Friday, November 22, 2019

Taiwan CDC Reports 4th Mainland Plague Case of 2019

Plague signs
Three Types of Plague -   Credit CDC


Eight days ago, in HK CHP Notification Of Two Plague Cases Being Treated In China, we learned of two recent cases of pneumonic plague from Inner Mongolia.

Bubonic plague is the most common - and most treatable - presentation, however in rare cases, more serious Pneumonic Plague or Septicemic 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.
At the same time, there were `rumors' in the dissident press of other cases, and while not confirmed, a location - Gansu Province - was frequently mentioned.  Meanwhile, China's censors were reportedly scrubbing social media (primarily Weibo) of chatter about plague cases.

Three days later as 3rd case was announced (see China: Inner Mongolia Reports Another Plague Case) - this time presenting as Bubonic Plague - and while also from Inner Mongolia, was not apparently linked to the first two cases. 
Since then, rumors in the media have been rife, with both Qinghai and Gansu Provinces frequently mentioned.
Today however, we get confirmation - somewhat belatedly - of a Septicemic Plague case from Gansu Province, which reportedly occurred in September of this year.

In response, Taiwan - which hasn't reported a local plague case since the early 1950s - has upped their fever screening at their ports of travelers coming from the Mainland, and is urging Hong Kong and Macau to do the same.

In mainland China, there have been 4 cases of plague so far this year. The CDC has continued to implement quarantine measures at the airport port and urged people to go to Inner Mongolia and other areas to avoid contact with rodents.

According to the Disease Control Agency, four cases of plague have been confirmed in China (2019) so far. The first case was the case of septic plague in Jiuquan City, Gansu Province in September. 

The recent three cases were from Xilin Gol League in Inner Mongolia, 11 of which Two cases of pneumonic plague announced on the 12th of the month were local herdsmen and couples who have been transferred to Beijing Hospital for treatment. According to the information released by the Beijing Health and Health Committee on November 21, the two cases of pneumonic plague are critically ill and their close contacts No related symptoms, isolation and monitoring have been removed according to standard procedures

The other case was a case of bubonic plague notified on November 17, and there was a history of stripping wild rabbits in the quarry, which was associated with the above two cases of no-flow disease, and is currently in isolation treatment.

According to the Department of Disease Control, the plague cases have not occurred since 1953 in the country. In order to prevent the spread of plague through international exchanges, the quarantine officers of the CDC continue to carry out screening and health assessment of inbound fever passengers at international ports.
The international port monitors the detection of the mouse vector and its serum samples, and invites the Hong Kong and Macao management and management units to strengthen the environmental protection of the port area, and requires the shipyards, aircraft and other transportation tool managers to implement anti-rat measures.

The plague is a common infectious disease of humans and animals. It mainly occurs in rodent small animals and their fleas. It is transmitted to various animals and humans by fleas. The initial symptoms are inflammation of the lymph nodes near the flea bites, called bubonic plague. Bloody plague, through the blood to infect various parts of the body, including the meninges. Secondary infections of the lungs can cause pneumonia, mediastinal inflammation or pleural effusion, and the spread of pneumonic plague can further contribute to human-to-human transmission. 

If the plague is untreated, the mortality rate is 30% to 60%, but modern medical treatment with effective antibiotics can significantly reduce the mortality rate of bubonic plague.The Department of Diseases and Diseases reminded that the plague natural foci in mainland China includes the western drought-plague foci, the southwest rat plague source, the gerbils in North China, and the Himalayan plague foci. Yunnan, Guizhou, Guangxi, Tibet, Qinghai, Cases occur in Gansu and Inner Mongolia. 

Domestic travel operators and self-help travelers, such as those planning the above-mentioned areas in mainland China, should arrange clean and hygienic accommodations. Avoid contact with rodents or other wild animals during tourism (especially rodents). Animals), do not eat raw meat or contact animal dead bodies to reduce the risk of rat bites and plague.

If you have any symptoms when you return to China, you should inform the airport quarantine personnel and seek medical advice as soon as possible. Please inform the tourist contact history when you seek medical treatment to facilitate early diagnosis and treatment. For more information, please visit the UNDCP World Wide Web ( or call the toll-free vaccination line 1922 (or 0800-001922).annex Plague introduction.pdf
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Four plague cases over three months is, admittedly, not a particularly alarming number.  We often see that many cases in a 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).
But Mainland China's history of suppressing `bad news' - particularly involving disease outbreaks - makes it difficult to know (or at least, believe) that these four cases fully represent the extent of their recent outbreak.
Currently treatable - at least, if caught in time - by modern antibiotics, Y. pestis has also shown disturbing signs of growing antibiotic resistance (see PLoS  Multiple Antimicrobial Resistance in Plague: An Emerging Public Health Risk), which could complicate matters considerably in the future.

Plague is listed as #4 on the CDC's list of the The 8 Zoonotic Diseases Of Most Concern In The United States. Of the 56 diseases listed, 8 were selected as being of particular concern in the United States.
The zoonotic diseases of most concern in the U.S. are:

While many of the wilder rumors circulating on Weibo and in the dissident Chinese press seem unlikely to be true, Taiwan is obviously taking the threat seriously.

Stay tuned.