Palavras-chave
peste pneumônica
fisiopatologia
vigilância epidemiológica
vacinas
F1/LcrV
saúde pública
Ciências da Saúde
Resumo
A peste pneumônica é uma forma grave da infecção por Yersinia pestis, caracterizada por rápida evolução pulmonar, potencial de insuficiência respiratória, sepse e transmissão entre contatos próximos durante a fase sintomática. Este artigo integra fisiopatologia, manifestações clínicas, diagnóstico, tratamento, quimioprofilaxia, prevenção, preparação epidemiológica e desenvolvimento de vacinas, com análise contextual de um evento investigado em Irkutsk, Rússia, em 2026. Realizou-se análise documental e atualização clínico-epidemiológica, com busca de literatura biomédica indexada no PubMed, documentos da Organização Mundial da Saúde e do Ministério da Saúde do Brasil, além de fontes jornalísticas utilizadas exclusivamente para reconstrução temporal do evento russo. Especial atenção foi dada às plataformas vacinais F1/LcrV, às vacinas vivas atenuadas e aos vetores adenovirais. Os dados recentes mostram resultados pré-clínicos robustos em modelos animais e, em 2026, avanço de uma candidata adenoviral F1-V para ensaio clínico de fase I; contudo, não existe vacina licenciada para uso rotineiro da população geral. A análise epidemiológica acrescenta mortalidade, letalidade, risco de transmissão e comparação histórica brasileira, mantendo a distinção entre óbito documentado, caso confirmado e evento suspeito. Conclui-se que a principal estratégia imediata permanece o reconhecimento precoce, isolamento, diagnóstico, tratamento antimicrobiano oportuno e investigação de contatos, enquanto a vacinação representa uma linha de pesquisa prioritária para prevenção futura. Como ampliação analítica, o manuscrito organiza as barreiras ao desenvolvimento de vacinas em perguntas de pesquisa: demonstração de eficácia em surtos raros e imprevisíveis; definição de correlatos de proteção e de evidências pré-clínicas; planejamento regulatório; sustentabilidade do financiamento; e avaliação do custo total e da biossegurança das plataformas de fabricação. A correspondência acadêmica utilizada para formular essas perguntas é tratada como motivação, não como evidência científica ou endosso do artigo. A análise dos substratos celulares e dos riscos biológicos é apresentada como uma linha complementar proposta pela autora, cuja relevância específica para candidatos contra Yersinia pestis requer avaliação documental comparativa.
Referências
1. WORLD HEALTH ORGANIZATION. Plague. Geneva: WHO, 2026. Disponível em: https://www.who.int/news-room/fact-sheets/detail/plague. Acesso em: 7 out. 2026.
2. METRÓPOLES. Peste pneumônica é fatal e causa catarro comparado a xarope de framboesa. 7 out. 2026. Fonte jornalística complementar para contextualização clínica; não utilizada como evidência de confirmação do evento russo.
3. CENTERS FOR DISEASE CONTROL AND PREVENTION. Clinical Care of Plague. Atlanta: CDC, 15 May 2024. Atualizado/consultado em 2026.
4. CENTERS FOR DISEASE CONTROL AND PREVENTION. Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response. MMWR, 2021.
5. PENG, W. et al. Protective outcomes of high-affinity monoclonal antibodies against drug-resistant plague strains. Frontiers in Immunology, 2026. PMID: 42416072.
6. EADS, D. A. et al. Exploring and Mitigating Plague for One Health Purposes. Current Tropical Medicine Reports, v. 9, n. 4, p. 169–184, 2022. DOI: 10.1007/s40475-022-00265-6. PMID: 39210935.
7. LEMAITRE, N. et al. Assessing the threat of Yersinia pestis harboring a multi-resistant IncC plasmid and the efficacy of an antibiotic targeting LpxC. Antimicrobial Agents and Chemotherapy, 2025. PMID: 39882860.
