Historical Background/Periodical Development
Plague, caused by a bacterium called Yersinia pestis, is transmitted from rodent to rodent by infected fleas.

Plague is characterized by periodic disease outbreaks in rodent populations, some of which have a high death rate. During these outbreaks, hungry infected fleas that have lost their normal hosts seek other sources of blood, thus increasing the increased risk to humans and other animals frequenting the area.

Ancient Disease
Plague is an ancient disease that is not likely to disappear, its continued outbreaks throughout the world attest to its tenacious presence. Since the first descriptions, many studies have examined the transmission, epidemiology and pathogenesis of the disease (Gage, 1998). Plague is a bacterial infection of small mammals transmitted from animal to animal by the bite of infected fleas. Plague cycles naturally in its enzootic foci, circulating between small mammals and fleas without human involvement. The quiescent periods, during which few or no human cases are detected, may last for years, leading to mistaken declarations of plague eradication. However long the silent periods last, plague may suddenly reappear. The combination of false assurance of its eradication, and the failure of public health vigilance, sets the stage for the panic that may ensue when enzootic plague spills over from its natural cycle into the peridomestic and commensal rodent populations (and their fleas), bringing plague into closer human contact. Poor sanitation, overcrowding and high numbers of rodents are conditions that enhance urban plague transmission. Thus, a plague outbreak has come to represent an indictment of social, environmental and political changes in the modern world.

Perspective and history: Plague has a remarkable place in history. For centuries, plague represented disaster for those living in Asia, Africa and Europe, where, it has been said, populations were so affected that sometimes there were not enough people left alive to bury the dead (Gross, 1995). Because the cause of plague was unknown, plague outbreaks contributed to massive panic in cities and countries where it appeared. The disease was believed to be delivered upon the people by the displeasure of the gods, by other supernatural powers or, by heavenly disturbance.

Innocent groups of people were blamed for spreading plague and were persecuted by the panicked masses. Numerous references in art, literature and monuments attest to the horrors and devastation of past plague epidemics. So imprinted in our minds is the fear of plague that, even now, entering into the 21st century, a suspected plague outbreak can incite mass panic and bring much of the world's economy to a temporary standstill. The number of human plague infections is low when compared to diseases caused by other agents, yet plague invokes an intense, irrational fear, disproportionate to its transmission potential in the post-antibiotic/vaccination era.

In Maharashtra State, Plague surveillance unit is established in the year 1953. Since establishment, regular Plague survey is carried out in Plague prone areas. But till 1987, no confirmed case of plague was detected and hence the plague unit was abolished from 1th December 1987.

During August and September 1994, there was suspected outbreak of Plague in village Mamla of District Beed. Total 634 serologically positive cases from all over State were reported. Therefor, Plague Surveillance Unit is reestablished from 3rd October 1994 and is functioning under Joint Director Of Health Services, (M&F), Pune till to date. Infrastructure of State and staffing pattern of Plague Surveillance Unit is given in Annexure I & II respectively.
Activities
Routine anti flea & Anti Rodent measures
Regular Surveillance
Plague surveillance unit is regularly doing surveillance activity in plague prone areas & in those district which reports high flea nuisance in the State.

Nature Of Surveillance Work

• Domestic rodents are collected by setting wonder traps in the houses.
• Wild rodents are collected by digging the burrows in the field.
• The samples of rodents organs, blood sera, organ smears and rodents fleas are collected and same are being sent to NICD Bangalore for serological and bacteriological investigation.

Control measures undertaken

• On the basis of the finding of the plague surveillance unit, the following measures are adopted for control of fleas, rodents & suspected plague cases.
• The dusting of Malathion 5% is carried out in 32000 high risk population of Beed & Osmanabad district to control the fleas.
• The sufficient stock of essential medicines such as Tetracycline, Septran is made available at 21 plague prone districts.
• The Malathion 5% is also made available for dusting at 6 High Risk districts.
• Re orientation of Health Workers during monthly meetings & visits.
• Health Education.
• Due to all above effective measures, not a single case of plague and rat–fall was noticed in the State since 1995.

Performance – District Wise
1994–Plague Outbreak
Districtwise Distribution of Suspected Plague Cases

Sr. No	District	Suspected Plague Cases	Seropositive Plague Cases
1	Raigad	2	2
2	Ratnagiri	0	0
3	Thane	93	0
4	Ahmednagar	14	6
5	Dhule	100	14
6	Jalgaon	393	76
7	Nasik	151	48
8	Pune	19	38
9	Solapur	90	45
10	Satara	51	8
11	Kolhapur	51	12
12	Sangli	31	16
13	Sindhudurg	5	1
14	Aurangabad	120	85
15	Beed	709	97
16	Jalna	47	9
17	Nanded	134	27
18	Latur	292	62
19	Osmanabad	170	8
20	Parbhani	334	1
21	Akola	161	52
22	Amaravati	101	7
23	Buldhana	77	20
24	Yawatmal	42	0
25	Bhandara	23	0
26	Chandrapur	2	0
27	Gadchiroli	1	0
28	Nagpur	66	0
29	Wardha	4	0
30	Mumbai	418	0
Total		3701	634

Seropositive Plague Cases in 1994

Sr. No.	Age Group	Male	Female	Total
1	< 5 yrs	27	23	50
2	5–14 yrs	128	49	177
3	15–24 yrs	80	27	107
4	25–34 yrs	63	41	104
5	35–44 yrs	17	14	31
6	45–54 yrs	11	9	20
7	> 55 yrs	7	5	12
8	Not known	82	51	133
Total		415	219	634