The death toll in the endemic Madagascar plague has risen to 124. Of the reported cases of the plague in Madagascar, 67%, were of the pneumonic form of the disease, which can spread from person to person.
Pneumonic plague is an advanced form of plague characterized by a severe lung infection that can be transmitted from person to person via airborne droplets e.g. through coughing or sneezing. The incubation period is short, and an infected person may die within 12 to 24 hours but if detected early can be easily and successfully treated with antibiotics.
The risk of plague is highest in areas that have poor sanitation, overcrowding, and a large population of rodents. In medieval times, the plague, or “black death,” was responsible for the deaths of millions of people in Europe. Today, there are only 1,000 to 2,000 cases reported worldwide each year, with the highest incidences in Africa.
Madagascar plague crisis
The plague is endemic to Madagascar, with an estimated 400 cases reported there every year, mostly the bubonic variety, but the current outbreak has affected more areas and started earlier than usual. It’s also unusual for large urban areas to be affected, as they have been this year, the WHO previously told CNN this meant health authorities weren’t ready, thus fuelling a rapid spread of the disease, according to Dr. Charlotte Ndiaye, WHO representative in Madagascar.
Typically, outbreaks occur during the rainy season, between November and March. “The rains drive the rodents out,” said Daniel Bausch, director of the UK Public Health Rapid Support Team, which also explains why cases are usually the bubonic form. But this year, cases began three months early, in August, after the death of a man in the central highlands of the country, a plague-endemic area.
Since then 40 of Madagascar’s 114 districts, have reported cases of pneumonic plague and less than 30% of people who have had contact with cases can be traced, according to the UN office. Cases have been reported in at least 10 cities, including the the larger, more populated, cities of Antananarivo and Toamasina.
Out of the reported cases 780 individuals have been cured of their infection since August 1 and six of the affected districts have not reported new cases for 15 days, the UN report states.
Dr. Charlotte also told CNN that about half the deaths are occurring in the community, not health centers, according to government figures, which demonstrates that more work needs to be done to help people understand that treatment is available, and they need to get health services as quickly as possible.
The government has mobilized resources to spray schools and other public places as a way to fight fleas and rodents and curb the spread of infection. People have been lining up at pharmacies in the capital to get medication and or protection. Additionally public schools are closed and the government has forbidden public gatherings, according to the International Federation of the Red Cross (IFRC)
“The international community is taking this very seriously,” said Daniel Bausch, director of the UK Public Health Rapid Support Team. Launched in 2016, this team consists of clinicians, scientists and academics deployed to tackle outbreaks of disease around the world within 48 hours.
WHO stated in its most recent situation report that the risk of regional spread is moderate due to neighboring islands and southern and east African countries. “The risk of international spread is low, because generally, people with plague are too sick to travel,” Dr. Charlotte Ndiaye, said in a CNN report. She explained that WHO is working closely with Madagascar’s airport authorities to ensure control measures, such as temperature checks and medical teams, are in place at airports and ports to prevent the spread of infection outside the country.
“Nine countries and overseas territories have been identified as priority countries in the African region for plague preparedness and readiness by virtue of having trade and travel links to Madagascar. These countries and overseas territories include Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La Réunion (France), Seychelles, South Africa, and Tanzania,” she added.