8. JIA, Q. et al. rLVS ΔcapB/Yp F1-V single vector platform vaccine expressing Yersinia pestis F1 and LcrV antigens provides complete protection against lethal respiratory challenge with virulent plague bacilli. Human Vaccines & Immunotherapeutics, 2025. PMID: 40417828.
9. DOLD, C. et al. An adenoviral-vectored vaccine protects mice against aerosol challenge with Yersinia pestis. Molecular Therapy, v. 34, n. 6, p. 3518–3534, 2026. DOI: 10.1016/j.ymthe.2026.02.036.
10. THE UNIVERSITY OF OXFORD. Phase I trial begins of new vaccine against the Plague. Oxford, 26 Jul. 2021.
11. WORLD HEALTH ORGANIZATION (WHO). Pneumonia of undetermined etiology — the Russian Federation. Disease Outbreak News, 10 Oct. 2026. Disponível em: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON620. Acesso em: 14 out. 2026. [10].
12. REUTERS. Dozens quarantined in Siberia after plague institute lab worker dies. 5 Oct. 2026. Fonte jornalística para contextualização do evento russo.
13. DEUTSCHE WELLE (DW). Russia: Claims about lab worker’s death spark plague fears. 6 Oct. 2026. Disponível em: https://amp.dw.com/en/russia-lab-worker-death-fact-check/a-79560752. Acesso em: 13 out. 2026. [DW, 2026].
14. THE STRAITS TIMES. China says it’s talking to Russia on suspected plague case. 6 Oct. 2026. Disponível em: https://www.straitstimes.com/asia/east-asia/china-says-its-talking-to-russia-on-suspected-plague-case. Acesso em: 13 out. 2026. [The Straits Times, 2026].
15. KESQ/CNN. Checklists, masks and mystery: What we know about the plague scare in Russia. 7 Oct. 2026. Disponível em: https://kesq.com/news/national-world/cnn-world/2026/10/07/checklists-masks-and-mystery-what-we-know-about-the-plague-scare-in-russia/. Acesso em: 13 out. 2026. [KESQ/CNN, 2026].
16. HONG KONG. CENTRE FOR HEALTH PROTECTION, DEPARTMENT OF HEALTH. CHP closely monitors case of pneumonia of undetermined etiology that resulted in death in Russia. 12 Oct. 2026. Disponível em: https://www.info.gov.hk/gia/general/202610/12/P2026101200466p.htm. Acesso em: 14 out. 2026. [Hong Kong CHP, 2026].
17. U.S. EMBASSY IN RUSSIA. Health Alert for U.S. citizens in Russia. 6 Oct. 2026. Publicação no canal oficial da Embaixada dos Estados Unidos na Rússia. Disponível em: https://telegram.me/s/USEmbRussia. Acesso em: 14 out. 2026. [U.S. Embassy in Russia, 2026].
18. NATURE. Plague scare: what scientists know, and what Russia won’t say. Nature, Oct. 2026. Disponível em: https://www.nature.com/articles/d41586-026-03215-8. Acesso em: 13 out. 2026. [Nature, 2026].
19. CNN BRASIL. Embaixada dos EUA na Rússia emite alerta após suspeita de morte por peste. 6 out. 2026. Disponível em: https://www.cnnbrasil.com.br/internacional/embaixada-dos-eua-na-russia-emite-alerta-apos-suspeita-de-morte-por-peste/. Acesso em: 14 out. 2026. [CNN Brasil, 2026].
20. ALEMPIC, J.-M. et al. An Update on Eukaryotic Viruses Revived from Ancient Permafrost. Viruses, v. 15, n. 2, 564, 2023. DOI: 10.3390/v15020564. PMID: 36851778.
21. MACKELPRANG, R. et al. Cooling perspectives on the risk of pathogenic viruses from thawing permafrost. mSystems, v. 10, n. 2, e00042-24, 2025. DOI: 10.1128/msystems.00042-24. PMID: 39772968.
22. Williamson ED, Kilgore PB, Hendrix EK, et al. Progress on the research and development of plague vaccines with a call to action. npj Vaccines. 2024;9:162. doi:10.1038/s41541-024-00958-1. PMID: 39242587.
