Bubonic plague, a term synonymous with death and devastation, is making headlines again. While a recent case reportedly seen in the UK was found to be a data error, the disease still has the potential to become an global health concern. The germ Yersinia pestis, which causes the plague, continues to thrive in Africa, Asia, and the Americas. Researchers are now racing to create a vaccine as the world becomes increasingly concerned about its possible return.

The most notorious plague epidemic, the Black Death, devastated Europe, Asia, and Africa in the 14th century, killing an estimated 200 million and eradicating almost 60% of Europe's population. This lethal pandemic, which was caused by a combination of bubonic, septicemic, and pneumonic plague, changed the course of history.

A laboratory report by the UK Health Security Agency (UKHSA) of disease cases in England and Wales for the week up to March 13 had first reported a case of bubonic plague. But UKHSA officials later explained that this was a reporting mistake due to a lab misallocation.

The bubonic plague continued to strike in waves over history, with some major outbreaks in the UK, such as the Great Plague of London in 1665 and the last major outbreak in Suffolk in 1918. Although controlled largely with antibiotics nowadays, the disease has never been eradicated.

Yersinia pestis: The Bacterium Behind the Plague

Yersinia pestis is a very virulent bacterium that can spread through a variety of pathways. The most usual method of transmission is by flea bites from rodents to humans carrying the bacteria. Recent studies, however, indicate that human ectoparasites, including lice, are also involved in transmission, especially in historical epidemics when there were few rats.

How does the Plague Spread?

Flea Bites: Infected fleas, which typically reside on rodents, transfer bacteria to humans during bites.

Direct Contact: Transmission is caused by handling infected animals or body fluids of infected animals.

Human Ectoparasites: Recent research has suggested that human lice may serve as carriers, infecting humans upon bite.

Airborne Transmission: During pneumonic plague, bacteria are transferred from individual to individual through respiratory droplets.

Types of Plague and Their Symptoms

Plague is not one disease but occurs in three principal forms:

1. Bubonic Plague

This is the most widespread form of the disease. Symptoms usually develop within 3-7 days of infection and comprise:

• High fever and chills
• Severe headaches
• Muscle pain and fatigue
• Painful swollen lymph nodes (buboes), typically in the groin, armpits, or neck

2. Septicemic Plague

This happens when the bacteria transmit through the bloodstream. Symptoms are:

• Fever and chills
• Abdominal pain and vomiting
• Sepsis developing rapidly, causing necrosis of the tissues

3. Pneumonic Plague

This is the deadliest form of the disease since it transmits through respiratory droplets, and therefore it's extremely contagious. Symptoms are:

• Severe respiratory distress
• Coughing up blood
• Chest pain and shortness of breath
• Rapid development of respiratory failure

Pneumonic plague is treated promptly with antibiotics because it is life-threatening within 24 hours.

Is Plague Still a Threat?

Plague still lingers despite the improvement in medicine. According to the World Health Organization (WHO), between 1,000 to 2,000 plague cases are still being reported every year. Recent occurrences have been in the US, Peru, China, Bolivia, Uganda, Tanzania, and Russia.

Researchers are also concerned that Yersinia pestis can become antibiotic-resistant, which might make treatment harder. Furthermore, the possibility of bioterrorism has focused efforts on more vaccine and second-line treatment studies.

Treatment and Prevention Measures

If plague is detected early enough, it can be very easily treated with the antibiotics:

Streptomycin and Gentamicin: Pitted against Yersinia pestis, these aminoglycoside antibiotics block protein synthesis in bacteria.

Doxycycline and Ciprofloxacin: These are also employed for post-exposure prophylaxis in high-risk exposures.

Early diagnosis and prompt administration of antibiotics can lower mortality rates to below 10%.

Researchers are working hard to create a vaccine for the plague, especially because of the fear of antibiotic-resistant strains. In the past, several vaccines have been created, including:

Live-Attenuated Vaccines: Employed in certain nations, although not popularly accepted because of safety issues.

Formalin-Killed Vaccines: They were given to US troops in Vietnam but proved useless against pneumonic plague.

Newer candidates under investigation are designed to offer greater and more effective protection against all types of plague.

Are We Prepared for Another Plague Outbreak?

With re-emergence possible, health agencies worldwide are following outbreaks closely and spending money on research in hopes of averting another pandemic-sized epidemic. While medicine has better equipment with which to battle the disease today, speedy detection, public awareness, and vaccine development continue to be important to guarantee that the bubonic plague no longer turns into a global catastrophe.

Although the bubonic plague might be perceived as a thing of the past, it is a current and ongoing threat. The recent false alert in the UK is a stark reminder of its latent threat. By learning from its history, mode of transmission, and possible treatments, we can more effectively prevent future outbreaks. While scientists press on with their quest to create a vaccine, public health interventions and ongoing research will be key to containing and eventually eliminating the plague.

In a controversial move that has rattled the U.S. medical community, federal health officials have severed ties with more than half a dozen major medical organizations from participating in government vaccine advisory workgroups.

