Two Tibetan herdsmen have died of pneumonic plague in a remote part of north-west China's Qinghai province, prompting health officials to seal off an entire town in a bid to stop one of the deadliest diseases known to man from spreading.
A team of experts has been rushed to the quarantined area, police have set up checkpoints and local officials are handing out information leaflets and making TV and radio announcements about how to prevent infection.
Pneumonic plague can kill within 24 hours and its close links to the bacteria that causes the bubonic plague that killed huge swathes of the population of medieval Europe means it occupies a particularly horrifying place in the collective psyche.
The latest fatality was a 37-year-old man called Danzin, from Ziketan town, who died on Sunday. He is a neighbour of the first man, a 32-year-old herdsman, who died from the disease. The outbreak, discovered last Thursday, has struck another 10 people in Ziketan, which has a population of 10,000.
A food seller surnamed Han at the Crystal Alley Market said authorities have called for homes and shops to be disinfected and for residents to wear masks when they go out. He said 80 per cent of shops in the town were closed and prices of disinfectants and some vegetables had tripled.
"People are so scared. There are few people on the streets," he told the Associated Press. "There are police guarding the quarantine centre at the township hospital but not on the streets."
China, the world's most populous nation with 1.3 billion people, has become markedly proactive in dealing with infectious diseases in the past few years. It was criticised for being too slow in its reaction following the Sars epidemic in 2002, but has introduced swift and stringent measures to counter the spread of the swine flu virus in recent months.
Qinghai's sheer remoteness may ultimately save it from becoming the site of a pandemic, as widespread traffic between local towns is relatively limited. Health officials were keeping a close watch for the tell-tale coughs and fevers that signal the onset of the disease, which is spread through the air and can be passed from person to person through coughing.
Pneumonic plague is largely curable if diagnosed in time – the World Health Organisation says that while the disease can kill 60 per cent of its victims if left unchecked, early diagnosis and treatment with generic antibiotics such as streptomycin and tetracycline can cut plague patients' mortality rate to less than 15 per cent. "In cases like this, we encourage the authorities to identify cases, to investigate any suspicious symptoms among close contacts and to treat confirmed cases as soon as possible," said the WHO spokeswoman in China, Vivian Tan. "So far, they have done exactly that, so at this point we don't have any additional advice."
Most of those affected by the illness were being treated locally, the Xinhua news agency reported. The local health bureau warned that anyone with a cough or fever who has visited the town since mid-July should seek treatment at a hospital.
China suffered a pandemic of plague which began in Yunnan province in the 19th century and which subsequently spread worldwide. It killed 100,000 people in southern China towards the end of the 19th century and remained endemic in Hong Kong until 1929.
Pneumonic plague can spread from person to person or from animals to people, and while it is also the least common form of plague, health workers have been concerned about it spreading in Qinghai for some time. In February this year, they said they had sent out 55 teams across the province to help monitor and control the disease.
Pneumonic plague: The facts
*Plague is a zoonotic disease, meaning it spreads from animals to humans, and has a 30 to 60 per cent fatality rate if untreated. According to the World Health Organisation there are 1,000 to 3,000 cases each year.
*Unlike bubonic plague, the so-called 'Black Death' that stalked Europe during the Middle Ages and is spread by flea or other insect bites, pneumonic plague is the only form that can be transferred directly between humans.
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