Madagascar Plague Outbreak: External Situation Report #10 - 14 November 2017
1. Situation update
WHO continues to support the Ministry of Public Health and other national authorities in Madagascar to monitor and respond to the outbreak of plague. From 7 to 10 November 2017, 86 confirmed, probable and suspect cases of plague were reported.
From 1 August to 10 November 2017, a cumulative total of 2 119 confirmed, probable and suspected cases of plague, including 171 deaths (case fatality rate 8%), have been reported from 55 of 114 (48%) districts in Madagascar. Analamanga Region has been the most affected, with 72% of all recorded cases.
Since the beginning of the outbreak, 1 618 (76%) of reported cases have clinically been classified as pulmonary plague, 324 (15%) as bubonic plague, one was septicaemic, and 176 have not yet been classified (further classification of cases is in process). A total of 82 healthcare workers (with no deaths) have been affected.
Of the 1 618 clinical cases of pneumonic plague, 365 (23%) have been confirmed, 573 (35%) are probable and 680 (42%) remain suspected (additional laboratory results are in process). Twenty-five isolates of Yersinia pestis have been cultured and are sensitive to all antibiotics recommended by the National Plague Control Program.
About 95% (6 729) of 7 122 contacts identified thus far have completed their 7-day follow up and a course of prophylactic antibiotics. Since the beginning of the outbreak, a total of eleven contacts developed symptoms and became suspected cases. On 10 November 2017, 218 out of 243 (90%) contacts under follow-up were reached and provided with prophylactic antibiotics.
Plague is endemic on the Plateaux of Madagascar, including Ankazobe District, where the current outbreak originated. A seasonal upsurge, predominantly of the bubonic form, usually occurs yearly between September and April. This year, the plague season began earlier and the current outbreak is predominantly pneumonic and is affecting both endemic and non-endemic areas, including major urban centres such as Antananarivo (the capital city) and Toamasina (the port city).
There are three forms of plague, depending on the route of infection: bubonic, septicaemic and pneumonic (for more information, see the link http://www.who.int/mediacentre/factsheets/fs267/en/).