The decision, communicated via email on Thursday, disinvites top experts from these groups from contributing to the workgroups that support the Advisory Committee on Immunization Practices (ACIP), a key body that guides the nation’s vaccination policies.

Organizations affected include the American Medical Association (AMA), the American Academy of Pediatrics (AAP), the Infectious Diseases Society of America (IDSA), and several others, many of whom have historically played a critical role in shaping vaccine guidelines.

“This is deeply concerning and distressing,” said Dr. William Schaffner, a renowned vaccine expert from Vanderbilt University who has been involved with ACIP workgroups for decades. “Removing these organizations will likely create conflicting messages about vaccine guidance. Patients might hear one thing from the government and another from their personal doctors.”

Longstanding Collaboration Ends Abruptly

For years, the ACIP has relied on a structured system where experts from various medical and scientific fields evaluate vaccine data and help draft recommendations. These recommendations, once approved by the Centers for Disease Control and Prevention (CDC), often inform clinical practice and determine insurance coverage.

But according to an email obtained by Bloomberg and confirmed by federal officials on Friday, the medical organizations are now being sidelined on the grounds that they are “special interest groups” and are assumed to carry a “bias” due to the populations they serve.

Dr. Schaffner defended the former system, highlighting how professional organizations offered practical insights on how recommendations could be realistically implemented in clinical settings. Importantly, all members were subject to conflict-of-interest vetting, ensuring objective guidance, he added.

Health Secretary Kennedy’s Sweeping Changes

This latest shake-up follows an earlier, unprecedented move in June when U.S. Health Secretary Robert F. Kennedy Jr. abruptly dismissed the entire ACIP panel, accusing it of being too closely aligned with vaccine manufacturers. Kennedy, a former leader in the anti-vaccine movement, has since appointed several known vaccine skeptics to the new committee.

Among the organizations removed from the workgroup process are the American Academy of Family Physicians, American College of Physicians, American Geriatrics Society, American Osteopathic Association, National Medical Association, and the National Foundation for Infectious Diseases.

In a joint statement released Friday, the AMA and several of the disinvited organizations denounced the decision, calling it “irresponsible” and “dangerous to our nation’s health.” The statement warned that excluding their medical expertise “will further undermine public and clinician trust in vaccines.”

The groups urged the administration to reverse the decision, emphasizing the importance of transparency and collaboration in public health decision-making.

Lawsuit and Fallout

Several of the ousted organizations had previously criticized Kennedy’s overhaul of the ACIP. Last month, three of them joined a lawsuit challenging the government’s decision to halt COVID-19 vaccine recommendations for most children and pregnant women, a policy shift that has been widely criticized by public health experts.

Meanwhile, newly appointed ACIP member Retsef Levi, a professor of business management with no formal medical background, defended the administration's direction on social media. Levi wrote that future workgroups would “engage experts from an even broader set of disciplines,” and claimed that membership would be based on “merit & expertise, not organizational affiliations with conflicts of interest.”

The Department of Health and Human Services (HHS) has not yet disclosed which experts will replace the disinvited members or when the new workgroups will begin operating.

The United States Centers for Disease Control and Prevention (CDC) is assessing a potential travel notice for China following a sharp rise in cases of chikungunya, a mosquito-borne viral infection that has sparked public health alarms in southern China, as reported by the Independent and the South China Morning Post.

Nearly 5,200 infections have been reported in the Guangdong province since early July, with most of them concentrated in the city of Foshan. Health officials there have since escalated their emergency response to a level III alert, which signals a “relatively major” public health threat in China’s four-tier system.

While the CDC has not yet published a formal advisory, a spokesperson told The Independent that the agency is “aware of the reported chikungunya outbreak in Guangdong Province in China and is currently assessing the size and extent of the outbreak.”

What is chikungunya?

Chikungunya is a viral infection transmitted by the bite of an infected Aedes mosquito, the same mosquito species responsible for dengue and Zika. Symptoms typically include sudden onset of fever and joint pain, but may also include headache, muscle pain, swelling, and rash.

Although most cases are mild and self-limiting, some infections can lead to prolonged joint pain or, in rare cases, long-term complications. Serious outcomes are more likely among those with pre-existing health conditions. There are no antiviral treatments available, so prevention, particularly mosquito control and bite avoidance, remains the primary approach.

Vaccines against chikungunya have recently become available and are recommended for travelers to high-risk areas, although they are not yet widely accessible.

According to local health authorities in Foshan, around 95% of reported cases have been mild, with patients recovering within a week. However, the outbreak’s rapid spread has raised concern among international health bodies.

Global spread and WHO alert

The outbreak in China follows a global pattern of chikungunya resurgence. The World Health Organization (WHO) issued an alert last week warning of the risk of the virus repeating its global spread from two decades ago. Diana Rojas Alvarez, a medical officer with WHO, said that nearly 5.6 billion people across 119 countries live in areas where the virus could potentially spread.

Chikungunya was first identified in 1952 in Tanzania and has since been detected in more than 110 countries, including major outbreaks in India, Italy, and the Americas. The virus is not spread from person to person; instead, it is carried by mosquitoes that have fed on infected individuals and then pass it to others.

