With pneumonic plague, the first signs of illness are fever, headache, weakness and rapidly developing pneumonia with shortness of breath, chest pain, cough and sometimes bloody or watery sputum.

[8] Pneumonic plague is a very aggressive infection requiring early treatment, which must be given within 24 hours of first symptoms to reduce the risk of death.

[citation needed] Antibiotic treatment for seven days will protect people who have had direct, close contact with infected patients.

[7] The mortality rate from untreated pneumonic plague approaches 100% although victims of the Black Death who vomited blood occasionally survived such as the chronicler Marcha di Marco Battagli.

[9][10] Since 2002, the World Health Organization (WHO) has reported seven plague outbreaks, though some may go unreported because they often happen in remote areas.

[15] The Qing court dispatched Wu Lien-teh, a doctor educated at Cambridge University, to oversee disease control and treatment efforts.

He made the novel observation that the disease was transmitted by air, and developed prototypical respirators to help prevent its spread.

[15] The People's Republic of China has eradicated pneumonic plague from most parts of the country, but still reports occasional cases in remote western areas, where the disease is carried by rats and the marmots that live across the Himalayan plateau.

Outbreaks can be caused when a person eats an infected marmot or comes into contact with fleas carried by rats.

[17] The expert said at the time that, due to the region's remoteness, the disease killed more than half the infected people.

[19] An outbreak of the disease in China began in August 2009 in Ziketan Town located in Qinghai Province.

They received treatment in Chaoyang District, Beijing, and authorities implemented preventative control measures.

[26] In August 2010, Peru's health minister Oscar Ugarte announced that an outbreak of plague had killed a 14-year-old boy and had infected at least 31 people in a northern coastal province.

Ugarte stated that authorities were screening sugar and fish meal exports from Ascope Province, located about 325 miles (520 km) northwest of Lima, not far from the popular Chicama beach.

[31] From 23 August to 30 September 2017, a total of 73 suspected, probable, and confirmed cases of pneumonic plague, including 17 deaths, were reported in Madagascar.

The WHO and Institut Pasteur de Madagascar were both involved in administering antibiotic compounds and attempting to stop the spread of the disease.

On 2 November 2007, wildlife biologist Eric York died of pneumonic plague in Grand Canyon National Park.