Plague in Madagascar Update (6)
19 Dec 2017
On 15 December 2017, the World Health Organisation (WHO) 
reported the number of new cases of plague in Madagascar continues to decline. In the week ending 10 December 2017, 33 new cases (including 4 deaths) were reported, compared to 89 cases and no deaths in the week before. The date of onset of the last confirmed bubonic case was 5 December 2017 and that of the last confirmed pneumonic case was 3 December 2017.
From 1 August to 10 December 2017, a total of 2 575 cases of plague (including 221 deaths) have been reported from 58 out of 114 districts in the country. Of these cases, 1 985 (77%) were classified as pulmonary (pneumonic) plague, 377 (15%) were bubonic plague, 1 was septicaemic and 212 were unclassified.
The Analamanga Region has been the most affected in the week ending 10 December, with 82% (27/33) of reported cases.
Advice for Travellers
Plague is rare in international travellers.
- Travellers visiting areas where plague occurs, or where there is an outbreak should be aware of the risk of infection.
- The risk may be highest in those who are camping, staying in very basic rural accommodation, hunting or who may have close contact with wildlife, particularly rats or other rodents.
- Contact with infected people during an outbreak is also a significant risk.
- Three types of plague occur, all caused by the same bacterium, Yersinia pestis.
- Bubonic plague spreads from animals to humans by flea bites or other skin penetration, so travellers should practice good insect bite avoidance. Close contact with sick or dead animals should be avoided.
- People become infected with pneumonic plague by breathing in plague bacteria in droplets coughed into the air by a person (or animal) already infected. Pneumonic plague is the most contagious form of the disease.
- Septicaemic plague can develop from the other forms of the disease when plague bacteria multiply in the blood and spread throughout the body.
No vaccine is available for plague. The most effective form of prevention is to avoid exposure to infected people or animals. If there is a possibility that a traveller has been exposed to plague, it is important to seek prompt medical attention as soon as possible. Progression of the disease may be prevented with appropriate antibiotic treatment.
Anyone experiencing rapidly progressing fever, chills, headache, weakness, respiratory symptoms, chest pain or swollen lymph nodes should seek prompt medical attention.