In a follow-up to a report last Friday on the pneumonic plague outbreak in Madagascar, the World Health Organization (WHO) offered up an updated case count and additional details surrounding the occurrence of plague on the island nation off the southeast coast of Africa.


The outbreak was detected on 11 September 2017 following the notification of the death of 47-year-old woman from Fort Duchesne, admitted to Soavinandriana Hospital with respiratory disease. After confirmation that the cause of illness and death was pneumonic plague, the Directorate of Health Surveillance and Epidemiological Surveillance (DVSSE) immediately launched field investigations.

These investigations revealed that the primary case was likely to have been a 31-year-old male from Tamatave (a.k.a. Toamasina) on the east coast, visiting Ankazobe District in the Central Highlands (Hauts-Plateaux) – a plague endemic area. He developed malaria-like symptoms in mid-August, and during his journey in a bush-taxi from Ankazobe District to Tamatave (via Antananarivo) on 27 August 2017, he developed severe respiratory symptoms and died. After preservation of the body at Moramanga District Hospital, he was buried in a village close to Tamatave. Subsequently, 27 other individuals became ill – all cases either had direct contact with the primary case or other epidemiologic links.

As of 14 September 2017, a total of 28 cases, including five deaths (case fatality rate 17.8%) have been reported since the initial case was detected on 27 August 2017. Two cases have been confirmed by rapid diagnostic test (RDT) at the Institut Pasteur de Madagascar (IPM). Thus far the outbreak is localized in Tamatave and Faratsiho in Vakinankaratra Region (100km southwest of Antananarivo).

Related: Congo, Madagascar top countries reporting most plague 2000-2009, US reports 57 cases

Plague is endemic in Madagascar and cases are reported nearly every year between the months of September and April. The last outbreak was from August 2016 to January 2017.

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LISTEN: Plague: An interview with Dr. Paul Ettestad