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What caused the Black Death?
  1. C J Duncan,
  2. S Scott
  1. School of Biological Sciences, University of Liverpool, Liverpool, UK
  1. Correspondence to:
 Professor C J Duncan
 School of Biological Sciences, University of Liverpool, Life Sciences Building, Liverpool L69 7ZB, UK;


For the whole of the 20th century it was believed that the Black Death and all the plagues of Europe (1347–1670) were epidemics of bubonic plague. This review presents evidence that this view is incorrect and that the disease was a viral haemorrhagic fever, characterised by a long incubation period of 32 days, which allowed it to be spread widely even with the limited transport of the Middle Ages. It is suggested that haemorrhagic plague emerged from its animal host in Ethiopia and struck repeatedly at European/Asian civilisations, before appearing as the Black Death. The CCR5-Δ32 mutation confers protection against HIV-1 in an average of 10% of the people of European origin today. It is suggested that all the Δccr5 alleles originated from a single mutation event that occurred before 1000 bc and the subsequent epidemics of haemorrhagic plague gently forced up its frequency to 5×10−5 at the time of the Black Death. Epidemics of haemorrhagic plague over the next three centuries then steadily raised the frequency in Europe (but not elsewhere) to present day values.

  • plague epidemics
  • viral haemorrhagic fever
  • CCR5-Δ32 mutation
  • emergent diseases

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