Authors: Martha Powell, Future Science Group
The plague outbreak in Madagascar is continuing to evolve, according to a situation update report issued by the WHO on October 9th. The report has highlighted a total of 387 plague cases (suspected, probable and confirmed) from the country since August 1st, with 230 of these occurring in the past 5 days (since October 4th).
The WHO also report that there have been 45 fatalities as a result of the outbreak, giving a case fatality rate of approximately 11.6%. In addition, it is thought that 71.6% of patients are suffering from the pneumonic form of the disease, which is considered more easily-transmitted than bubonic or septicaemic.
Plague is known to be endemic in the central highlands of Madagascar, with a seasonal outbreak (September–April) of cases, which are predominantly bubonic in nature. This year has seen an altered pattern, with an early start to the outbreak and illnesses reported in two regions considered non-endemic – the north and the southeast. Moreover the pneumonic disease has spread to major urban areas, including the capital city, Antananarivo. Overall, the risk level within Madagascar is considered very high, owing to the risk of spread and the severe nature of this disease; however, global risk is perceived to be low.
Since the outbreak the WHO has been involved in activities including establishing a multisectoral national response coordination committee and providing technical and operational support to the country. Moreover, the local government is working to put in vector-control measures for fleas and is canceling mass gatherings where plague could be spread.
With regards to travelers, for those leaving the country all departing passengers are obliged to undergo screening at international airports. For those visiting, preventative measures have been advised, for example, the European Centre for Disease Prevention and Control (Stockholm, Sweden) has advocated that travelers ensure personal protection against fleabites, avoid of dead or sick animals and are aware and alert for possible plague symptoms.
Looking forwards, the WHO has stated that there is an urgent need to establish appropriate isolation and treatment facilities, and scale up infection prevention and control measures to try and control this outbreak.