23. King DF, Groves H, Weller C. The role of correlates of protection in overcoming barriers to vaccine development and demonstrating efficacy. npj Vaccines. 2024;9:78. doi:10.1038/s41541-024-00873-5.
24. U.S. Food and Drug Administration. Product Development Under the Animal Rule: Guidance for Industry. 2015. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/product-development-under-animal-rule
25. U.S. Food and Drug Administration. Animal Rule Information. https://www.fda.gov/emergency-preparedness-and-response/preparedness-research/animal-rule-information
26. World Health Organization. Non-clinical evaluation of vaccines. https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/norms-and-standards/vaccine-standardization/non-clinical-evaluation-of-vaccines
27. FLECK-DERDERIAN, S. et al. Plague During Pregnancy: A Systematic Review. Clinical Infectious Diseases, 2020. PMID: 32435806.
28. WORLD HEALTH ORGANIZATION. Manual for plague surveillance, diagnosis, prevention and control. Geneva: World Health Organization, 2024. ISBN 978-92-4-009042-2.
29. WORLD HEALTH ORGANIZATION. Defining collaborative surveillance: a core concept for strengthening the global architecture for health emergency preparedness, response and resilience. Geneva: WHO, 2023.
30. WORLD HEALTH ORGANIZATION (WHO). International Health Regulations (2005), as amended. Geneva: WHO. Disponível em: https://www.who.int/health-topics/international-health-regulations/. Acesso em: 14 out. 2026. [87].
31. WORLD HEALTH ORGANIZATION (WHO). Cell substrates. Norms and standards for biological products. Disponível em: https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/norms-and-standards/cell-substrates. Acesso em: 11 out. 2026. [WHO, 2026b].
32. WORLD HEALTH ORGANIZATION (WHO). Animal testing for quality control of biological products: guidelines for replacement or removal of animal tests. Disponível em: https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/norms-and-standards/vaccine-standardization/animal-testing-for-quality-control-of-biological-products. Acesso em: 11 out. 2026.
33. U.S. FOOD AND DRUG ADMINISTRATION (FDA). Investigating Viruses in Cells Used to Make Vaccines; and Evaluating the Potential Threat Posed by Transmission of Viruses to Humans. Disponível em: https://www.fda.gov/vaccines-blood-biologics/science-research-biologics/investigating-viruses-cells-used-make-vaccines-and-evaluating-potential-threat-posed-transmission. Acesso em: 11 out. 2026. [FDA, 2026].
34. U.S. FOOD AND DRUG ADMINISTRATION (FDA). Animal Rule Information. Atualizado em 2026. Disponível em: https://www.fda.gov/emergency-preparedness-and-response/preparedness-research/animal-rule-information. Acesso em: 11 out. 2026. [79].
35. RYDLOVA, A. et al. Development of a live-attenuated vaccine challenge model of Yersinia pestis in humans: Expert consultation on clinical trial considerations, January 2025. Vaccine, 2025. PMID: 40652682.
36. FREY, S. E. et al. Clinical trial of a recombinant plague vaccine (Flagellin/F1/V) in healthy adults. 2017. Registro associado: NCT01381744.
37. CHU, K. et al. Estudo clínico de fase 2a de vacina recombinante de subunidade contra peste F1/rV em adultos saudáveis. 2016. Registro associado: NCT02596308.
38. ALMEIDA, A. M. P. et al. Plague surveillance in Brazil: 1983–1992. Revista do Instituto de Medicina Tropical de São Paulo, 1995.
39. ARAGÃO, A. I. et al. Tendência secular da peste no Estado do Ceará, Brasil. Cadernos de Saúde Pública, 2007.
40. KOOL, J. L. Risk of person-to-person transmission of pneumonic plague. Clinical Infectious Diseases.
41. MELLO, D. A. Estudo retrospectivo da peste humana no Nordeste oriental do Brasil. Revista da Sociedade Brasileira de Medicina Tropical. Estudo epidemiológico de 1935–1967.
