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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).


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

  2. CDC. Update: human plague -- India, 1994. MMWR 1994;43:722-3.

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