Madagascar Plague Outbreak: External Situation Report #1 - 4 October 2017
1. Situation update
On 13 September 2017, the Madagascar Ministry of Public Health notified WHO of an outbreak of pneumonic plague, following the death of a 47-year-old woman in Soavinandriana Hospital, Antananarivo on 11 September 2017 due to a respiratory disease. Blood samples collected from the case-patient confirmed plague at the Institut Pasteur de Madagascar using rapid diagnostic test (RDT). This initial case triggered a field investigation, which established that the current outbreak started on 23 August 2017 when the index case, a 31-year-old male from Tamatave, developed a malaria-like illness. On 27 August 2017, the index case travelled by public transport (bush taxi) from Ankazobe District to Tamatave (via Antananarivo) while symptomatic, and died on the way. A large cluster of infections later occurred amongst his contacts (secondary cases), with onward transmission (tertiary cases). Since then, cases of pneumonic plague without any apparent epidemiological links have been detected in different parts of the country, including non-endemic areas and major cities.
As of 3 October 2017, a total of 194 cases (suspected, probable and confirmed) with 30 deaths (case fatality rate 15.5%) have been reported from 20 districts in 10 regions. Of these, 124 cases and 21 deaths (case fatality rate 16.9%) had the pneumonic form of the disease. Eight healthcare workers from one health facility in Tamatave have contracted pneumonic plague. Of 29 cases with specimens collected, 19 (66%) have been confirmed by either polymerase chain reaction (PCR) or RDT performed at the Institut Pasteur de Madagascar. On 3 October 2017, 37 new cases including 2 deaths have been reported.
On 29 September 2017, the Malagasy health authorities confirmed pneumonic plague as the cause of death of a Seychelles basketball coach, who was attending the Indian Ocean Basket-ball Club championship from 23 September - 1 October 2017. A South African basketball official also tested positive for plague by PCR test on 3 October 2017. The risks of further spread associated with this tournament are currently being assessed, as all the participants are being monitored. Plague is endemic in Madagascar, especially in the central highlands, where a seasonal upsurge (predominantly the bubonic form) occurs each year, usually between August and September. There are three forms of plague infection, depending on the route of infection: bubonic, septicaemic and pneumonic (for more information, see the link http://www.who.int/mediacentre/factsheets/fs267/en/).