42. PAN AMERICAN HEALTH ORGANIZATION. Vectors: integrated management and public health entomology — Plague. Washington, DC: PAHO/WHO, 2026.
43. WORLD HEALTH ORGANIZATION (WHO). WHO Director-General’s opening remarks at the media briefing, 7 October 2026. 7 Oct. 2026. Disponível em: https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing---7-october-2026. Acesso em: 13 out. 2026. [WHO, 2026b].
44. EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL (ECDC). ECDC closely monitoring situation following case of pneumonia of unknown origin in Russia. 6 Oct. 2026. Disponível em: https://www.ecdc.europa.eu/en/news-events/ecdc-closely-monitoring-situation-following-case-pneumonia-unknown-origin-russia. Acesso em: 13 out. 2026. [ECDC, 2026].
45. U.S. DEPARTMENT OF STATE. Russia International Travel Information. Travel Advisory: Level 4 — Do Not Travel. Atualização consultada em 14 out. 2026. Disponível em: https://travel.state.gov/content/travel/en/international-travel/International-Travel-Country-Information-Pages/RussianFederation.print.html. [U.S. Department of State, 2025].
46. Hartley L, Harold S, Hawe E. The efficacy, safety, and immunogenicity of plague vaccines: A systematic literature review. Current Research in Immunology. 2023;4:100072. doi:10.1016/j.crimmu.2023.100072. PMID: 37954941.
47. World Health Organization. Cell substrates. https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/norms-and-standards/cell-substrates
48. World Health Organization. Animal testing for quality control of biological products. Guidance on replacement or removal of animal tests, adopted in 2025. https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/norms-and-standards/vaccine-standardization/animal-testing-for-quality-control-of-biological-products
49. Mao W, Olson K, Urli Hodges E, Udayakumar K. Progress, impacts and lessons from market shaping in the past decade: a systematic review. Frontiers in Public Health. 2025;13:1614471. doi:10.3389/fpubh.2025.1614471. PMID: 40917430.
50. WORLD HEALTH ORGANIZATION (WHO). Clinical evaluation of vaccines. Disponível em: https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/norms-and-standards/vaccine-standardization/clinical-evaluation-of-vaccines. Acesso em: 11 out. 2026.
51. WORLD HEALTH ORGANIZATION (WHO). Guidelines on the replacement or removal of animal tests for the quality control of biological products. 21 nov. 2025. Disponível em: https://www.who.int/publications/m/item/guidelines-on-replacement-of-animal-tests-for-quality-control. Acesso em: 11 out. 2026.
52. BERNDT, Ernst R. et al. Advance market commitments for vaccines against neglected diseases: estimating costs and effectiveness. Health Economics, v. 16, n. 5, p. 491–511, 2007. DOI: https://doi.org/10.1002/hec.1176.
53. ANDERSON, G. W. Jr. et al. Recombinant V antigen protects mice against pneumonic and bubonic plague caused by F1-capsule-positive and -negative strains of Yersinia pestis. Infection and Immunity, 1996. PMID: 8890210. DOI: 10.1128/iai.64.11.4580-4585.1996. https://pubmed.ncbi.nlm.nih.gov/8890210/.
54. LEARY, S. E. et al. Active immunization with recombinant V antigen from Yersinia pestis protects mice against plague. Infection and Immunity, v. 63, n. 8, p. 2854–2858, 1995. DOI: 10.1128/iai.63.8.2854-2858.1995. PMID: 7622205. https://pubmed.ncbi.nlm.nih.gov/7622205/.
55. SMILEY, S. T. et al. Flagellin-F1-V fusion protein is an effective plague vaccine in mice and two species of nonhuman primates. 2009. PMID: 18987167. https://pubmed.ncbi.nlm.nih.gov/18987167/.
56. WILLIAMSON, E. D. et al. Recombinant (F1 + V) vaccine protects cynomolgus macaques against pneumonic plague. Vaccine, v. 29, n. 29–30, p. 4771–4777, 2011. DOI: 10.1016/j.vaccine.2011.04.084. PMID: 21570437. https://pubmed.ncbi.nlm.nih.gov/21570437/.
