Madagascar: Plague activity reported in multiple districts of Madagascar through March

Event

From Jan. 1-March 11, at least 21 confirmed cases of bubonic plague have been confirmed in Madagascar. Eight of these cases were reported since March 1 in Amoron'i 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. This represents the most complete data available as of March 12.

Context

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 Madagascar's public health system and limited access to healthcare in rural areas may also facilitate the spread of the disease.

Plague is caused by a bacterium that is usually transmitted through the bite of an infected flea. However, an infection can also occur through direct contact with tissues or fluids from infected animals - such as a scratch or bite. Bubonic plague occurs when the bacteria infects a person's lymph nodes. This form of plague is not easily transmissible from person to person. However, when the bacteria spread through the bloodstream to the lungs, pneumonic plague can transmit directly from person to person via respiratory droplets containing the plague bacteria. Symptoms of plague generally develop 1-7 days after exposure. All forms of plague cause nondescript symptoms, such as fever, chills, and extreme weakness. Symptoms of bubonic plague also include swollen, tender, and painful lymph nodes and symptoms of pneumonic plague include pneumonia with shortness of breath, chest pain, and cough.

Advice

Consult a travel medicine provider before departure regarding plague vaccination. Practice basic health precautions. Avoid flea bites. Seek medical attention if symptoms develop within a week of being in affected areas.