The Black Death Spreads Through Madagascar Claiming 57 Lives Thus Far

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.

The majority of these cases—474 (69%)—are classified as pneumonic plague, while bubonic plague accounts for 156 (22%); in addition, there has been 1 case of septicaemic plague, and 54 cases have not been specified. Of the 684 cases, only 63 have been confirmed, with 271 cases marked as probable and 350 still marked as suspected.

A recent WHO press release suggests that the disease may have also made its way to Seychelles. On October 10, 2017, the WHO was notified of a probable case of pneumonic plague by officials from the Seychellois Ministry of Health. The case in question was a 34-year-old man who had returned home from Madagascar on October 6, 2017. Quickly after returning to Seychelles (October 9), the man developed symptoms and went to a local health center for care. After suspecting pneumonic plague, healthcare providers referred him to a hospital, where he was isolated and received treatment. On October 11, 2017, a rapid diagnostic test came back as “weakly positive,” for the infection and since then, the case remains probable until the WHO can provide confirmation.

Between October 9-11, 2017, 8 of the patient’s contacts also presented with mild symptoms. They have since been isolated as well. According to the WHO, 10 specimens have been taken from the man, his contacts, and 2 suspected cases. The specimens are being sent to Institut Pasteur in France to be tested.

In response, flights from Seychelles to and from Madagascar have been stopped. However, the WHO has not called for travel and trade restrictions as of yet. The Madagascar Ministry of Health has teamed up with the WHO to implement “exit screening at the international airport in Antananarivo to prevent international spread.” WHO and partners are also working on strengthening security measures at entry points as well.

Public health response efforts include the creation of a Crisis Emergency Committee, who have been channeling their efforts into coordinating surveillance, contact tracing, case management, isolation, and providing supplies.

To keep up-to-date on the latest case/death counts of the plague outbreak in Madagascar, be sure to check out the Contagion® Outbreak Monitor.