Human plague occurrences in Africa: an overview from 1877 to 2008

Plague remains a public health concern worldwide, but particularly in Africa. Despite the long-standing history of human plague, it is difficult to get a historical and recent overview of the general situation. We searched and screened available information sources on human plague occurrences in African countries and compiled information on when, where and how many cases occurred in a centralised database. We found records that plague was probably already present before the third pandemic and that hundreds of thousands of human infections have been reported in 26 countries since 1877. In the first 30 years of the 20th century, the number of human cases steadily increased to reach a maximum in 1929. From then on the number decreased and fell below 250 after 1945. Since the 1980s, again increasingly more human infections have been reported with the vast majority of cases notified in East Africa and Madagascar. We show that public health concerns regarding the current plague situation are justified and that the disease should not be neglected, despite the sometimes questionability of the numbers of cases. We conclude that improving plague surveillance strategies is absolutely necessary to obtain a clear picture of the plague situation in endemic regions.