Pneumonic Plague in China

Released: August 18, 2009

• Travel Health Notice
• About Plague
• Recommendations for Travellers
• Don't Forget...
• Other Related Information

Travel Health Notice

The Ministry of Health (MoH) in China has reported an outbreak of pneumonic plague in Qinghai Province, China. As of August 6, 2009, there have been 12 confirmed cases, of which three have died. The local health authorities in the remote village of Ziketan have also quarantined 332 contacts of those with plague, and implemented other measures such as controlling traffic to the area to further contain the outbreak.

The Public Health Agency of Canada advises travellers to avoid exposure to persons suspected of infection with plague. Travellers should also avoid contact with rodents and take precautions to reduce the risk of exposure to flea bites.

Make sure you check with Canada’s Department of Foreign Affairs and International Trade for advice on travel to China .

About Plague

There are three forms of the plague: bubonic (most common), septicemic, and pneumonic. They are all caused by the same bacteria, Yersinia pestis, but present differently depending on what part of the body the bacteria has infected.

Pneumonic plague, occurs when the bacteria spread into the lungs causing respiratory illness. It is easily spread from person to person by inhalation of respiratory droplets (i.e., coughing).

All forms of the plague cause high mortality unless diagnosed and treated early.

Symptoms

• Take about 1 to 7 days to appear, shorter for pneumonic form.
• Initially are “flu-like”, for example: fever, chills, head and body-aches, vomiting and nausea.
• Fever and painful swollen lymph nodes- in the bubonic form
• Include pneumonia, water on the lungs, chest inflammation, and coughing up blood.
• Without early diagnosis and treatment, septicemic and pneumonic plague are almost always fatal.

Transmission

• Plague is typically transmitted by fleas or through direct contact with infected animals.
• Pneumonic plague is spread by airborne droplets (sneezing or coughing).  You can catch it by coming into contact with secretions from the nose or throat of a person who is infected.
• Pneumonic plague can also occur as a secondary stage of bubonic plague. In this instance, transmission occurs through the bite of an infected flea followed by the bacteria spreading to the lungs. 

 

Recommendations for Travellers

1. Avoid exposure to persons suspected of infection with pneumonic plague
2. Take precautions to reduce risk of exposure to flea bites
   1. Cover up:
      • Wear light-coloured, long-sleeved, tucked-in shirts, long pants, shoes (not sandals) and a hat.
   2. Use insect repellent on exposed skin:
      • Insect repellents that contain DEET are the most effective;
      • Use as directed by the manufacturer;
      • Do not apply to cuts, scrapes, abrasions or irritated skin;
      • Do not spray directly on your face;
      • Wash your hands after you apply insect repellent to avoid contact with your lips and eyes;
      • Do not use products that contain both insect repellent and sunscreen;
      • If you want to use sunscreen and an insect repellent with DEET, apply the sunscreen first.  Let it soak into your skin for about 20 minutes, then apply repellent with DEET; and
      • Wash off repellent at the end of the day, before you go to bed.
   3. Consider your accommodations:
      • You have proof of immunity (e.g. through blood testing).

   More information on precautions to take to avoid flea bites while travelling

3. Avoid rodent nests and burrows, and sick or dead animals
4. If travelling to Qinghai Province, China, discuss the benefits of taking an antibiotic medication (chemoprophylaxis) with a health care professional before leaving
   1. Travellers should visit a travel health clinic at least six weeks before travel.
   2. It is recommended that you also protect yourself from flea bites even if you use an antibiotic medication (chemoprophylaxis).
   3. Discuss your risks with a health care professional to determine whether to take antibiotic medication and which one to take.
   4. If your doctor, nurse or health care provider prescribes antibiotic medication, it is important that you take it as directed in order to protect yourself fully.

Don't Forget...

1. Consult a health care provider or visit a travel health clinic at least six weeks before you travel.
2. What to do if you get sick when you are travelling.
3. What to do if you get sick after you return to Canada.
4. Know what vaccines you need and when to get them.

Other Related Information

• Public Health Agency of Canada – Plague
• World Health Organization – Fact sheet: Plague
• World Health Organization – Plague in China [Aug 11, 2009]