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PLAGUE, PNEUMONIC - CHINA (02): (QINGHAI)
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 3 Aug 2009
Source: The New York Times [edited]
<http://www.nytimes.com/2009/08/04/world/asia/04china.html>
Officials have sealed off an isolated town of 10 000 people in rural
west-central China after an outbreak of pneumonic plague killed 2
residents, the state-run Xinhua news service reported on Monday [3 Aug 2009].
An official who answered the emergency line at Renmin Hospital in
Ziketan, where the outbreak is centered, said that all roads into and
out of the area had been closed off, but that residents remained free
to move about within the town. The official, who refused to give his
name, said it was unclear when the blockade would be lifted. Repeated
calls to a plague emergency phone line produced only busy signals.
Ziketan is a remote, ethnically Tibetan town in eastern Qinghai
Province, one of the largest and least populated regions of China.
Officials said the 1st victim, a 32-year-old herdsman, died last
Thursday [30 Jul 2009], and the 2nd, a neighbor who also was a
herdsman, died on Sunday [2 Aug 209], more than a day after being
admitted to a hospital.
Local health officials told Xinhua that they had quarantined 10 other
people, mostly relatives of the dead men, but that none had developed
coughs or fever, signs of the deadly disease.
While bubonic plague is spread by bites from infected rodent fleas,
the deadlier pneumonic plague bacteria are spread through the air by
coughing, and it kills about 6 in 10 sufferers, sometimes within a
day, if it is not treated.
The World Health Organization said that the mortality rate could be
reduced to about 15 percent through treatment with common
antibiotics. A spokeswoman for the agency told Bloomberg News that
experts were monitoring the outbreak but were not especially concerned by it.
[Byline: Michael Wines]
--
Communicated by:
ProMED-mail Rapporteur Brent Barrett
[In the initial posting (Plague, pneumonic - China: (QH), RFI
20090801.2702), it was stated that besides the initial death, 11
others were infected. Here, that it not stated but 1 of those appears
to have also succumbed to pneumonic plague.
The following is adapted from reference 1 with the internal citations
changed to begin with 2:
CDC guidelines identify contacts within 2 meters (6.6 ft) as being at
greatest risk and do not consider the organism likely to be carried
through air ducts or vents (2). Isolation precautions, such as hand
washing, wearing latex gloves and gowns, and protection of mucous
membranes, should be undertaken for all bubonic plague patients for
48 hours. If no pneumonia is found or there are no draining lesions,
isolation can be discontinued.
Pneumonic plague patients should also be managed under respiratory
droplet precautions, including
- accommodation in an individual room,
- restriction of patient movement outside the room and access to the room, and
- masking of both patient and health-care deliverers.
It is thought that the risk of transmission is ended after the
completion of at least 4 days of therapy (3). The Working Group on
Civilian Biodefense recommended isolation during the 1st 48 hours and
until clinical improvement occurs (4).
Laboratory-acquired plague has been reported and can result in
primary pneumonic plague. Probably initially reported in Wu's 1926
classic monograph on plague (5), the laboratory transmission of
_Yersinia pestis_ appears to be rare. A case report with a review of
4 other cases was published in the USA in 1962 (6). _Y. pestis_ has
been found to maintain some viability for some periods of times (at
least 5 days) on environmental surfaces under controlled conditions
(7). Such an environmental risk for humans is likely to be minimal,
and environmental decontamination is not recommended (4).
A cluster of pneumonic plague in the USA occurred in the early part
of the 20th century in northern California (Fall of 1919) (8).
References
----------
1. Oyston PCF, Titball RW: Plague. In, Beyond Anthrax. The
Weaponization of Infectious Diseases. (Lutwick LI, Lutwick SM, eds)
Humana Press, New York, 2009, 55-76.
2. Dennis DT, Gage KL, Grantz N, et al: Plague manual: epidemiology,
distribution, surveillance and control. World Health Organization,
Geneva, 1999 [available from
<http://www.who.int/csr/resources/publications/plague/WHO_CDS_CSR_EDC_99_2_EN/en/>].
3. McGovern TW, Friedlander AM: Plague. In, Textbook of Military
Medicine: Medical Aspects of Chemical and Biological Warfare.
(Zajtchuk R, Bellamy RF, eds), Office of the Surgeon General, Borden
Institute, Washington, DC, 1997, pp 479-502 [available from
<http://www.bordeninstitute.army.mil/published_volumes/chemBio/Ch23.pdf>].
4. Inglesby TV, Dennis DT, Henderson DA, et al: Plague as a
biological weapon -- medical and public health management, JAMA 2000;
283: 2281-90 [available from
<http://jama.ama-assn.org/cgi/content/full/283/17/2281>].
5. Wu L-T: A Treatise on Pneumonic Plague. League of Nations, Geneva,
1926 [abstract available from
<http://www.ajtmh.org/cgi/content/abstract/s1-7/4/269>].
6. Burmeister RW, Tigertt WD, Overholt EL: Laboratory-acquired
pneumonic plague. Report of a case and review of previous cases. Ann
Intern Med 1962; 56: 789-800 [abstract available from
<http://www.annals.org/cgi/content/abstract/56/5_Part_1/789?ck=nck>].
7. Rose LJ, Donlan R, Banerjee SN, Arduino MJ: Survival of _Yersinia
pestis_ on environmental surfaces. Appl Environ Microbiol 2003; 69:
2166-71 [available from
<http://aem.asm.org/cgi/content/full/69/4/2166>].
8. Kellogg WH: An epidemic of pneumonic plague. Am J Public Health
1920; 10: 599-605 [available from
<http://www.ajph.org/cgi/reprint/10/7/599>]. - Mod.LL]
[Ziketan town can be located on the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00E4>. - Sr.Tech.Ed.MJ]
[see also:
Plague, pneumonic - China: (QH), RFI 20090801.2702
Plague, human - Mongolia: (BO), RFI 20090612.2177
2007
----
Plague, bubonic - Mongolia (Gobisumber) 20070924.3163
Plague, human, fatal - Mongolia (Hovsgol) (03) 20070810.2602
Plague, human, fatal - Mongolia (Hovsgol) 20070807.2567
Plague, rodents - Russia (Volgograd, Astrakhan): susp. 20070128.0368
2005
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Plague - China (Tibet) 20050626.1798
Plague, camels - Uzbekistan, Kazakhstan, Turkmenistan: susp. 20050212.0479
2004
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Plague - Turkmenistan (Dashoguz): susp (02) 20040707.1820
Plague - Turkmenistan (Dashoguz): susp 20040706.1811
Plague warning - Russia: RFI 20040427.1178
2003
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Plague - Mongolia 20030908.2255
Plague, bubonic - Kazakhstan (Kzyl-Orda) 20030822.2119
Plague - Kazakhstan (Mangistausk): suspected 20030801.1881
2002
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Plague - Mongolia 20020919.5361
2001
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Plague, bubonic - Mongolia (Central): correction 20010904.2115
Plague, bubonic - Mongolia (Central) 20010808.1871
2000
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Plague, bubonic - Mongolia & China: background (03) 20000924.1645
Plague, bubonic - Mongolia & China: background (02) 20000920.1620
Plague, bubonic - Mongolia & China: Background 20000802.1290
Plague, bubonic, marmots - Mongolia: RFI 20000801.1274
1999
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Plague, bubonic - Kazakhstan (05) 19990817.1418
Plague, bubonic - Kazakhstan 19990802.1322
1998
----
Plague, marmots - Kyrgyzstan (Dzhetyoguz) 19980811.1572]
...................................ll/mj/dk
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