Since early September, at least 33 people have died and over 200 more have been infected in a plague outbreak in Madagascar. We covered the initial outbreak here.

Different: Bubonic and pneumonic, urban location

Plague is endemic to Madagascar and with the peak number of infections between August and November. A ‘normal’ outbreak sees around 400 cases over the course of the year. It is also primarily bubonic plague, and occurs in remote, mountainous areas.

This outbreak is different. It features both bubonic and pneumonic plague. WHO reports that as of October 3rd, ‘124 cases and 21 deaths (case fatality rate 16.9%) had the pneumonic form of the disease.’

It is occurring in more populated areas, including the capital Antananarivo, the coastal cities of Toamasina and Mahajanga, and seven other cities. WHO spokesman Christian Lindmeier warned that its presence in urban areas could lead to a wider and faster spread of infection.

Travel advice

The Canadian Government offers this advice if you are headed to Madagascar –

If you plan to travel to Madasgascar, it is recommended that you:

  • Protect yourself from flea bites while travelling.
  • Avoid rodent’s nests and burrows.
  • Do not pick up or touch dead animals.
  • Avoid exposure to persons suspected of infection with pneumonic plague.

Seek medical attention if you develop a fever while in Madagascar or within a week of your departure from Madagascar. For more information see the updates on the plague.

Please click here to read the rest of the advice.

Patient zero?

Late last month, the WHO gave some background on the first patient to die in the outbreak

 …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.

At least four people who made direct or indirect contact with him later became ill and died.

Seychellois coach dead, events cancelled

A basketball coach from the Seychelles died after contracting the disease. He and his team were taking part in the Indian Ocean Club championship. A South African basketball official has been confirmed as infected and all other participants are being monitored.

The universities of Toamasina and Antananarivo have been closed to try to limit further spread. Public events have been cancelled. Air Seychelles has cancelled flights between the two countries.

Research helps explain why the plague keeps occurring

A very interesting read from Cosmos looks at recent papers exploring plague outbreaks in Madagascar. In one of them, scientists identified different strains of the plague and found that, while these 18 different strains might be transmitted from one region to another, ‘seldom if ever established a new territory.’ Because no single strain is dominant, so it is harder to find a single treatment and solution.

If you are interested in the topic, the article mentions several other pieces of research and is well worth a read.

Sources – 

 

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