57. WORLD HEALTH ORGANIZATION. Guidelines on the replacement or removal of animal tests for the quality control of biological products. 21 Nov. 2025. https://www.who.int/publications/m/item/guidelines-on-replacement-of-animal-tests-for-quality-control.
58. AFTALION, M. et al. Rapid induction of protective immunity against pneumonic plague by Yersinia pestis polymeric F1 and LcrV antigens. Vaccines, v. 11, n. 3, 581, 2023. DOI: 10.3390/vaccines11030581. PMID: 36992165.
59. ASSOCIATED PRESS. Russia reports a worker at a Siberian plague institute got pneumonia from an unknown cause and died. 5 Oct. 2026. Fonte jornalística para contextualização do evento contemporâneo.
60. BRASIL. Ministério da Saúde. Manual de vigilância e controle da peste. Atualizado em 10 jul. 2026.
61. BRASIL. Ministério da Saúde. Peste. Brasília, DF: Ministério da Saúde, 2026. Disponível em: https://www.gov.br/saude/pt-br/assuntos/saude-de-a-a-z/p/peste. Acesso em: 7 out. 2026.
62. CENTERS FOR DISEASE CONTROL AND PREVENTION. Preventing Plague. Atlanta: CDC, 5 Mar. 2025. Consultado em 2026.
63. COURA, J. R. et al. Focos inveterados de peste no Brasil. A propósito de um pequeno surto da doença ocorrido recentemente no município de Nova Friburgo, Estado do Rio de Janeiro. Revista da Sociedade Brasileira de Medicina Tropical, 1967;1(6):293–310. DOI: 10.1590/S0037-86821967000600002.
64. DERBISE, A. et al. Contribution of the type 3 secretion system to adaptive and innate immunity induced by a live Yersinia pseudotuberculosis plague vaccine. Vaccine, 2025. PMID: 39978224.
65. DUBYANSKIY, V. M.; YESZHANOV, A. B. Ecology of Yersinia pestis and the Epidemiology of Plague. Advances in Experimental Medicine and Biology, 2016. PMID: 27722862.
66. EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL. Disease information about plague. Stockholm: ECDC.
67. FEODOROVA, V. A.; MOTIN, V. L. Plague vaccines: current developments and future perspectives. Emerging Microbes & Infections. PMID: 26038406.
68. FUNDAÇÃO OSWALDO CRUZ. Serviço de Referência Nacional em Peste: diagnóstico, vigilância e controle. Instituto Aggeu Magalhães, 2026.
69. HINCKLEY, A. F. et al. Transmission dynamics of primary pneumonic plague in the USA. Epidemiology and Infection. PMID: 21733272.
70. MORAND, S. et al. Yersinia pestis: the Natural History of Plague. Trends in Microbiology, 2020. PMID: 33298527.
71. MWENGEE, W. et al. Treatment of plague with gentamicin or doxycycline in a randomized clinical trial in Tanzania. Clinical Infectious Diseases. PMID: 16447105.
72. NELSON, C. A. et al. Antimicrobial Treatment of Human Plague: A Systematic Review of the Literature on Individual Cases, 1937–2019. Clinical Infectious Diseases, 2020. PMID: 32435802.
73. QUENEE, L. E.; SCHNEEWIND, O. Plague vaccines and the molecular basis of immunity against Yersinia pestis. Human Vaccines, 2009. PMID: 19786842.
74. REUTERS. Russia tells WHO it properly informed WHO after plague institute worker’s death. 7 Oct. 2026. Fonte jornalística para contextualização do evento contemporâneo.
75. REUTERS. WHO seeks details on Russian media reports of a second lab worker with pneumonia. 7 Oct. 2026. Relato inicial posteriormente complementado por atualização da OMS e declarações russas; não constitui confirmação de segunda morte ou de peste.
