WHO continues to support the Ministry of Public Health and other national authorities in Madagascar to monitor and respond to the outbreak of plague. From 6 to 17 November 2017, 216 cases of plague (1 confirmed, 20 probable and 195 suspect) were reported to WHO. The date of onset of the last case of bubonic plague was 7 November 2017 and the last confirmed case of pneumonic plague was reported on 14 November 2017.
From 1 August to 17 November 2017, a cumulative total of 2 267 confirmed, probable and suspected cases of plague, including 195 deaths (case fatality rate 9%), have been reported from 55 of 114 (48%) districts in Madagascar. Analamanga Region in central Madagascar has been the most affected, with 68% of all recorded cases. Since the beginning of this outbreak, the vast majority of cases have been treated and have recovered.
The majority of the reported cases (1 732, 76%) have been clinically classified as pneumonic plague, 327 have been classified as bubonic plague (14%), one was septicemic, and 207 have not yet been classified (further classification of cases is in process). Eighty-one healthcare workers have had illness compatible with plague, none of whom have died. Of the 1 732 clinical pneumonic cases, 389 (22%) have been confirmed, 612 (35%) are probable and 731 (42%) remain suspected (additional laboratory results are in process). Thirty isolates of Yersinia pestis have been cultured and are sensitive to all antibiotics recommended by the National Plague Control Program.
The most recently confirmed case was reported on 14 November and, to date, no cases of plague have been reported outside of Madagascar. While the number of new cases and hospitalizations are declining, evidence suggests that the epidemic phase of the outbreak is ending. However, WHO anticipates plague cases to be reported until the endemic plague season ends in April 2018.
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