Box 12
Follow-up Activities in the Aftermath of the 1994 Plague Outbreak in India

In September, 1994, rumored outbreaks of bubonic and pneumonic plague in western India caused widespread panic and extensive disruptions in international travel and trade. The Indian Ministry of Health authorized an investigation by a WHO international team that included scientists from CDC, the Russian Federation, and by the WHO South East Asia Regional Office. The work of this team was severely compromised by the inability of Indian laboratories to confirm plague cases by using standard diagnostic methods.

The lack of diagnostic capabilities arose because the Indian Ministry of Health, a former world leader in plague vaccines and diagnosis, believing that plague no longer existed in the country, had allowed its laboratory diagnostic infrastructure to deteriorate. At the suggestion of WHO, the government of India invited CDC team members to return to conduct field training exercises with Indian epidemiologists and hold workshops in plague microbiology at India’s National Institute for Communicable Diseases (NICD). Later that year, microbiologists from NICD, the All-India Institute of Medical Science, and the Haffkine Institute in Bombay came to CDC’s laboratory in Fort Collins, Colorado, as visiting scientists to learn techniques for confirming infection with Yersinia pestis (the causative agent of plague), procedures for preparing standardized diagnostic reagents, and new and advanced molecular methods for identifying and characterizing Y. pestis strains.

The relationships that developed among U.S. and Indian scientists during the 1994 outbreak and subsequent collaborations had lasting scientific and diplomatic effects. During the Cold War, India had maintained few contacts with the U.S. public health community, preferring to collaborate with Russian health officials, who (up until 1989) had sent regular shipments of plague diagnostic reagents to NICD. After 1994, however, India was more open to public health collaboration with the United States. For example, the Indian Ministry of Health worked closely with CDC when it renovated and modernized its national plague laboratory during the late 1990s, and also when it reorganized and computerized its national communicable disease surveillance system. The Indian Ministry of Health also played an active role in two regional and two global workshops on plague organized by WHO and CDC between 1996 and 2000.

International contacts made during the 1994 plague outbreak also led to working relationships with the Kazakh Institute for Research on Plague Control in Almaty, Kazakhstan, the Chinese Academy of Preventive Medicine in Beijing, and the Institute of Endemic Diseases Control and Research in Yunnan, China.

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