A city in northern China sounded an alert after a suspected case of bubonic plague was reported, according to official media. Bubonic plague is a bacterial disease that is spread by fleas living on wild rodents such as marmots.

Bayannur, Inner Mongolia Autonomous Region, announced a level 3 warning of plague prevention and control, state-run People’s Daily Online reported.

The suspected bubonic plague case was reported on July 4 by a hospital in Bayannur. The local health authority announced that the warning period will continue until the end of 2020.

“At present, there is a risk of a human plague epidemic spreading in this city. The public should improve its self-protection awareness and ability, and report abnormal health conditions promptly,” the local health authority said.

What is plague?

Plague is an infectious disease caused by the bacteria Yersinia pestis, a zoonotic bacteria, usually found in small mammals and their fleas.

There are three forms of plague infection: bubonic, septicemic and pneumonic. Bubonic plague is the most common form and is characterized by painful swollen lymph nodes or ‘buboes’.

Plague can be a very severe disease in people, with a case-fatality ratio of 30 per cent to 60 per cent for the bubonic type, and is always fatal for the pneumonic kind when left untreated.

Historically, plague was responsible for widespread pandemic with high mortality. It was known as the ‘Black Death’ during the fourteenth century, causing more than 50 million deaths in Europe. 

Nowadays, plague is easily treated with antibiotics and the use of standard precautions to prevent acquiring infection.

It is transmitted between animals through fleas. Humans can be infected through:

* The bite of infected vector fleas.

* Unprotected contact with infectious bodily fluids or contaminated materials.

* The inhalation of respiratory droplets/small particles from a patient with pneumonic plague.

Bubonic plague

Bubonic plague is the most common form of plague and is caused by the bite of an infected flea. Plague bacillus, Y. pestis, enters at the bite and travels through the lymphatic system to the nearest lymph node where it replicates itself. The lymph node then becomes inflamed, tense and painful, and is called a ‘bubo’. At advanced stages of the infection the inflamed lymph nodes can turn into open sores filled with pus. Human to human transmission of bubonic plague is rare. Bubonic plague can advance and spread to the lungs, which is the more severe type of plague called pneumonic plague.

Septicemic plague

Patients develop fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic plague can occur as the first symptoms of plague, or may develop from untreated bubonic plague. This form results from bites of infected fleas or from handling an infected animal.

Pneumonic plague

Pneumonic plague, or lung-based plague, is the most virulent form of plague. Incubation can be as short as 24 hours. Any person with pneumonic plague may transmit the disease via droplets to other humans. Untreated pneumonic plague, if not diagnosed and treated early, can be fatal.

How did the new case emerge in China?

On July 1, state-run Xinhua news agency said that two suspected cases of bubonic plague reported in Khovd province in western Mongolia have been confirmed by lab test results.

The confirmed cases are a 27-year-old resident and his 17-year-old brother, who are being treated at two separate hospitals in their province, it quoted a health official as saying. The brothers ate marmot meat, the health official said, warning people not to eat marmot meat.

A total of 146 people who had contact with them have been isolated and treated at local hospitals.

A couple died of bubonic plague in the western Mongolian province of Bayan-Ulgii last year after eating raw marmot meat. 

The news of bubonic plague came after Chinese researchers issued an early warning over another potential pandemic caused by an influenza virus in pigs.

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