The World Health Organisation has reported on a new outbreak of pneumonic plague in Madagascar. Between 27th August and 14th of September, 28 cases of infection were reported and five of those people had died. The primary case is thought to have been a young man from Tamatave who was travelling Ankazobe District to Tamatave, via the capital Antananarivo.

Last year, an outbreak of bubonic plague killed at least 31 people in the country.

For information from the CDC on the plague, its different forms, diagnosis and treatment, please click here.

From the WHO Weekly Bulletin on Outbreaks and Other Emergencies, Week 37: 9-15 Sept 2017

Plague – Madagascar

On 13 September 2017, the WHO was notified of an outbreak of pulmonary plague in Madagascar. The outbreak was detected on 11 September 2017 following the notification of the death of 47-year-old woman from Fort Duchesne, admitted to Soavinandriana Hospital with respiratory disease. After confirmation that the cause of illness and death was pneumonic plague, the Directorate of Health Surveillance and Epidemiological Surveillance (DVSSE) immediately launched field investigations.

These investigations revealed that the primary case was likely to have been a 31-year-old male from Tamatave (a.k.a. Toamasina) on the east coast, visiting Ankazobe District in the Central Highlands (Hauts-Plateaux) – a plague endemic area. He developed malaria-like symptoms in mid-August, and during his journey in a bush-taxi from Ankazobe District to Tamatave (via Antananarivo) on 27 August 2017, he developed severe respiratory symptoms and died. After preservation of the body at Moramanga District Hospital, he was buried in a village close to Tamatave. Subsequently, 27 other individuals became ill – all cases either had direct contact with the primary case or other epidemiologic links.

As of 14 September 2017, a total of 28 cases, including five deaths (case fatality rate 17.8%) have been reported since the initial case was detected on 27 August 2017. Two cases have been confirmed by rapid diagnostic test (RDT) at the Institut Pasteur de Madagascar (IPM). Thus far the outbreak is localized in Tamatave and Faratsiho in Vakinankaratra Region (100km southwest of Antananarivo).

Public health actions

  • The Ministry of Public Health is coordinating the response to the outbreak by conducting field investigations and contact tracing in all the main affected areas. Active case search for cases is ongoing.
  • Chemoprophylaxis has been provided to all the contacts of confirmed and suspected cases.
  • Information on pneumonic plague has been distributed to the health professionals to improve the case management.
  • Technical support for testing and analysis is being provided by IPM.
  • Awareness campaigns are being conducted through the community to sensitize those affected on plague, and prevention methods.
  • Houses of all the identified cases and close contacts in Antananarivo have been sprayed with insecticides.
  • Recommendations to follow proper burial procedures for all suspected and confirmed cases have been provided.

Situation interpretation

Plague is endemic in Madagascar and cases are reported nearly every year between the months of September and April. The last outbreak was from August 2016 to January 2017. These epidemics usually provoke fear in the communities, which in turn leads to communities indiscriminately obtaining over-the-counter prophylactic antibiotics directly from pharmacies. Other people wear masks to protect themselves. These exaggerated behaviours stigmatise cases and their relatives, and could promote antimicrobial resistance. More measures need to be put in place to educate the communities on appropriate preventive measures. Focus should be on hygiene promotion in surrounding areas. Plague is only severe when not properly treated. Due to low effectiveness, vaccines against pneumonic plague are not recommended, except in high-risk groups.

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