{
  "license": "CC BY 4.0",
  "outbreaks": [
    {
      "id": "justinian",
      "years": "541-549",
      "start": 541,
      "name": "Plague of Justinian",
      "place": "Constantinople and the Mediterranean",
      "lat": 41,
      "lon": 28.97,
      "form": "unknown",
      "toll": "Death toll not reliably established",
      "era": "first",
      "note": "The First Pandemic reached Constantinople in 541-542 and returned in at least 18 waves until about 750. Ancient DNA shows it was an independent emergence from rodents, unrelated to the later Black Death strain.",
      "sources": [
        {
          "name": "Glatter & Finkelman, Am J Med 2021",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/",
          "tier": "analysis"
        },
        {
          "name": "Wagner et al., Lancet Infect Dis 2014",
          "url": "https://doi.org/10.1016/S1473-3099(13)70323-2",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "black-death",
      "years": "1346-1353",
      "start": 1346,
      "name": "Black Death",
      "place": "Europe, Middle East, North Africa",
      "lat": 38.19,
      "lon": 15.55,
      "form": "mixed",
      "toll": "At least a third of Europe; WHO: more than 50 million deaths",
      "era": "second",
      "note": "Arrived in Messina in October 1347 on Genoese ships and spread across Europe by 1350. Ancient DNA traces its source to central Eurasia, near Lake Issyk-Kul in modern Kyrgyzstan, around 1338.",
      "sources": [
        {
          "name": "Glatter & Finkelman, Am J Med 2021",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/",
          "tier": "analysis"
        },
        {
          "name": "WHO plague fact sheet",
          "url": "https://www.who.int/news-room/fact-sheets/detail/plague",
          "tier": "primary"
        },
        {
          "name": "Spyrou et al., Nature 2022",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC9217749/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "naples-genoa",
      "years": "1656-1657",
      "start": 1656,
      "name": "Naples and Genoa",
      "place": "Italy",
      "lat": 40.85,
      "lon": 14.27,
      "form": "bubonic",
      "toll": "About two thirds of both cities",
      "era": "second",
      "note": "One of the deadliest urban epidemics of the Second Pandemic.",
      "sources": [
        {
          "name": "Glatter & Finkelman, Am J Med 2021",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "london",
      "years": "1665-1666",
      "start": 1665,
      "name": "Great Plague of London",
      "place": "London, England",
      "lat": 51.51,
      "lon": -0.13,
      "deaths": 100000,
      "form": "bubonic",
      "toll": "More than 100,000 deaths, about a quarter of the city",
      "era": "second",
      "note": "Recorded week by week in the parish Bills of Mortality, the primary record of the epidemic.",
      "sources": [
        {
          "name": "The National Archives (UK)",
          "url": "https://www.nationalarchives.gov.uk/education/resources/great-plague/",
          "tier": "primary"
        },
        {
          "name": "Glatter & Finkelman, Am J Med 2021",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "marseille",
      "years": "1720-1722",
      "start": 1720,
      "name": "Great Plague of Marseille",
      "place": "Provence, France",
      "lat": 43.3,
      "lon": 5.37,
      "form": "bubonic",
      "toll": "About 30 percent of the city",
      "era": "second",
      "note": "Introduced by the ship Grand Saint Antoine. Often called Europe's last major outbreak, though Messina (1743) and Moscow (1770-71) followed.",
      "sources": [
        {
          "name": "Devaux, Infect Genet Evol 2013",
          "url": "https://doi.org/10.1016/j.meegid.2012.11.016",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "moscow",
      "years": "1770-1771",
      "start": 1770,
      "name": "Moscow plague",
      "place": "Moscow, Russia",
      "lat": 55.75,
      "lon": 37.62,
      "deaths": 100000,
      "form": "bubonic",
      "toll": "More than 100,000 deaths",
      "era": "second",
      "note": "Triggered the Plague Riot of 1771 and shaped Russian quarantine policy for a century.",
      "sources": [
        {
