Two cases of pneumonic plague reported in northern China

Chinese officials downplay, say both patients are being treated as rules mandate

By DTE Staff
Last Updated: Thursday 14 November 2019
A sick rat on a sidewalk. Photo: Getty Images

Two years after an outbreak in Madagascar, plague has surfaced again, this time in China.

Chinese news agency Xinhua said the Beijing Municipal Health Commission had confirmed two cases of pneumonic plague. In its latest update, it said that while one patient was stable, another was critically ill.

Both patients hail from China's Inner Mongolia Autonomous Region. They are being treated in a hospital in Chaoyang district.

Chinese officials have downplayed the cases, saying both patients are receiving proper treatment and there is no need of panic.

“So far, people who have had close contact with the patients have been quarantined for medical observation in accordance with relevant provisions of the state. None have reported fever or other abnormal symptoms,” Xinhua said.

Plague still a risk

According to the Atlanta-based Centers for Disease Control and Prevention (CDC), plague is caused by the bacterium, Yersinia pestis. Humans usually get plague after being bitten by a rodent flea that is carrying the plague bacterium or by handling an animal infected with plague.

Plague is infamous for killing millions of people in Europe during the Middle Ages, it said. Historically, plague was responsible for widespread pandemics with high mortality. It was known as the Black Death during the fourteenth century, causing more than 50 million deaths in Europe.

Usually, Yersinia pestis infects the lymph node, which is then referred to as ‘bubo’, and is called bubonic plague. It is not transmitted from person-to-person.

However, if bubonic plague travels to the lungs, it becomes pneumonic plague and that can be transferred from one person to another via droplets or contact. The incubation period of this plague can be as short as 24 hours.

“Plague can be a very severe disease in people, with a case-fatality ratio of 30-60 per cent for the bubonic type, and is always fatal for the pneumonic kind when left untreated,” the World Health Organization (WHO) has said. The fact that both the Chinese cases have been diagnosed as pneumonic is therefore important.

According to the WHO, 3,248 plague cases, including 584 deaths, were reported worldwide from 2010-2015. This is the last global update on plague by it. The countries having maximum endemicity for plague are the Democratic Republic of the Congo, Peru and Madagascar.

While the deadly infection has gone out of people’s memory, the WHO has warned that people in all continents, except Oceania, are susceptible to it, especially in Asia, the Middle East and Europe. The endemicity is clearly reflected here.

The last outbreak of plague happened in Madagascar in 2017. As many as 2,348 cases, including 202 deaths were reported from the African country.

“Considering the smaller number of cases and their distribution over time, it is possible that the outbreak was in fact a series of small clusters and individual pneumonic cases arising independently from bubonic infection,” a commentary published in The Lancet in May 2019, said.

“This distinction is crucial for pneumonic plague because it speaks to the efficacy of control efforts. Pneumonic plague is not highly contagious, and it should be possible to interrupt person-to-person transmission through education campaigns and simple social distancing," it added.

In this instance, the commentary said, control of person-to-person transmission could have been more effective than might be surmised from the overall epidemic curve. 

An average of seven human plague cases have been reported each year (range: 1–17 cases per year) according to the CDC’s update on plague till 2017.  

The WHO does not recommend any vaccination for the disease except high-risk groups for prevention. However, it advises that governments should strengthen surveillance efforts, especially, if there has been an outbreak in the past.

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