The plague's ability to cause disease and capacity for rapid spread mean it should be taken far more seriously.
Writing in PLoS Medicine, Nils Chr. Stenseth and colleagues warn that the disease remains a threat, particularly in Africa. More than 90 per cent of cases and deaths in the last five years occurred in the Democratic Republic of Congo, Madagascar, Malawi, Mozambique, Tanzania and Uganda.
Plague is endemic in a variety of rodent species in a range of habitats. Increased mobility of people and changes to habitats is spreading plague to previously unaffected areas. Climate change may also be helping to increase its prevalence.
The authors point out that the plague is extraordinarily adaptable. The emergence of multidrug-resistant strains of Yersinia pestis, the causative bacterium, would represent a major threat to human health.
They also note that plague has been used as a weapon throughout history, from catapulting corpses over city walls to dropping infected fleas from aircraft, and warn of possible terrorist use.
There is a greater than ever need for studies of the dynamics of infection, transmission, outbreak management and improved surveillance and monitoring systems, the authors say.