It is primarily a vector‐borne zoonotic disease, affecting rodents and other wild and domestic animals. Plague is caused by the bacteria Yersinia pestis. Human plague outbreaks are continuously being reported, from Indonesia in 2007 and the DRC and Tanzania in 2014, to the large outbreak of pneumonic plague more recently reported in Madagascar in 2017 ( WHO 2a). However, countries that have never experienced plague, or not experienced plague for a long while, can be affected as the limits of the existing foci are not fixed and new foci can emerge. As of 2017, the DRC, Madagascar and Peru are the countries with the highest incidence of the disease. Finally, although Asia is the region with the biggest natural foci of the disease, the reservoir consists of gerbils and marmots there is a limited at‐risk population in contact with these animals, so outbreaks are sporadic ( WHO 2016). Peru and the USA also regularly report cases. Since 2000, over 95% of the burden associated with plague has been concentrated in Africa, particularly the Democratic Republic of the Congo (DRC), Madagascar, Uganda and the United Republic of Tanzania ( WHO 20a). Between 19, 38,310 human cases of plague were reported from 25 countries, including 2845 deaths ( WHO 2019a). This severe disease remains a current threat in many parts of the world, and has increased over the last few decades. Plague has caused major historic pandemics including the "Plague of Justinian" in the 6th century, the "Black Death" in the 14th century (which resulted in the death of one‐third of the European population), and the "Third Pandemic" in the 19th century ( Rasmussen 2015).
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