The concern is not just local: international travel plays a key role in how the virus crosses borders. Infected travelers returning to or visiting countries with mosquito populations capable of transmitting the virus can trigger new outbreaks.

China’s response: Mosquito control and surveillance

The first case in this outbreak was reported in Foshan’s Shunde district on July 8 and was believed to be imported. Since then, local and national health authorities have moved quickly to contain the spread.

Measures taken include the use of drones to detect rooftop water accumulation, the release of larva-eating fish into lakes, and widespread public awareness campaigns. Residents have been urged to eliminate standing water, install window screens, and wear protective clothing.

Hospitals in affected areas have increased bed capacity for confirmed cases and designated specialized treatment centres. Border controls have been stepped up in Hong Kong to prevent imported cases from mainland China, with expanded testing capabilities introduced at key entry points.

CDC travel warnings: What it means for travelers

The CDC’s travel health notices are used to inform travelers about global disease risks and provide precautionary guidelines. The warning system has four levels, ranging from “practice usual precautions” (Level 1) to “avoid all travel” (Level 4).

As of now, China has only a Level 1 travel health notice for measles. However, the CDC has issued Level 2 notices for chikungunya in several countries including Bolivia, Kenya, and Madagascar in recent months.

If the CDC decides to escalate China’s status, it would be a significant development, both in terms of travel planning and diplomatic perception.

US–China tension and public health

The potential issuance of a travel notice also comes against the backdrop of complex US–China relations. While the CDC’s move would be grounded in public health data, the optics of a travel warning could have broader implications.

On Thursday, Chinese foreign ministry spokesperson Guo Jiakun responded to the reports, saying that China is in communication with the WHO and “making every effort to ensure a safe environment for travelers.”

The WHO has not issued any travel restrictions related to the outbreak but continues to monitor the situation closely.

A word of caution for travelers

With mosquito-borne diseases on the rise globally, driven by climate change, urbanization, and increased mobility, health experts advise travelers to stay informed and take preventive measures.

“Mosquito control is key,” said an official from the Hong Kong Centre for Health Protection. “Simple actions like using insect repellent, sleeping under mosquito nets, and avoiding stagnant water can go a long way in preventing infection.”

As global health agencies monitor the chikungunya outbreak in China, travelers to affected areas should remain vigilant and stay updated with official advisories. Prevention remains the best protection in the face of a disease with no cure.

August is known as the Hair Loss Awareness Month and the first Saturday of this month is known as the International Alopecia Day.

Hair loss is a common concern, affecting over 85% of men, 55% of women, and between 15–38% of adolescents at some point in their lives. For those with advanced or long-lasting alopecia, the emotional and social impact can be profound.

Baldness has been linked to significant declines in mental health and quality of life, with higher rates of anxiety, depression, stress, and reduced self-esteem.

What Is Alopecia?

It is a term used for hair loss that affects the scalp or even the entire body, temporarily or permanently. Alopecia can happen due to variety of reasons, including heredity, hormonal changes, and medical conditions, or as simple as normal aging.

Aim of Alopecia Day

The day aims to form a community of those who experience this autoimmune disease.

Origin of International Alopecia Day

International Alopecia Day was initiated by American activist Lynn W. Walker in 2011. She herself lives with a diagnosis of alopecia totalis and created this day to unite people with similar experiences, reduce stigma, and highlight beauty and strength regardless of the presence of hair.

Theme of Alopecia Day 2025

This year's theme as per Alopecia UK is, 'Strength in Numbers', which urges more and more people to join the International Alopecia community and to do away with the shame of hair loss and form a support group, across the world.

Alopecia And Its Kinds

As per the National Library of Medicines, US, alopecia refers to the loss or absence of hair in areas where it normally grows. It can be localized or widespread, temporary or permanent, and affects people of all ages and genders. As a symptom with diverse underlying causes, alopecia is generally categorized into two main types: nonscarring (the most common) and scarring (cicatricial).

For many patients, hair loss leads to significant emotional distress and a reduced quality of life. Accurate diagnosis requires a thorough history, physical examination, and targeted investigations to identify the root cause and guide effective treatment. Managing alopecia can be challenging, but this overview outlines key assessment and treatment approaches for the most common forms to support better outcomes.

Forms of alopecia

There are several main types of alopecia, including:

alopecia areata: an autoimmune disease that causes hair loss, often in small, round patches on the scalp, but it can occur anywhere on the body

alopecia totalis: complete loss of scalp hair

alopecia universalis: hair loss over the entire body

androgenetic alopecia: hereditary baldness

Ways You Can Participate In International Alopecia Day

• Learn and share knowledge about alopecia
• Participate in activities for Alopecia Day
• Embrace the symbol by wearing blue
• Share you story to build a support group
• If you are a doctor, you can also advocate for the right alopecia treatment
• Contribute financially to alopecia research and awareness groups
• Volunteer to help spread alopecia awareness
• Raise voice against bullying, as many people are bullied due to their hair loss