Plague – Madagascar

Plague activity has been reported in multiple districts of Madagascar through March.

For the period Jan to March, at least 21 confirmed cases of bubonic plague have been confirmed. Eight of these cases were reported since March 1 in Amoroni Mania (Ambositra and Manandriana).

Since the start of the year, 37 suspected cases have been reported, affecting multiple regions, including Alaotra-Mangoro, Analamanga, Haute Matsiatra, and Itasy. Roughly nine deaths have been associated with this disease activity.

Plague is endemic to Madagascar, where 200 to 700 cases are reported each year, primarily the bubonic form. The risk of plague spreading to humans is elevated in Madagascar, where the fleas that transmit the disease are highly resistant to insecticide. The poor state of Madagascars public health system and limited access to healthcare in rural areas may also facilitate the spread of the disease.

Photo: Yersina pestis bacteria in the gut of a flea.

Plague is an infectious disease caused by the bacterium Yersinia pestis. Symptoms include fever, weakness and headache. Usually this begins one to seven days after exposure. In the bubonic form there is also swelling of lymph nodes, while in the septicemic form tissues may turn black and die, and in the pneumonic form shortness of breath, cough and chest pain may occur.

Bubonic and septicemic plague are generally spread by flea bites or handling an infected animal. The pneumonic form is generally spread between people through the air via infectious droplets.

Plague has historically occurred in large outbreaks, with the best known being the Black Death in the 14th century which resulted in greater than 50 million dead.

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