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International Notes Update: Human Plague -- India, 1994

During August 26-October 5, 1994, a total of 5150 suspected pneumonic or bubonic plague cases and 53 deaths were reported from eight states of India, primarily in the south-central and southwestern regions. Of the 5150 cases, 2793 (54.2%) were reported from Maharashtra state (including Bombay), 1391 (27.0%) from Gujarat state (including the city of Surat), 749 (14.5%) from Delhi, and 169 (3.3%) from the states of Andhar Pradesh, Haryana, Madhya Pradesh, Rajasthan, Uttar Pradesh, and West Bengal (including Calcutta). As of October 5, a total of 167 (3.2%) of these cases were confirmed by serology. Confirmed cases were reported from Delhi (44 cases); Gujarat (35 cases); Maharashtra (79 cases); and Haryana, Madhya Pradesh, and Uttar Pradesh (9 cases). Of the 53 deaths (crude case-fatality ratio=1.0%), 49 (92.5%) were reported from Surat.

As of October 5, no imported plague cases have been detected in other countries. No plague cases have 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: During 1970-1991, 296 laboratory-confirmed plague cases (295 indigenously acquired and one imported) were reported in the United States, with a case-fatality ratio of 14.5% (1). Reliable data about the plague outbreaks in India are unavailable, and case criteria have not been described. However, the low reported crude case-fatality ratio suggests that 1) many suspected plague cases were not true cases, 2) deaths were underreported, or 3) antibiotic treatment was administered promptly in virtually all cases.

Travelers to India and other plague-endemic countries are at low risk for infection with Yersinia pestis. Because of the potential for importation of plague into the United States, CDC has intensified surveillance at international ports of entry. Under a protocol implemented by CDC, the Immigration and Naturalization Service, and the U.S. Customs Service, persons traveling by air from India to the United States are now being provided written information about the symptoms of plague and the need to seek prompt medical attention if symptoms occur. Under international health regulations (2), air passengers who have an illness suspected to be plague (i.e., based on clinical presentation and travel history) during a flight or at disembarkation are subject to isolation and transfer to an appropriate diagnostic and treatment facility. As of October 5, CDC has evaluated for plague three air passengers who disembarked in the United States; none was found to have plague. If importation of plague into the United States should occur, the potential for epidemic spread is low (1,3).

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). Additional information about plague is available to physicians and the general public from the CDC Voice Information System, telephone (404) 332-4555, and to physicians, public health officials, and laboratory personnel from CDC's Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, telephone (303) 221-6453.

References

  1. Craven RB, Maupin GO, Beard ML, Quan TJ, Barnes AM. Reported cases of human plague infections in the United States, 1970-1991. J Med Entomol 1993;30:758-61.

  2. World Health Organization. International health regulations. 3rd annotated ed. Geneva: World Health Organization, 1983:26-9.

  3. CDC. Human plague -- India, 1994. MMWR 1994;43:689-91.

+------------------------------------------------------------------- -------+ |             | | Erratum: Vol. 43, No. 39 | |             | | SOURCE: MMWR 43(41);763 DATE: Oct 21, 1994 | |             | | In the article "Update: Human Plague -- India, 1994", on page | | 723, in the second paragraph of the editorial note, the fourth | | sentence should read "Under federal foreign quarantine regulations | | (2), air passengers who have an illness suspected to be plague | | (i.e., based on clinical presentation and travel history) during a | | flight or at disembarkation are subject to isolation and transfer | | to an appropriate diagnostic and treatment facility." The reference | | cited in the sentence should be "2. Office of the Federal Register. | | Code of federal regulations: foreign quarantine. Washington, DC: | | Office of the Federal Register, National Archives and Records | | Administration, 1993. (42 CFR Part 71)." | |             | +------------------------------------------------------------------- -------+

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