The number of plague cases are closing in on 700 cases, according to the latest World Health Organization (WHO) update. Between 1 August and 12 October 2017, a total of 684 cases (suspected, probable and confirmed) including 57 deaths (case fatality rate 8.3%) have been reported from 35 out of 114 districts in the country.

Yersinia pestis Image/CDC
Yersinia pestis

Of these, 474 cases (69.3%) were clinically classified as pneumonic plague, 156 (22.8%) were bubonic plague, one case was septicaemic plague, and 54 cases were unspecified. At least fifteen healthcare workers have contracted plague since the beginning of the outbreak.

Concerning the susceptibility to antibiotics, the Pasteur Institute Madagascar reports:

Monitoring the susceptibility of strains of Yersinia pestis to different antibiotics (ATB) is a priority for the success of the National Program for the Control of Plague.

It detects the emergence of strains of reduced susceptibility or resistance to Streptomycin (Sm) and Sulfamides (Sxt), antibiotics recommended and used in the National Program and to evaluate other alternatives (Tetracycline (Tet) , Ciprofloxacin (Cip), Chloramphenicol (Chl)) for treatment.

Since the beginning of the season, the 11 isolated strains are sensitive to these ATBs. They are from Miarinarivo, Moramanga, Mahajanga, Tsiroanomandidy and Andramasina.

Plague is known to be endemic on the Plateaux of Madagascar (including Ankazobe District where the current outbreak originated) and a seasonal upsurge (predominantly the bubonic form) usually occurs early every year between September and April. Unlike the usual endemic pattern, the plague season began early this year, and the current outbreak has affected major urban centres, including Antananarivo (the capital city) and Toamasina (the port city).