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From 1950  to  2019,  a  total  of  267  plague  cases  in humans  were  reported  in  the  Inner  Mongolia Autonomous  Region  with  133  deaths  and  10,710 Yersinia pestis isolates;  21  of  these  cases  were  reported from  the  Meriones unguiculatus  (M. unguiculatus) plague  focus  with  6  deaths  and  6,771  isolates. According  to  the  plague  situation  in  the  Inner Mongolia  Autonomous  Region  and  the implementation  of  local  preventive  measures,  the prevalence of plague in humans in the M. unguiculatus plague  focus  of  the  Inner  Mongolia  Autonomous Region  could  be  divided  into  four  stages.  The  first stage  was  the  initial  stage  of  plague  prevention  and control  (1950–1959),  with  0.80  cases  annually  and  a case fatality rate of 37.50%.  The second stage was the plague eradication stage (1960–1979),  with 0.15 cases annually and a case fatality rate of  33.33%.  The third stage  was  the  plague  surveillance  stage  (1980–1999), with  0.25  cases  annually  and  a  case  fatality  rate  of 20.00%.  The  fourth  stage  is  the  comprehensive prevention  and  control  stage  under  the  emergency system  (2000–2019),  with  0.25  cases  annually  and  a case fatality rate of 20.00%. The surveillance of rodent density  (1981–2019)  and  studies  on  plague-related factors  among  M. unguiculatus  have  shown  that  the higher  the  M. unguiculatus  density,  the  higher  the nocturnal  rodent  capture  rate  (r=0.670,  p<0.05)  and the  higher  the  indirect  hemagglutination  assay  (IHA) positive rate of M. unguiculatus (r=0.344, p<0.05); the higher  the  percentage  of  hosts  infected,  the  lower  the M. unguiculatus  density  (r=–0.361,  p<0.05)  and  the lower  the  IHA  positive  rate  of  M. unguiculatus (r=–0.337, p<0.05); the higher the percentage of nests infected  with  fleas,  the  lower  the  IHA positive  rate  of M. unguiculatus  (r=–0.348,  p<0.05).  Together,  these results  suggest  that  it  is  necessary  to  simultaneously monitor  the  pathogens,  serology,  and  vector  index  of M. unguiculatus  to  accurately  reflect  the  plague prevalence  among  local  animals.  Although  bubonic plague is  the  main plague type of  the M. unguiculatus plague focus, severe pneumonic plague or septic plague may  be  secondary  when  the  bubonic  plague  is misdiagnosed  or  not  treated  in  time.  In  addition,  the plague  in  animals  is  relatively  virulent  in  the  M. unguiculatus plague focus, and the risk of spreading to humans  is  higher.  For  plague  in  the  Inner  Mongolia Autonomous  Region,  comprehensive  control  efforts should be aimed at the M. unguiculatus focus, covering host animals, vector insects, and humans.

china cdc weekly

Epidemiological Characteristics of Plague in the &lt;em&gt;Meriones unguiculatus&lt;/em&gt; Plague Focus — Inner Mongolia Autonomous Region, China, 1950−2019