China: Inner Mongolia MOH Announces 5th Case Of Plague

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Two weeks ago, in HK CHP Notification Of Two Plague Cases Being Treated In China, we learned of two pneumonic plague cases (M 48, F 46) - originating from Inner Mongolia - who were being treated at a Beijing hospital.  

Bubonic plague is the most common - and most treatable - presentation of Plague, however in rare cases, Pneumonic Plague may develop. 

With Pneumonic Plague, the infected person develops a severe pneumonia, with coughing and hemoptysis (expectoration of blood), and may spread the disease by droplets from human-to-human.

Almost immediately we began to see (unconfirmed) reports of a wider outbreak, carried in the Chinese dissident press, and on social media. Reports that were quickly denied by the Chinese government, although they did report that contacts of the first two cases were `under observation'. 

Three days later (see China: Inner Mongolia Reports Another Plague Case) a 3rd case was announced - a 55 y.o. male who had caught and skinned a rabbit -  this time presenting as Bubonic plague. 

Despite intense censorship, social media (primarily Weibo) and the dissident press continued to report on (unconfirmed) roadblocks and quarantines in Inner Mongolia, with both Qinghai and Gansu Provinces also frequently mentioned.

Six days ago, in Taiwan CDC Reports 4th Mainland Plague Case of 2019, we learned - somewhat belatedly - of a Septicemic Plague case from Gansu Province, which reportedly occurred in September of this year.

Despite the furor in social media and in the dissident press, it is not unusual to see a handful of plague cases reported each year from China. 

We often see that many cases (or more) each year in the Western United States, and two years ago, Madagascar saw an epidemic involving hundreds of cases (see WHO WER: Plague Around The World).

Despite the denials of a larger problem, China does appear to be aggressively screening patients - particularly in Inner Mongolia - for plague symptoms, and has activated plague prevention and control plans.  

 This (translated) report from the Inner Mongolia Board of Health website.

Ordos City plague prevention and control of plague prevention and control of the joint meeting of the group held in the city 
Published: 2019-11-26 15:43:50　　 

Source: Wei Jian Committee Propaganda Department

November 25, Ordos City plague prevention and control of plague prevention and control of the joint meeting of the group held in the city. Ordos Municipal People's Government Vice Mayor Yu-jen masterpiece thematic deployment.

The meeting heard a report on the prevention and control of members of the unit plague the city health committee, city grass Bureau, the Municipal Transportation Bureau, the Municipal Public Security Bureau, Airport Group, railway civil aviation centers, to carry out plague prevention and control problems encountered in the work on the various sectors We proposed solutions.

The meeting urged all member units to further strengthen cooperation, implementation of joint prevention and control, long-term mechanism, and to increase supervision and inspection efforts to flag areas, strengthen the prevention and control of plague emergency training exercises, control public opinion to do the work. (Han Li Li Xiaomei feeds)

All of which brings us to a report from the Inner Mongolia MOH of a 5th plague case (4th from Inner Mongolia) since these reports began last September.  Once again, it is reportedly Bubonic plague, and it involves a herdsman from south-central Inner Mongolia.

(translated)

A case of bubonic plague confirmed in Siziwangqi of our district

Release time: 2019-11-27 23:40:00

Review: Liu Wei Editor: Edited by Huang Lihua: Emergency Office 

November 27, 2019, a herdsman on the bank of Sumu River, the bank of Siziwang Banner, Ulanchabu, was diagnosed as a bubonic plague during consultation with experts from the state and the autonomous region during the consultation at Siziwangqi People's Hospital.

The patient had been active in the source of the plague before he became ill. At present, the patient has been isolated and treated at the local hospital, and his condition is stable. The relevant prevention and control measures have been implemented. Four close contacts have been isolated for medical observation as required. At present, there are no abnormalities such as fever.

Wangsizizi Banner has completely killed the patient's residence and the surrounding herdsmen's residence, and carried out anti-rat and flea prevention and publicity education around the patient's residence.

Experts remind the general public:

1. Maintain good personal hygiene habits, avoid crowded places as much as possible, and wear masks in time when you go to a medical institution for treatment or if you have fever, cough and other related symptoms.

2. If you suspect that you have contact with the case, you can report to the local disease control department and obtain professional guidance. If you have symptoms such as fever, cough, lymph node pain, hemoptysis or bleeding, you should seek medical treatment in time.

3. Minimize contact with wild animals when traveling, do not hunt, strip, or carry epidemic animals without authorization, and take measures to prevent fleas from biting to avoid being bitten by fleas.

4. Field workers should raise awareness of plague prevention and strengthen personal protection measures. (Contributed by Lu Yakai)

China's penchant for censoring or suppressing `bad news' - particularly when it involves disease outbreaks - makes it difficult to assess the size, scope and significance of these plague cases. 

As previously mentioned, plague (Y. pestis) is endemic in rodents across much of China - including Inner Mongolia - and it is possible the shortage of pork due African Swine Fever (once again, badly under reported by the Chinese government) has driven more people to hunt, handle, and consume bushmeat, increasing the odds of human infection. 

Despite its fearsome reputation, Plague is treatable - if caught early enough - by modern antibiotics. While we may hear of more cases in the coming days, the more bombastic reports circulating on Chinese social media are unlikely to pan out. 

That said, large urban outbreaks of plague have (rarely) been reported in modern times - including in India in 1994 and Madagascar in 2017 - and so we'll continue to keep an eye on these reports in the coming days.