As pointed out on this website–HERE and HEREand on my radio show after reports of a plague outbreak on the island nation of Madagascar recently, that plague is endemic in the country, in fact, Madagascar likely has seen more plague cases than any other country in recent decades.

This image depicts a magnified view of an oriental rat flea, Xenopsylla cheopis. Image/CDC
This image depicts a magnified view of an oriental rat flea, Xenopsylla cheopis. Image/CDC

On Monday, the World Health Organization Regional Office for Africa released a statement (computer translated) that also notes this fact.

The statement came after a flurry of media accounts that seemed to sensationalize the outbreak without taking into account the plague history in the country.

The WHO states ” that the plague is endemic in the country, with epidemic seasonal peaks ranging from September to March.”

WHO cautions that for the bubonic form of the disease, which is found in most cases of the current epidemic, plague is transmitted by the bite of a flea from a plague rat, not flies nor mosquitoes, as has been mistranslated some newspapers. In addition, the pulmonary form known as pneumonic plague, which is found in only less than 4% of cases in the current outbreak, occurs either secondary to bubonic form at an advanced stage, or by inhalation, person-to-person.

Plague is an infectious disease caused by the bacterium, Yersinia pestis. It is found inanimals 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 contactwith 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.

Bubonic plague: This is the most common form. In this form, the bacteria enter the body through the bite of an infected flea or rodent. Here the bacteria infect the lymphatic system. After a few days to week, the person will experience fever, chills, weakness, and swollen lymph glands. These are called buboes.

Untreated bubonic plague is fatal about half the time.

Septicemic plague: This form is also contracted from a flea or rodent bite. Sometimes it appears subsequent to untreated bubonic or pneumonic plague. It involves bloodstream dissemination to all areas of the body. Buboes do not occur. Symptoms are endotoxic shock and disseminated intravascular coagulation. Untreated septicemic plague is nearly always fatal.

Pneumonic plague: Probably the most serious form of plague and it’s when the bacteria infect the lungs and cause pneumonia. It is contracted when the bacteria is inhaled (primary) or develops when bubonic or septicemic plague spreads to the lungs.

Pneumonic plague is contagious and can be transmitted person to person. It is highly communicable under appropriate climate conditions, overcrowding and cool temperatures. Untreated pneumonic plague is frequently fatal.

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