Since August 2017, an outbreak of plague
—infamous for claiming millions of lives in Europe back in the Middle Ages—has been ongoing in Madagascar.
Bubonic plague is no stranger to the country; in fact, cases of bubonic are reported almost on an annual basis, especially between the months of September and April, in what the World Health Organization (WHO) dubs
the “epidemic season.” What is strange about this outbreak is that most of the cases are pneumonic plague, making this “an unusual and serious event,” according to the WHO, “particularly since it is occurring in [the] densely populated coastal cities” of Antananarivo and Toamasina.
According to the Centers for Disease Control and Prevention (CDC), plague is a bacterial infection caused by the bacterium Yersinia pestis
and is often transmitted to humans through the bites of infected rodent fleas. In the past, plague epidemics
have occurred in Africa, Asia, and South America, with the majority of cases since the 1990s occurring in Africa. Within the last 20 years, most plague cases have been among individuals who reside in smaller towns or rural, agricultural regions rather than urban areas such as the current outbreak in Madagascar.
It was the death of a 47-year-old woman in a hospital in Antananarivo on September 11, 2017, that prompted officials from the Madagascar Ministry of Public Health to notify the WHO of the outbreak, according to WHO’s first External Situation Report
. After a rapid diagnostic test confirmed plague in blood samples that had been collected from the patient, officials launched a field investigation which determined that the outbreak started on August 23, 2017.
According to the report, a symptomatic 31-year-old man from Tamative—the index case—left the Ankazobe District to return home via a bush taxi, and died in route. Officials observed “a large cluster of infections” that followed among those individuals the man had contact with, which in turn, led to “onward transmission” of the disease. Since then, plague cases have been springing up in all different parts of the country.
The most recent WHO External Situation Report, issued on October 12, 2017, shows that the case count has reached 684; this number includes suspected, probable, and confirmed cases. The outbreak has claimed 57 lives thus far, since August 1, 2017; these cases were reported from 35 out of 114 districts in the country. Furthermore, according to the report, 18 of the 22 regions in Madagascar have been affected by the outbreak, with the Antananarivo Renivohitra District hit the hardest.