Madagascar: Plague Epidemic - Joint Situation Report No. 1, as of 10 October 2017

Situation Report
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• Since August 2017, a total of 449 cases have been reported, the majority pneumonic (322), with 48 deaths: a case fatality rate of 10 per cent (down from 17.7 per cent).

• About 65 per cent of all cases have been recorded in the capital Antananarivo and Toamasina, the two largest cities in the country.

• 33 Districts have been affected, 5 recently.

• In accordance with WHO regulations, no movement restriction measures have been instituted.

• Responses have been scaled up and the multi-sectoral coordination structure is now activated to support health interventions.

• The closure of schools has been extended by one week from 09 October as a preventive measure in the affected districts.

449 Cumulative plague cases

48 Death, representing a case fatality rate of 10%

322 Cases are pneumonic

388 Cases recorded in the cities of Antananarivo and Toamasina

5,000 Patients can be treated with current medicines stocks

17.7 à 10% Decrease of the fatality rate

Situation overview

Madagascar records between 300 and 600 cases of plague during the September-to-April plague season. Cases of bubonic and pneumonic plague have been detected in several towns in Madagascar since August 2017. The beginning of the plague season 2017-2018 is 1 month ahead of the normal start. Pneumonic plague is highly transmissible (from one person to another) and, without appropriate treatment, can be rapidly fatal. From 1 August to 9 October, 449 cases of plague - mainly pneumonic with 322 cases, and 48 deaths (case fatality rate 10.6 per cent) were reported in 33 health districts across the country.

This current outbreak is concentrated in densely populated urban centers (almost 80 per cent of the cases are in the two largest cities of the country), and other non-endemic areas, where there is little experience in responding to plague. The outbreak of plague in Madagascar was reported to the World Health Organization (WH)O on 13 September 2017 after being detected on 11 September following the death of a 47-year-old woman from Fort Duchene in Soavinandriana Hospital from respiratory complications. After confirming pneumonic plague, the Directorate of Health and Epidemiological Surveillance (DVSSE) immediately carried out investigations.

Since the beginning of the plague season, sanitation responses have been conducted. However, responding to pneumatic plague in an urban to reducing morbidity and mortality is challenging. Human-to-human transmission must be interrupted.

The outbreak does not seriously affect other sectors such as transport, energy, banking, telecommunications, security, etc. However, as these sectors are important to support the health response, a coordinated multi-sectoral response has been activated


$ 9.5 million required, of which $2.9 million has already been raised

The joint response plan of the Government of Madagascar and its partners requires US$9.5 million, with the initial response plan adapted to respond to an urban context.

To date, WHO has provided $1.5 million, UNICEF $500,000, IFRC $250,000, UNDP $300,000 and UNFPA $331,000. In addition, discussions for emergency funding from the OCHA-managed Central Emergency Response Fund (CERF) is underway.

Some have also provided in-kind assistance: China gave $200,000 in medicine, DHL is providing storage facilities, and USAID has donated 18,000 respirator masks, 100,000 simple masks and 10 vehicles to support operations of the Department of Public Health.

UN Office for the Coordination of Humanitarian Affairs
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