Health officials in Madagascar are reporting the deaths of two individuals from two separate municipalities of Miarinarivo district last month from bubonic plague, according to a  L’express de Madagascar report (computer translated).

Yersinia pestis
Produced by the National Institute of Allergy and Infectious Diseases (NIAID), this digitally-colorized scanning electron micrograph (SEM) depicts a number of purple-colored Yersinia pestis bacteria that had gathered on the proventricular spines of a Xenopsylla cheopis flea./CDC

The deaths, recorded on Oct. 31, confirmed by the Pasteur Institute of Madagascar, according to the report of the Ministry of Public Health.

Since August, the number of victims of the plague in Madagascar is increasing. Twenty deaths have been recorded to date. Tsiroanomandidy and Moramanga are the cities most affected by the plague this year.

According to the World Health Organization, the plague is endemic in Madagascar, with epidemic seasonal peaks ranging from September to March.

The term “plague” has struck fear into the hearts of people for centuries and for good reason. Historically, plague has destroyed entire civilizations. Probably the most noteworthy, the “Black Death” of the 1300s, that killed approximately one-third of Europe’s population.

Plague is an infectious disease caused by the bacterium, Yersinia pestis. It is found in animals throughout the world, most commonly rats but other rodents like ground squirrels, prairie dogs, chipmunks, rabbits and voles. Fleas typically serve as the vector of plague. Human cases have been linked to the domestic cats and dogs that brought infected fleas into the house.

People can also get infected through direct contact with an infected animal, through inhalation and in the case of pneumonic plague, person to person.

Yersinia pestis is treatable with antibiotics if started early enough.

There are three forms of human plague; bubonic, septicemic and pneumonic.

Plague is now commonly found in sub-Saharan Africa and Madagascar, areas which now account for over 95% of reported cases worldwide, according to the CDC.

In fact, in a study published in  The American Journal of Tropical Medicine and Hygiene in Sept 2013, 21,725 cases of human plague reported globally during the last decade (2000-2009), including 1,612 deaths, for a case-fatality rate of 7.4%.

Leading all countries with number of human plague cases was the Congo, which reported 10,581 during the decade. The author of the  notes that all these occurred in the Oriental Province following years of civil strife and influxes of displaced persons.

Following the Congo was Madagascar recording 7,182 cases. The island country was the leading country in plague occurrence during the previous decade, 1990-1999.

Robert Herriman is a microbiologist and the Editor-in-Chief of Outbreak News Today and the Executive Editor of The Global Dispatch

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