Plague Cases in China Raise Alarm for Potential Epidemic: Public Health Watch

The mere mention of the word “plague” conjures up some ghastly images, even among the most hardened of infectious disease specialists.

After all, it’s not every communicable disease that earns the moniker “Black Death.” So, it’s no surprise that news from China last week regarding 2 new confirmed cases of pneumonic plague—the most deadly of the 3 known forms of the disease, along with bubonic and septicemic, caused by bacterium Yersinia pestis—has generated global headlines.

“Cases [of the plague] continue to occur around the world, and there are some hotspots,” Ashok Kumar Chopra, CSc, PhD, professor, Department of Microbiology & Immunology, and member, Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, told Contagion®. “When they occur of course people get worried about it because they are aware of how dangerous it can be.”

Of course, this is hardly the first outbreak of pneumonic plague since the disease ravaged the global population in the 14^th century, killing some 200 million people, or roughly one-third of the population of Europe at the time. It is only the most recent.

Indeed, according to Dr. Chopra, who has written about the plague, there are parts of the world that share a long history with the disease. In Madagascar, for example, an outbreak in 2017 resulted in more than 2000 confirmed or suspected cases and 200 deaths, per figures from the World Health Organization (WHO), following smaller case clusters in 2014 and 2015.

“The majority of cases in Madagascar, more than 76%, were pneumonic plague, and we still don’t really know what caused the most recent outbreak there,” Chopra explained. “There is some thought that the outbreak originated in a more rural area, and that a person infected with it traveled to an urban area, which increased the spread of the disease in the country.”

Officials in China are likely mindful of that, he added, given that the 2 cases confirmed last week were being treated in a hospital in Beijing, the country’s capital city.

And, sadly, there are other historical records for them to tap into for guidance. In the 21^st century alone, cases have been reported in Algeria (2003), the Democratic Republic of the Congo (2005-06), India (2002), Malawi (2002), Peru (2010), and Zambia (2001). In fact, this isn’t even the first go-around for China, which reported 12 cases of the plague in 2009, according to the WHO. Investigators have suggested that the infamous “Black Plague” of the 14^th century may have originated in China and spread via Silk Road trade.

Back to the present day, Chopra noted that there has been “very limited information” out of China to date, which is perhaps not surprising given the country’s recent history with regard to press freedom and transparency. However, at least up until now, all indications are that officials there have handled the outbreak appropriately, quarantining those with confirmed disease and treating those with whom they’ve already been in contact prophylactically with antibiotics.

Indeed, as of this writing, the outbreak appears to have been contained to the 2 confirmed cases.

However, while he doesn’t want to start a panic, Chopra also suggested that we won’t know the full scope of this outbreak until we learn more about the patients involved. Were they immunocompromised prior to getting sick? Did they travel within China or outside the country? Given that the symptoms of the plague typically mimic those of the common cold or flu, at least initially, was the disease recognized quickly and appropriate protocols implemented?

On these questions, “it’s too soon to tell,” Chopra said. “It could become an epidemic. We just don’t know. A lot of hospitals don’t see too many cases of the plague, so physicians may not be aware to look for it.”

A sobering thought, given that we know that when it comes to the plague, history too often repeats. And those who fail to learn from it…