One Health Resource Center
One Health Resource Center
January 10, 2017
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WHO reports suspected plague outbreak in Madagascar

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WHO reported that health officials are currently investigating a suspected outbreak of pneumonic and bubonic plague in the Southeastern region of Madagascar that resulted in 62 illnesses and 26 deaths.

The cases, six of which have been confirmed, occurred in two adjacent districts in two neighboring regions —Befotaka district in Atsimo-Atsinanana Region and Iakora district in Ihorombe Region. These are the first cases to be reported in the area since 1950.

Of the reported cases, five were classified as pneumonic plague and the remaining as bubonic plague. Retrospective investigations revealed that the outbreak may have started in mid-August.

In early December when the outbreak was first reported to WHO, 15 members of Madagascar’s ministry of health were deployed to the area to conduct epidemiological investigations and vector control, manage suspected cases, identify contacts and train community health workers on surveillance and early case detection. Despite arrangements with local authorities, WHO reported that additional response efforts have been slow to implement in the area as it is “hard to reach and highly insecure.” A helicopter has been made available; however, its use is limited due to poor weather and financial limitations.

Since the affected area is very remote, the risk for international spread is unlikely, according to WHO. However, the full magnitude of the outbreak has yet to be defined and transmission in the area may be ongoing.

WHO called for additional ecological investigations to better understand the occurrence of the outbreak and to implement long-term surveillance and control measures.

Plague is a severe disease caused by the transmission of Yersinia pestis between animals and humans through the bite of infected fleas, direct contact and inhalation, according to WHO. It is rarely contracted through ingestion of infective materials. The disease is associated with a case–fatality ratio of 30% to 60% when left untreated, and a mortality rate of less than 15% when rapidly diagnosed and treated with antibiotics such as streptomycin and tetracycline. There were 320 cases of plague reported worldwide in 2015, including 77 deaths.