76. ROSENZWEIG, J. A.; HENDRIX, E. K.; CHOPRA, A. K. Plague vaccines: new developments in an ongoing search. Applied Microbiology and Biotechnology, 2021. PMID: 34142207.
77. SUN, W. Plague Vaccines: Status and Future. Advances in Experimental Medicine and Biology, 2016. PMID: 27722869.
78. VENUGOPAL, G.; PECHOUS, R. D. Yersinia pestis and pneumonic plague: insight into how a lethal pathogen interfaces with innate immune populations in the lung to cause severe disease. Cellular Immunology, 2024. PMID: 39002222.
79. WORLD HEALTH ORGANIZATION. Human plague, 2019 to 2025. Weekly Epidemiological Record, 25 Sept. 2026, Vol. 101, Issue 38. Disponível em: https://www.who.int/publications/journals/weekly-epidemiological-record/wer101-38. Acesso em: 7 out. 2026.
80. WORLD HEALTH ORGANIZATION. Plague Outbreak Toolbox. Geneva: WHO, atualização abr. 2024.
81. WORLD HEALTH ORGANIZATION. WHO guidelines for plague management: revised recommendations for the use of rapid diagnostic tests, fluoroquinolones for case management and personal protective equipment for prevention of post-mortem transmission. Geneva: World Health Organization, 2021. ISBN 978-92-4-001557-9. Disponível em: https://www.who.int/publications/i/item/9789240015579. Acesso em: 7 out. 2026.
82. MEMÓRIAS DO INSTITUTO OSWALDO CRUZ. Memories of Memórias: shaping a century of plague research and public health policy in Brazil. SciELO. Disponível em: https://scielo.br/j/mioc/a/tTrCYVKkTm8hmYypy6qMFDH/. Acesso em: 11 out. 2026.
83. AVALIAÇÃO da PCR e hibridização com sondas moleculares como ferramentas para o diagnóstico e caracterização de Yersinia pestis. Revista da Sociedade Brasileira de Medicina Tropical, 1999. DOI: 10.1590/S0037-86821999000400018. Disponível em: https://www.scielo.br/j/rsbmt/a/WQVyTrFzPnqwCY4SZBVcBqz/?lang=pt. Acesso em: 11 out. 2026.
84. INFECÇÃO por Yersinia pestis, no Estado da Bahia: controle efetivo ou silêncio epidemiológico? Revista da Sociedade Brasileira de Medicina Tropical. SciELO. Disponível em: https://www.scielo.br/j/rsbmt/a/bgYjvyrRf3rDXhnLGgjHNdx/?lang=pt. Acesso em: 11 out. 2026.
85. WORLD HEALTH ORGANIZATION. Correlates of vaccine-induced protection: methods and implications. WHO/IVB/13.01, 2013. https://www.who.int/publications/i/item/WHO-IVB-13.01
86. HUMORAL AND cellular immune correlates of protection against bubonic plague by a live Yersinia pseudotuberculosis vaccine. PubMed PMID: 30467064. https://pubmed.ncbi.nlm.nih.gov/30467064/
87. TNFα and IFNγ contribute to F1/LcrV-targeted immune defense in mouse models of fully virulent pneumonic plague. Vaccine, 2011. https://www.sciencedirect.com/science/article/abs/pii/S0264410X10012879
88. CURRENT challenges in the development of vaccines for pneumonic plague. https://pmc.ncbi.nlm.nih.gov/articles/PMC2365752/
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Michelle Aires da Silva, Izabele Marques Cardoso, Maria Rosa Cardoso Rodrigues Hay Mussi, Maria Roberta Cardoso Rodrigues Oliveira, Daniel Teixeira de Farias, Claudio Francisco André Júnior, Rebeca Aparecida Fabro de Melo, Jean Carlos Casagrande, Isabela Ortiz Vilela, Renata Vasconcelos Xavier de Oliveira, Jucilene Quesia Costa Cerqueira, Jaelton Marcelino de Sousa, Jaime Vieira Crespo (Autor)