          "name": "Glatter & Finkelman, Am J Med 2021",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "third-pandemic",
      "years": "1855-1959",
      "start": 1855,
      "name": "Third Pandemic",
      "place": "Yunnan, Hong Kong, India and worldwide",
      "lat": 22.32,
      "lon": 114.17,
      "form": "bubonic",
      "toll": "An estimated 12 million deaths in India alone, 1898-1918",
      "era": "third",
      "note": "Began in Yunnan around 1855, reached Hong Kong in 1894 and was carried by steamships to every inhabited continent. Alexandre Yersin identified the bacterium in Hong Kong in 1894.",
      "sources": [
        {
          "name": "Glatter & Finkelman, Am J Med 2021",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/",
          "tier": "analysis"
        },
        {
          "name": "Bramanti et al., Proc Biol Sci 2019",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC6501942/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "san-francisco",
      "years": "1900-1904",
      "start": 1900,
      "name": "San Francisco plague",
      "place": "San Francisco, USA",
      "lat": 37.79,
      "lon": -122.41,
      "cases": 121,
      "deaths": 113,
      "form": "bubonic",
      "toll": "121 cases, 113 deaths",
      "era": "third",
      "note": "The first plague epidemic in the continental US. Infection spread from urban rats into wild ground squirrels by 1908, seeding today's US foci.",
      "sources": [
        {
          "name": "Morens & Fauci, mBio 2012",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3388889/",
          "tier": "analysis"
        },
        {
          "name": "Kugeler et al., Emerg Infect Dis 2015",
          "url": "https://wwwnc.cdc.gov/eid/article/21/1/14-0564_article",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "manchuria-1910",
      "years": "1910-1911",
      "start": 1910,
      "name": "Manchurian pneumonic plague",
      "place": "Northeast China",
      "lat": 45.75,
      "lon": 126.65,
      "deaths": 60000,
      "form": "pneumonic",
      "toll": "About 60,000 deaths",
      "era": "third",
      "note": "Began among marmot trappers in Manzhouli on the Siberian border. Wu Lien-teh halted it in under four months, with masks, quarantine and cremation; his gauze mask is a precursor of the N95.",
      "sources": [
        {
          "name": "Liu et al., Int J Infect Dis 2015",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7110523/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "manchuria-1920",
      "years": "1920-1921",
      "start": 1920,
      "name": "Second Manchurian epidemic",
      "place": "Northeast China",
      "lat": 49.6,
      "lon": 117.4,
      "deaths": 9300,
      "form": "pneumonic",
      "toll": "About 9,300 deaths",
      "era": "third",
      "note": "Wu Lien-teh's own survey counted 9,300 deaths, including about 600 Russians.",
      "sources": [
        {
          "name": "Wu Lien-teh et al., J Hyg 1923",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2167333/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "los-angeles",
      "years": "1924-1925",
      "start": 1924,
      "name": "Los Angeles pneumonic plague",
      "place": "Los Angeles, USA",
      "lat": 34.05,
      "lon": -118.24,
      "deaths": 30,
      "form": "pneumonic",
      "toll": "About 30 deaths",
      "era": "third",
      "note": "The last urban plague epidemic in the US and the last documented person-to-person spread there.",
      "sources": [
        {
          "name": "CDC plague maps and statistics",
          "url": "https://www.cdc.gov/plague/maps-statistics/index.html",
          "tier": "primary"
        },
        {
          "name": "Glatter & Finkelman, Am J Med 2021",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7513766/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "surat",
      "years": "1994",
      "start": 1994,
      "name": "Surat and Beed",
      "place": "India",
      "lat": 21.17,
      "lon": 72.83,
      "cases": 876,
      "deaths": 54,
      "form": "mixed",
      "toll": "876 reported cases, 54 deaths",
      "era": "modern",
      "note": "An inadequate early response and international overreaction caused an estimated US$3 billion in losses from travel and trade restrictions.",
      "sources": [
        {
