title: A cluster of primary pneumonic plague transmitted in a truck cab in a new enzootic focus in China.
abstract: We investigated a cluster of five cases of severe pneumonia from one village in Yunnan Province, China. We searched for severe pneumonia in the village and hospitals. We interviewed patients and family members about exposures. We tested acute and convalescent sera for antigen and antibody of severe acute respiratory syndrome, avian influenza, and plague. The only common exposure of the five patients was riding together in the enclosed cab of a truck for 1.5 hours while taking the first patient to the hospital. Seroconversion to plague F1 antigen confirmed plague in three survivors. Unfamiliarity of clinicians with plague and lack of sputum examination, blood culture, or postmortem examination delayed the diagnosis. No plague cases occurred among family and village contacts and health care workers. High infectivity in this cluster was limited to a crowded, poorly ventilated truck.
authors.affiliation: Chinese Field Epidemiology Training Program, Beijing, 100050, China. hmluo@vip.sina.com
authors.forename: Huiming
authors.initials: H
authors.lastname: Luo
authors.forename: Xingqi
authors.initials: X
authors.lastname: Dong
authors.forename: Furong
authors.initials: F
authors.lastname: Li
authors.forename: Xu
authors.initials: X
authors.lastname: Xie
authors.forename: Zhizhong
authors.initials: Z
authors.lastname: Song
authors.forename: Zhujun
authors.initials: Z
authors.lastname: Shao
authors.forename: Zhongjie
authors.initials: Z
authors.lastname: Li
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Tong
authors.forename: Guangfa
authors.initials: G
authors.lastname: Wang
authors.forename: Hongtao
authors.initials: H
authors.lastname: Zhang
authors.forename: Tielong
authors.initials: T
authors.lastname: Yang
authors.forename: Gao
authors.initials: G
authors.lastname: He
authors.forename: Zeyuan
authors.initials: Z
authors.lastname: He
authors.forename: Robert E
authors.initials: RE
authors.lastname: Fontaine
authors.forename: Guang
authors.initials: G
authors.lastname: Zeng
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood*; D001426:Bacterial Proteins / Q000276:immunology*; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D010930:Plague / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D015010:Yersinia pestis / Q000276:immunology*; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D001426:Bacterial Proteins; C086725:caf1 protein, Yersinia pestis