A fourth person was near death in Ziketan, a remote town of 10,000 people in a Tibetan area of Qinghai province, the official Xinhua news agency said.

Another patient was in serious condition and seven others were infected, most of them relatives of the first fatality, a 32-year-old herdsman.

Local authorities have quarantined the town, which is about 200 kilometres (125 miles) southwest of the provincial capital Xining, and its vicinity but some people were trying to flee, residents said.

"Some of my hometown folks left, they are afraid of pneumonic plague," said a businessman who works in the town but hails from neighbouring Sichuan province.

"There are checkpoints in the street and the roads are strictly controlled so they can only leave on foot," the man, who refused to give his name, told AFP by telephone.

"I heard many migrant workers have left, they may go back to their hometowns," he said.

"Those who left without permission lack responsibility. I will not leave."

It was not clear whether any people had managed to breach the quarantine zone, and calls to the local police went unanswered.

Residents said Ziketan resembled a ghost town, with most of the shops shuttered and people staying at home.

"My shop is closed. Most of the shops in the street are closed, especially the supermarket and big shops, leaving just the small vegetable shops," a local vendor told AFP.

"There are few people in the street and people try to avoid going out," he said.

"Some families, including my friends, have left to take refuge, most of them are going back to their hometowns in this county."

Medical staff have been disinfecting the region and tracking down people who have been in close contact with plague patients, Xinhua said.

"In some places, the doctor will enter houses to check" on people, a local businessman told AFP.

"My business is affected, I've had very few clients recently."

Vivian Tan, a spokeswoman for the World Health Organization in Beijing, said there was no real need to stop people leaving the town if steps such as hospitalising patients, tracing their contacts and raising public awareness of what to do with suspected cases were in place.

"As long as these basic measures are taken there really shouldn't be anything stopping people from leaving or from moving freely," she told AFP.

"Ultimately, it's up to the local authorities to take what measures they think are best for the situation," she said in response to reports the town had been quarantined.

Pneumonic plague spreads through the air, making it easier to contract than bubonic plague, which requires that a person is bitten by an infected flea.

The WHO says pneumonic plague is the most virulent but least common form of plague. The mortality rate is high and patients can die 24 hours after infection without treatment with antibiotics.

earlier related report
China plague toll rises to three: report
The death toll from an outbreak of pneumonic plague in northwest China has risen to three, state media reported Tuesday as authorities maintained a quarantine lockdown on a town of 10,000 people.

The latest victim was a 64-year-old man who died Monday in Ziketan, a remote town in a Tibetan area of Qinghai province where two fatalities had previously been reported, the Global Times said.

At least nine other people were infected with the highly virulent disease -- most of them relatives of the first fatality, a 32-year-old herdsman, reports said, quoting local health authorities.

Qinghai provincial health authorities refused to comment when contacted by AFP Tuesday.

Ziketan, which is about 200 kilometres (125 miles) southwest of the provincial capital Xining, had enough supplies to get by on its own for the time being, the official Xinhua news agency said.

Health authorities were urging people who had visited Ziketan on or after July 16 to seek immediate help if they developed a cough or fever.

Medical staff were tracking down people who had been in close contact with the patients but there had been no reports of new infections, Xinhua said.

Late Tuesday a fourth patient was said to be near death in Ziketan while another was in a serious condition, Xinhua reported, citing health authorities.

The World Health Organization said the outbreak was a concern but hoped it could be contained as previous outbreaks in the same area had been in recent years.

"It's definitely a concern because this is probably the most lethal form of plague there is," WHO spokeswoman Vivian Tan told AFP in Beijing.

"But it is happening in a remote area of the country and the authorities seem to be taking the right measures so it's probably too soon to say how serious the situation is."

Tan said the bacteria which causes the plague is endemic in some rodents in the region.

"If the fleas from those animals do bite human beings they could lead to the bubonic plague, which is more common, and if that is left untreated it could sometimes lead to the pneumonic plague which we're seeing in Qinghai at the moment," she said.

However, Tan said there had been no reports of bubonic plague in the region, and the cause of the outbreak was unclear.

"At this point the authorities are still investigating so we can't really pinpoint the source of the problem," she said.

The vast high-altitude area is sparsely inhabited, mainly by Tibetan herders.

Plague in the region is mainly due to the handling of carcasses of infected rodents such as marmots, which are hunted for food and fur, the WHO says.

Pneumonic plague spreads through the air, making it easier to contract than bubonic plague, which requires that a person is bitten by an infected flea.

The WHO says pneumonic plague is the most virulent but least common form of plague. The mortality rate is high and patients can die 24 hours after infection.

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