The plague outbreak has caught the attention of the world due to it’s large numbers, early appearance, number of pulmonary cases and location.

This anteroposterior x-ray reveals a bilaterally progressive plague infection involving both lung fields Image/CDC
This anteroposterior x-ray reveals a bilaterally progressive plague infection involving both lung fields
Image/CDC

Between 1 August and 13 October 2017, a total of 711 cases (suspected, probable and confirmed) including 64 deaths (case fatality rate 9.0%) have been reported from 37 (32.5%) out of 114 districts in the country.

Of these, 506 cases (71.2%) were clinically classified as pneumonic plague, 167 (23.5%) were bubonic plague, one case was septicaemic plague, and 36 cases were unspecified. At least 26 healthcare workers have contracted plague since the beginning of the outbreak.

Eighteen (81.2%) out of 22 regions in the country, including traditionally non-endemic areas, have been affected. Antananarivo Renivohitra District has been the most affected to date.

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 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).

Related:

Bipolar staining of a plague smear prepared from lymph aspirated from an adenopathic lymph node, or bubo, of a plague patient./CDC
Bipolar staining of a plague smear prepared from lymph aspirated from an adenopathic lymph node, or bubo, of a plague patient./CDC