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Plague in Madagascar (Update 4)

13 Nov 2017

On 9 November the World Health Organisation (WHO) Link reported the outbreak of plague continues in Madagascar, although incidence rates have been falling since mid-October 2017.

From 1 August to 8 November 2017, 2 034 cases of plague, including 165 deaths were reported. Of these cases, 1 565 (77%) were pulmonary (pneumonic) plague, 297 (15%) were bubonic plague and 1 was septicaemic. A further 171 cases have not been were not yet classified Eight-two healthcare workers have been affected, none of whom have died.Cases have been reported from 55 of the 114 districts in the country. Analamanga Region has reported 71% of all recorded cases.

Advice for Travellers

Plague is rare in international travellers.

  • Travellers visiting areas where plague occurs, or where there is an outbreak should be aware of the risk of infection.
  • The risk may be highest in those who are camping, staying in very basic rural accommodation, hunting or who may have close contact with wildlife, particularly rats or other rodents.
  • Contact with infected people during an outbreak is also a significant risk.
  • Three types of plague occur, all caused by the same bacterium, Yersinia pestis.
    • Bubonic plague spreads from animals to humans by flea bites or other skin penetration, so travellers should practice good insect bite avoidance. Close contact with sick or dead animals should be avoided.
    • People become infected with pneumonic plague by breathing in plague bacteria in droplets coughed into the air by a person (or animal) already infected. Pneumonic plague is the most contagious form of the disease.
    • Septicaemic plague can develop from the other forms of the disease when plague bacteria multiply in the blood and spread throughout the body.

No vaccine is available for plague. The most effective form of prevention is to avoid exposure to infected people or animals. If there is a possibility that a traveller has been exposed to plague, it is important to seek prompt medical attention as soon as possible. Progression of the disease may be prevented with appropriate antibiotic treatment.

Anyone experiencing rapidly progressing fever, chills, headache, weakness, respiratory symptoms, chest pain or swollen lymph nodes should seek prompt medical attention.