Madagascar's "Worst Plague Outbreak in 50 Years" May Finally Be Winding Down

Plague is one of the oldest—and most feared&mdash;of all diseases, according to the World Health Organization (WHO). And right now, Madagascar is in the midst of their worst plague outbreak in 50 years, but the vigorous efforts made by health officials to get it under control seem to be paying off. Infamously known as the “Black Death,” plague accounted for a staggering 50 million deaths in Europe in the fourteenth century. Since then, the disease has never gone away. Madagascar is no stranger to the plague; in fact, the bubonic form of the disease is endemic on the Plateaux of Madagascar, including the Ankazobe District, which is where the current outbreak originated. Plague season came early this year for the large island nation—the epidemic season usually ranges from September to April&mdash;bringing with it an outbreak of predominantly the pneumonic form of the disease, which, according to WHO is the most virulent form. Pneumonic plague, or lung-based plague, is always fatal in infected individuals if left untreated. Between August 1, 2017, and November 10, 2017, a total of 2119 confirmed, probable, and suspected cases of plague were reported, according to the latest External Situation Report released by WHO, and the death toll has reached 171. Furthermore, 365 of the 1618 clinical cases of pneumonic plague have been confirmed. The good news is that the number of new cases of pneumonic plague appears to have been declining since the middle of October. In addition, health officials cultured 25 isolates of Yersinia pestis—the zoonotic bacteria that causes plague that is usually found in small mammals and their fleas&mdash;and found that all isolates were sensitive to all antibiotics recommended by the National Plague Control Program. WHO representatives have worked hard to optimize infection prevention and control (IPC) efforts, including: training providers at several health facilities in the area and plague treatment centers stationed in Ambalavao, Antsirabe, and Fianarantsoa, working with partners such as United Nations International Children’s Emergency Fund (UNICEF), Médecins Sans Frontières (MSF), and others to support water, sanitation, and hygiene (WASH) IPC, working with UNICEF to distribute WASH IPC supplies such as garbage cans, soap, chlorine powder, handwashing facilities, among others, to the plague treatment centers. As we stated in our last plague update, WHO has also been working on the creation of a “dignified and safe burial protocol,” for those who have died from the disease. This has since been “finalized and submitted to the national authorities for validation,” according to the WHO Situation Report. WHO expects the passing of this protocol to “encourage communities to report all cases of deaths.” Officials have conducted pre-tests in some areas where they implemented the protocol—Antanarivo Ville and Tamative&mdash;and found that 90% of the population appeared to be on board with the proposed protocol measures. WHO has dubbed 9 countries and overseas territories—Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La Réunion, Seychelles, South Africa, and Tanzania&mdash;as “priority countries in the African region for plague preparedness and readiness by virtue of having trade and travel links to Madagascar,” according to the report. WHO also, in collaboration with several national health authorities, compiled a plague preparedness checklist designed to help these areas assess how ready they are for an outbreak if one should hit, and assist them in the development of actions that could help fill any gaps. “We’ve accomplished a great deal in a short time, and helped to strengthen overall regional health security,” said the WHO Regional Emergencies director for the WHO African Region Ibrahima-Soce Fall, MD. “But to ensure longer-term sustainability, we have to provide continuing support for Madagascar’s health system to better anticipate, detect, and respond to future plague outbreaks. Supporting these efforts improves health security for everyone.” For the latest confirmed case counts of pneumonic plague in Madagascar, be sure to check out the Contagion® Outbreak Monitor.