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PLoS Negl Trop Dis. 2018 Aug 16;12(8):e0006635. doi: 10.1371/journal.pntd.0006635. eCollection 2018 Aug.

Human plague associated with Tibetan sheep originates in marmots.

Dai R1, Wei B1, Xiong H1, Yang X1, Peng Y2,3,4, He J1, Jin J1, Wang Y2,3,4, Zha X5, Zhang Z2,3,4, Liang Y2,3,4, Zhang Q1, Xu J2,3,4, Wang Z1, Li W2,3,4.

Author information

Qinghai Institute for Endemic Disease Control and Prevention, Xining, China.
National Institute for Communicable Disease Control and Prevention, China CDC, Changping, Beijing, China.
State Key Laboratory of Infectious Disease Prevention and Control, Beijing, China.
Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, Hangzhou, China.
Center for Disease Control and Prevention of Tibet Autonomous Region, Lhasa, China.


The Qinghai-Tibet plateau is a natural plague focus and is the largest such focus in China. In this area, while Marmota himalayana is the primary host, a total of 18 human plague outbreaks associated with Tibetan sheep (78 cases with 47 deaths) have been reported on the Qinghai-Tibet plateau since 1956. All of the index infectious cases had an exposure history of slaughtering or skinning diseased or dead Tibetan sheep. In this study, we sequenced and compared 38 strains of Yersinia pestis isolated from different hosts, including humans, Tibetan sheep, and M. himalayana. Phylogenetic relationships were reconstructed based on genome-wide single-nucleotide polymorphisms identified from our isolates and reference strains. The phylogenetic relationships illustrated in our study, together with the finding that the Tibetan sheep plague clearly lagged behind the M. himalayana plague, and a previous study that identified the Tibetan sheep as a plague reservoir with high susceptibility and moderate sensitivity, indicated that the human plague was transmitted from Tibetan sheep, while the Tibetan sheep plague originated from marmots. Tibetan sheep may encounter this infection by contact with dead rodents or through being bitten by fleas originating from M. himalayana during local epizootics.

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