International Notes
Update: Human Plague -- India, 1994
From August 26 through October 18, 1994, a total of 693
suspected bubonic or pneumonic plague cases with positive test
results for antibodies to Yersinia pestis were reported by India to
the World Health Organization (WHO). Cases were reported from five
states (Maharashtra {488 cases}, Gujarat {77 cases}, Karnataka {46
cases}, Uttar Pradesh {10 cases}, and Madhya Pradesh {4 cases}) and
from the federal district of New Delhi (68 cases). Nationwide, 56
fatal plague cases have been reported; no deaths have been reported
since October 11.
As of October 19, WHO considered the outbreak to be under
control because few new suspected cases had been reported. In
addition, WHO continues to recommend no restrictions for travelers
visiting India. However, travelers to the city of Surat, Gujarat,
or the Beed district, Maharashtra -- areas where plague
transmission
may be ongoing -- are advised to seek medical attention for any
illness that begins within 6 days of departure.
As of October 19, no imported plague cases had been detected
in persons in other countries. No plague cases had been reported in
U.S. residents in India.
Reported by: World Health Organization, Geneva. Div of Quarantine,
National Center for Prevention Svcs; Bacterial Zoonoses Br, Div of
Vector-Borne Infectious Diseases, National Center for Infectious
Diseases, CDC.
Editorial Note
Editorial Note: The reliability of reported data about the plague
outbreaks in India is unknown, and criteria for clinical and
laboratory confirmation of cases have not been described. However,
the most recent data suggest that transmission has been more
geographically limited than previously reported (1,2). Studies have
been initiated to accurately assess the extent of the outbreaks,
their relation to persistent foci of transmission, and the clinical
spectrum and epidemiologic features of the illness, including the
incidence of person-to-person transmission.
Travelers to India and other plague-endemic countries continue
to be at low risk for infection with Y. pestis. As of October 19,
health officials had identified and evaluated 12 airline passengers
who had arrived from India with febrile or other illnesses and who
disembarked in the United States. Using similar surveillance
protocols, health officials have evaluated 40 travelers in Canada
(B. Gushulak, Laboratory Center for Disease Control, Ottawa,
personal communication, October 18, 1994) and 27 in the United
Kingdom (J. Watson, Public Health Laboratory Service Communicable
Disease Surveillance Center, London, personal communication,
October 18, 1994); none have been diagnosed with plague.
Suspected human plague cases in international travelers should
be reported through state and local health departments to CDC's
Division of Quarantine, National Center for Prevention Services,
telephone (404) 639-8107 or (404) 639-2888 (nights, Sundays, and
holidays).
References
CDC. Human plague -- India, 1994. MMWR 1994;43:689-91.
CDC. Update: human plague -- India, 1994. MMWR 1994;43:722-3.
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