          "name": "WHO WER 2006;81(28)",
          "url": "https://www.who.int/publications/i/item/WER8128-278-284",
          "tier": "primary"
        }
      ]
    },
    {
      "id": "oran",
      "years": "2003",
      "start": 2003,
      "name": "Oran re-emergence",
      "place": "Oran, Algeria",
      "lat": 35.7,
      "lon": -0.63,
      "cases": 18,
      "deaths": 1,
      "form": "bubonic",
      "toll": "18 cases, 1 death",
      "era": "modern",
      "note": "Algeria's first plague in more than 50 years, from a focus thought to be extinct.",
      "sources": [
        {
          "name": "Bertherat et al., Emerg Infect Dis 2007",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2851531/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "zobia",
      "years": "2004-2005",
      "start": 2004,
      "name": "Zobia diamond mine",
      "place": "Bas-Uele, DR Congo",
      "lat": 3,
      "lon": 25.97,
      "cases": 130,
      "deaths": 57,
      "form": "pneumonic",
      "toll": "130 suspected cases, 57 deaths",
      "era": "modern",
      "note": "A pneumonic outbreak among workers at a reopened mine. WHO's later summary gives 134 cases.",
      "sources": [
        {
          "name": "WHO DON, 15 Mar 2005",
          "url": "https://www.who.int/emergencies/disease-outbreak-news/item/2005_03_15-en",
          "tier": "primary"
        }
      ]
    },
    {
      "id": "ziketan",
      "years": "2009",
      "start": 2009,
      "name": "Ziketan pneumonic cluster",
      "place": "Qinghai, China",
      "lat": 35.6,
      "lon": 99.98,
      "cases": 12,
      "deaths": 3,
      "form": "pneumonic",
      "toll": "12 cases, 3 deaths",
      "era": "modern",
      "note": "Traced to a marmot that had contact with the index patient's dog. 332 close contacts were isolated.",
      "sources": [
        {
          "name": "WHO DON, 11 Aug 2009",
          "url": "https://www.who.int/emergencies/disease-outbreak-news/item/2009DON061",
          "tier": "primary"
        }
      ]
    },
    {
      "id": "madagascar-2017",
      "years": "2017",
      "start": 2017,
      "name": "Madagascar urban pneumonic epidemic",
      "place": "Antananarivo and Toamasina",
      "lat": -18.88,
      "lon": 47.51,
      "cases": 2417,
      "deaths": 209,
      "form": "pneumonic",
      "toll": "2,417 cases, 209 deaths (1 Aug to 26 Nov)",
      "era": "modern",
      "note": "Unprecedented in Africa: 77 percent of cases were pneumonic and it hit the capital and the main port. Isolates stayed sensitive to all recommended antibiotics.",
      "sources": [
        {
          "name": "WHO situation report 14, Dec 2017",
          "url": "https://reliefweb.int/report/madagascar/madagascar-plague-outbreak-external-situation-report-14-4-december-2017",
          "tier": "primary"
        }
      ]
    },
    {
      "id": "beijing-2019",
      "years": "2019",
      "start": 2019,
      "name": "Pneumonic cases treated in Beijing",
      "place": "Inner Mongolia and Beijing",
      "lat": 39.9,
      "lon": 116.4,
      "cases": 4,
      "deaths": 1,
      "form": "mixed",
      "toll": "2 pneumonic, 2 bubonic, 1 death",
      "era": "modern",
      "note": "A couple from Inner Mongolia was diagnosed with pneumonic plague in Beijing; genomics traced the infection to local reservoirs.",
      "sources": [
        {
          "name": "Shen et al., China CDC Weekly 2020",
          "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8428464/",
          "tier": "analysis"
        }
      ]
    },
    {
      "id": "ituri-2022",
      "years": "2022",
      "start": 2022,
      "name": "Ituri ninth outbreak",
      "place": "Rethy, Ituri, DR Congo",
      "lat": 2.15,
      "lon": 30.9,
      "cases": 653,
      "deaths": 7,
      "form": "bubonic",
      "toll": "653 cases, 7 deaths (year)",
      "era": "modern",
      "note": "Ituri reports cases almost every week; 14 of its 36 health zones report plague each year.",
      "sources": [
        {
          "name": "WHO R&D Blueprint, Plague in the African Region",
          "url": "https://cdn.who.int/media/docs/default-source/documents/r-d-blueprint-meetings/global-consultation-on-plague-vaccines/1_reena-doshi_plague-rd-bp-v1.pdf",
          "tier": "primary"
        }
      ]
    }
  ]
}