Plague in India posed little threat to U.S. public health.

Recent outbreaks or bubonic and pneumonic plague in India posed little threat to public health in the United States, according to CDC officials. Nonetheless, the agency took important measures to prevent the introduction of the disease into the United States.

Dr. Peg Tipple, Division of Quarantine (DQ), National Center for Preventive Services, said the agency increased surveillance at international ports of entry in Seattle, Miami, Chicago, New York, Los Angeles, Honolulu, and San Francisco. "DQ staff at ports of entry worked closely with the airlines to assure that flights carrying visitors from India and returning from India were evaluated upon their arrival in the States," said Dr. Tipple, "If someone showed symptoms suggestive of plague, they were examined by a physician, and if they had the plague they were to be quarantined until they received adequate treatment." Plague alert notices were handed out to passengers flying in from India to these airports. No plague cases have been reported in the United States as a result of the situation in India.

CDC distributed detailed information about the plague outbreak to state, county, and local public health officials, apprising them of the procedures for identification, diagnosis, and treatment. CDC also established a voice Information Hotline [phone]) for physicians, international travelers, and private citizens who are interested in the latest information on the plague outbreak. Dottie Knight, Informations Resources Management Office, said 5,344 callers used the direct number to respond to the outbreak between September 26 and October 12 (1994). A total of 3,418 messages were faxed about the plague in India, in addition to the 897 faxed messages about drugs to treat plague.

Most human plague is the bubonic form, which results from the bites of infected fleas; however, plague can also be transmitted to humans by handling infected animals or inhaling airborne droplets from the coughs of people with pneumonic plague. Both forms of the plague are caused by infection with the bacterium Yersinia pestis, carried by rodents and their fleas. The incubation period is 2 to 7 days and the illness is characterized by rapid onset of fever, chills, headache, generalized aches and pains, and extreme exhaustion. Plague is readily treatable with antibiotics, but the death rate from untreated cases can exceed 50% to 60%.

"Person-to-person spread of pneumonic plague requires close contact with a patient who is actively coughing," said Duane Gubler, National Center for Infectious Diseases. "The large infectious droplets expelled by plague patients during coughing can only travel short distances. Plague bacilli (the germ that causes the plague) are killed by light and drying out." Only a handful of plague cases occur each year in the United States, and all of those occur out west where people are more likely to come into contact with small rodents that carry the bacteria. No person-to-person cases of pneumonic plague transmission have occurred in the United States since 1924.

The plague in India is yet another example of a reemerging infectious disease posing a threat to the health in the United States.