Plague Outbreak Strikes Madagascar – Health Risks

• At least 54 people have died and 500 have been infected since an outbreak of plague started in August 2017.
• Further cases of the plague are expected to occur.
• The World Health Organisation have stepped up their response to the outbreak.

Health: At least 54 people have been killed and a further 500 have been infected as a plague outbreak has struck the African island nation of Madagascar. The country is suffering from both the bubonic plague and pneumonic plague. About 70 per cent of the cases that have been registered are the pneumonic form of the disease. At present, the fatality rate is just over 11 per cent. At least eight health workers have contracted the disease.

This outbreak of the plague began after a single death in the town of Ankazobe; the disease has since spread nationwide, with urban areas facing an unusual level of impact.

Plague is an infectious disease which can become severe if left untreated. However, if diagnosed early, it can usually be treated with antibiotics and general care. If untreated, the fatality rate is between 30 and 100 per cent depending on outbreak. Plague is transmitted between animals and humans by the bite of infected fleas, direct contact with infected tissues, and inhalation of infected respiratory droplets. There are three forms of plague, depending on the route of infection: bubonic, septicaemic, and pneumonic. Bubonic plague, the most common form, cannot be passed from human to human. Pneumonic is the deadliest and most rapid form of the plague. It can be transmitted person to person via droplets in the air. Septicaemic plague is spread through the bloodstream. For example, if bacteria enters through a cut on a person’s skin. Symptoms for the plague are flu-like, including, fever, chills, body aches, nausea, vomiting, and swelling of the lymph nodes in the groin, neck, or armpits. Unlike the ebola crisis of 2014 in West Africa, it is believed that this outbreak of the plague is manageable; because there are known and proven treatment options, particularly if the disease is caught early.

In the Middle Ages, the plague (known as the Black Death) claimed the lives of an estimated 50 million people across Europe, around 45 to 50 per cent of the population at the time. Between 2010 and 2015, 3248 people were reported to have been infected with the disease worldwide, of which 584 died. Plague is most common in Madagascar (where around 80 per cent of the annual cases occur), Democratic Republic of Congo, and Peru, but there is the potential that outbreaks will occur outside of these nations.

Plague is endemic to Madagascar, where typically around 400 cases occur each year. While outbreaks can occur year-round, they are more common between September and April, and are usually confined to the rural central highlands, with most cases spread by fleas which bite rats. The most common form is usually the less deadly bubonic plague. This latest outbreak has concerningly impacted urban areas, including the capital city Antananarivo, and seen a majority of cases of the more severe pneumonic strain of plague. In the 2014 outbreak in Madagascar, 40 people died from 119 confirmed cases of both bubonic and pneumonic plague. Most of the cases occurred in the Madagascan countryside.

All public gatherings have been banned and schools closed in Madagascar as public health measures. The World Health Organisation (WHO) has sent 1.2 million doses of antibiotics, with more expected soon, to treat the current outbreak and to prevent it from spreading. The WHO has also released US$1.5 million in emergency funding but has requested a total of US$5.5 million to effectively respond to the outbreak. The local Red Cross has mobilised 700 volunteers to monitor the outbreak and provide community education. Medicines Sans Frontiers and other medical aid groups have also sent personnel to assist Madagascan authorities.

The risk of this outbreak spreading internationally is low, partly thanks to Madagascar’s position as an island nation. However, one person has been confirmed as infected in the island nation of Seychelles after returning from Madagascar. The Seychelles authorities were quick to isolate the patient and provide treatment to those with whom he had contact and monitor 42 others who have recently visited Madagascar.