In a follow-up on the plague outbreak in Madagascar, a total of 73 cases (suspected, probable and confirmed) of pneumonic plague, including 17 deaths (case fatality rate 23.3%) have been reported from August 1 through Sep 30, 2017.

Oriental rat flea, Xenopsylla cheopis/CDC

The 73 pneumonic cases are geographically spread across nine districts, with the capital Antananarivo (27 cases, 7 deaths) being the most affected, followed by the port city of Toamasina (18 cases, 5 deaths), and the rural district of Faratsiho (13 cases, 1 death).

In addition, 58 cases of bubonic plague, including seven deaths, have been reported throughout the country. One case of septicemic plague has also been identified. Collectively, 133 cases and 24 deaths (case fatality rate 18.3%) have been reported from 14 central, east and northern districts.

Plague is endemic in Madagascar, especially in the central highlands, where a seasonal upsurge (predominantly the bubonic form) occurs each year, usually between August and September. Although the occurrence of the pneumonic form of the disease during the seasonal surge is usually expected, the current outbreak affecting major urban centres is unusual and concerning.