Well over three hundred years have gone by since the plague died out as an indigenous disease in Britain. It lingers on only as a rare rural infection in Madagascar, Tanzania, Kenya, Zaire, Botswana, Uganda, Bolivia, Brazil, Peru, the US, Vietnam, China, Mongolia, Kazakhstan and Burma. Worldwide, the annual number of human cases rarely exceeds a couple of thousand. As the Oxford Textbook of Medicine says: 'The major animal reservoirs are urban rats as well as rural rodents including ground squirrels and prairie dogs. The Oriental rat flea Xenopsylla cheopis is the most efficient vector. When bitten by a rodent flea humans become an accidental host and play no role in disease transmission except in rare epidemics of pneumonic plague.'

LRB 21 April 2005 | PDF Download