title: Mortality risk factors show similar trends in modern and historic populations exposed to plague.
abstract: BACKGROUND
  Plague has been responsible for two major historic pandemics (6th-8th century CE; 14th-19th century CE) and a modern one. The recent Malagasy plague outbreaks raised new concerns on the deadly potential of the plague-causing bacteria Yersinia pestis. Between September 2014 and April 2015, outbreaks of bubonic and pneumonic plague hit the Malagasy population. Two hundred and sixty-three cases, including 71 deaths, have been reported in 16 different districts with a case fatality rate of 27%. The scope of our study was to ascertain whether the risk factors for health in modern-day populations exposed to plague and in ancient populations that faced the two historic pandemics varied or remained substantially unaltered.
  
  
  METHODS
  The risk of mortality of the Malagasy population with those obtained from the reconstruction of three samples of European populations exposed to the historic pandemics was contrasted.
  
  
  RESULTS
  The evidence shows that the risks of death are not uniform across age neither in modern nor in historic populations exposed to plague and shows precise concentrations in specific age groups (children between five and nine years of age and young adults).
  
  
  CONCLUSIONS
  Although in the post-antibiotic era, the fatality rates have drastically reduced, both modern and historic populations were exposed to the same risk factors that are essentially represented by a low standard of environmental hygiene, poor nutrition, and weak health systems.
authors.affiliation: Soprintendenza Archeologia Lazio e Etruria Meridionale, Rome, Italy. mauro.rubini@beniculturali.it.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rubini
authors.forename: Emanuela
authors.initials: E
authors.lastname: Gualdi-Russo
authors.forename: Vanessa S
authors.initials: VS
authors.lastname: Manzon
authors.forename: Natascia
authors.initials: N
authors.lastname: Rinaldo
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bianucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D005260:Female; D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049691:History, Medieval; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010930:Plague / Q000453:epidemiology* / Q000266:history / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D015010:Yersinia pestis / Q000302:isolation & purification* / Q000472:pathogenicity; D055815:Young Adult