WHO continues to support the Ministry of Public Health and other national authorities in Madagascar to monitor and respond to the outbreak of plague. Since mid-October 2017, there has been a decline in the overall incidence of the disease and the number of patients hospitalized due to plague infection across the country. From 7 – 8 November 2017, no new suspected cases of pulmonary plague and no new deaths have been reported in Madagascar.

Image/onestopmap via pixabay
Image/onestopmap via pixabay

From 1 August to 8 November 2017, a total of 2,034 confirmed, probable and suspected cases of plague, including 165 deaths (case fatality rate 8%), have been reported from 55 of the 114 districts in the country. Of these, 1,565 (77%) were clinically classified as pulmonary plague, 297 (15%) were bubonic plague, one was septicemic, and 171 were not yet classified (further classification of cases is in process). Since the beginning of the outbreak, 82 healthcare workers (with no deaths) have been affected.

Of the 1,565 clinical cases of pneumonic plague, 371 (24%) have been confirmed, 581 (37%) are probable and 613 (39%) remain suspected (additional laboratory results are in process). Twenty-eight specimens cultured Yersinia pestis, which were sensitive to antibiotics recommended by the National Program for the Control of Plague.

Overall, 14 of the 22 (64%) regions in Madagascar have been affected. Analamanga Region has been the most affected, with 71% of all recorded cases.

Plague is endemic on the Plateaux of Madagascar, including Ankazobe District, where the current outbreak originated. A seasonal upsurge, predominantly of the bubonic form, usually occurs yearly between September and April. This year, the plague season began earlier and the current outbreak is predominantly pneumonic, and is affecting both endemic and non-endemic areas, including major urban centres such as Antananarivo (the capital city) and Toamasina (the port city).