Severe outbreak of Pneumonic Plague in Madagascar

Pneumonic plague has been detected in several cities in Madagascar, WHO reports. This form of plague is highly transmissible (person-to-person) and quickly causes death without treatment. At least 19 people have died since August 27.

WHO is concerned that the outbreak may spread because it is already present in several cities and this is just the start of the plague epidemic season, which usually runs from September to April.

Plague is endemic to Madagascar but contrary to past outbreaks, this one affects large urban areas, including the capital and port cities.

The overall risk of further spread at the national level is high, at the regional level is moderate due to frequent flights to neighboring Indian Ocean islands, and at the global level is perceived to be low.

The outbreak is affecting the densely populated cities in Madagascar that include capital Antananarivo/Analamanga with 3 724 021 inhabitants, Tamatave/Atsinanana with 1 412 021 inhabitants, Majunga/Boeny with 889 277 inhabitants, and Finanrantsoa/Haut Matsuartra with 1 333 550 inhabitants.

Eight regions have reported cases including Sava, Boeni and Atsinanana. These coastal regions are non-endemic areas for bubonic plague. Many of the cases identified are directly or indirectly linked to the first recognized case, which is evidence of person-to-person transmission of pneumonic plague.

“Urgent public health response is required and support is needed to strengthen capacities already available at country level to control the outbreak,” WHO said.

According to WHO, on August 23, a 31-year-old male from Tamatave, visiting Ankazobe District in central highlands, developed malaria-like symptoms. On August 27, he developed respiratory symptoms during his journey in a shared public taxi from Ankazobe District to Tamatave (via Antananarivo). His condition worsened and he died. His body was prepared for a funeral at the nearest hospital, Moramanga District Hospital, without safety procedures. Additionally, 31 people who came into contact with this case either through direct contact with the primary case or had other epidemiological links, became ill, and four cases of them died.

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