Epidemiology
Where plague exists today: countries and regions with the disease
Quick answer
- Plague has not been eradicated: it circulates naturally in rodents and fleas in several regions of the world.
- Human cases occur every year, mainly in Africa, Asia and rural areas of the Americas — generally a few hundred to a few thousand cases a year worldwide.
- Madagascar and the Democratic Republic of the Congo are among the countries with the most notifications.
- Brazil does not have endemic transmission with regular human cases.
Plague has not been eradicated
Many people associate plague with the medieval past, but the disease still exists. Yersinia pestis maintains natural reservoirs in rodents and their fleas, and human infection occurs when that cycle comes close to people.
The World Health Organization records human cases every year. Numbers vary considerably, but generally range from a few hundred to a few thousand notified cases per year worldwide.
Where the disease circulates
| Region | Note |
|---|---|
| Africa (Madagascar, DR Congo, Uganda, Tanzania) | Where most human cases are concentrated |
| Central Asia, China and Mongolia | Natural foci in rodents, including marmots; sporadic cases |
| South and Central Asia | Rural areas with occasional notifications |
| South and Central America (Peru, Bolivia, Ecuador) | Historical foci in Andean areas |
| United States (southwest) | Rare cases in rural, semi-arid areas |
| Middle East and Caucasus | Limited foci under active surveillance |
What “endemic” means
Endemic does not mean frequent outbreaks. It means the agent circulates constantly in nature in that region — which requires permanent surveillance.
Madagascar: the best-known case
Madagascar is one of the countries where plague circulates most intensely, especially in the central highlands. In 2017, the country experienced a predominantly pneumonic plague outbreak in urban areas, with around 2,300 cases and more than 200 deaths, contained with a rapid response.
What about Brazil?
Brazil is not considered an endemic area with regular human transmission. The disease arrived in 1899 and had historical foci in the Northeast, but human cases fell sharply during the 20th century and the last notifications date from the 2000s.
Why this is not a global threat
- Person-to-person transmission occurs only in the pneumonic form, and requires close contact.
- The disease is treatable with antibiotics, with good response when diagnosed early.
- Surveillance and reporting systems detect and contain outbreaks.
- Most cases occur in rural areas, with exposure to rodents and fleas.
Frequently asked questions
Has plague been eradicated?
No. The bacterium still circulates in rodents and fleas in several regions and human cases are recorded every year.
Which countries have the most plague cases?
The largest numbers come from Africa, particularly Madagascar and the Democratic Republic of the Congo. There are also foci in Central Asia, China, Mongolia, Peru and the southwestern United States.
Is there plague in Brazil?
There is no endemic transmission with regular human cases. Historical foci exist in rodents and fleas, mainly in the Northeast, under surveillance.
How many plague cases occur worldwide each year?
Numbers vary, but WHO typically records a few hundred to a few thousand cases per year, with wide variation between years.
Sources
Medical review
Review by a licensed health professional is being arranged. This educational content is based on reference sources (WHO, CDC and medical literature) and does not replace evaluation, diagnosis or treatment by a health professional.
How this content was produced
- Who
- Produced by the Equipe editorial do Peste.com.br, the editorial team responsible for gathering, verifying and classifying public information about plague (Yersinia pestis).
- How
- Information is compiled from official and scientific sources (WHO, CDC and national health authorities) and from recognised news outlets. Every statement is classified as confirmed, reported or unconfirmed, and each article lists its sources.
- Why
- To offer clear, source-based information in Portuguese about plague and to separate verified fact from rumour. This content is educational and does not replace medical advice.
- Medical review
- Review by a licensed health professional is being arranged; no credential is claimed until a real professional is credited.
- Last review
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