 2008 · cited 294 times (Europe PMC)
  • Research article Fleas and flea-borne diseases [8]
    Bitam I, Dittmar K, Parola P, Whiting MF, Raoult D · Int J Infect Dis · 2010 · cited 290 times (Europe PMC)
  • Research article Plague [9]
    Prentice MB, Rahalison L · Lancet · 2007 · cited 198 times (Europe PMC)
  • Research article Yersinia pestis: the Natural History of Plague [10]
    Barbieri R, Signoli M, Chevé D, Costedoat C, Tzortzis S, Aboudharam G, et al. · Clin Microbiol Rev · 2020 · cited 146 times (Europe PMC)

References

  1. Demeure CE, Dussurget O, Mas Fiol G, Le Guern AS, Savin C, Pizarro-Cerdá J. Yersinia pestis and plague: an updated view on evolution, virulence determinants, immune subversion, vaccination, and diagnostics. . 2019. PMID 30940874 · DOI · PMC6760536
  2. Spyrou MA, Keller M, Tukhbatova RI, Scheib CL, Nelson EA, Andrades Valtueña A, et al.. Phylogeography of the second plague pandemic revealed through analysis of historical Yersinia pestis genomes. . 2019. PMID 31578321 · DOI · PMC6775055
  3. Keller M, Spyrou MA, Scheib CL, Neumann GU, Kröpelin A, Haas-Gebhard B, et al.. Ancient Yersinia pestis genomes from across Western Europe reveal early diversification during the First Pandemic (541-750). . 2019. PMID 31164419 · DOI · PMC6589673
  4. Macleod R, Seersholm FV, De Sanctis B, Lieverse A, Timpson A, Schulting R, et al.. Lethal plague outbreaks in Lake Baikal hunter-gatherers 5,500 years ago. . 2026. PMID 42310115 · DOI · PMC13275307
  5. Perry RD, Fetherston JD. Yersinia pestis--etiologic agent of plague. Clin Microbiol Rev. 1997. PMID 8993858 · DOI · PMC172914
  6. Gage KL, Kosoy MY. Natural history of plague: perspectives from more than a century of research. Annu Rev Entomol. 2005. PMID 15471529 · DOI
  7. Stenseth NC, Atshabar BB, Begon M, Belmain SR, Bertherat E, Carniel E, et al.. Plague: past, present, and future. PLoS Med. 2008. PMID 18198939 · DOI · PMC2194748
  8. Bitam I, Dittmar K, Parola P, Whiting MF, Raoult D. Fleas and flea-borne diseases. Int J Infect Dis. 2010. PMID 20189862 · DOI
  9. Prentice MB, Rahalison L. Plague. Lancet. 2007. PMID 17416264 · DOI
  10. Barbieri R, Signoli M, Chevé D, Costedoat C, Tzortzis S, Aboudharam G, et al.. Yersinia pestis: the Natural History of Plague. Clin Microbiol Rev. 2020. PMID 33298527 · DOI · PMC7920731

About this article

Sources
NLM Medical Subject Headings (definition, synonyms); NCBI PubMed (counts, identifiers); Europe PMC (open-access abstracts and citation counts).
Verification
Every reference was resolved against PubMed on 2026-10-31; title, year and DOI matched.
Review state
automated source verified; no human expert review has been recorded yet.
Version
1, last updated 2026-10-29.

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At a glance

5,828
PubMed records on this heading
11%
published since 2020
458
review articles
4
randomized trials
10
verified references below

Counts come from PubMed on 2026-10-29; they show how much has been written, not how strong the evidence is.

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