1. Situation update
The outbreak of plague in Madagascar continues, with an overall reduction in the case fatality rate. On 12 October 2017, 61 new cases and no deaths were reported from six districts. Between 1 August and 12 October 2017, a total of 684 cases (suspected, probable and confirmed) including 57 deaths (case fatality rate 8.3%) have been reported from 35 out of 114 districts in the country. Of these, 474 cases (69.3%) were clinically classified as pneumonic plague, 156 (22.8%) were bubonic plague, one case was septicaemic plague, and 54 cases were unspecified. At least fifteen healthcare workers have contracted plague since the beginning of the outbreak.
Of the 684 cases reported, 63 (9.2%) were confirmed, 271 (39.4%) were classified as probable and 350 (51.2%) remain suspected. To date, 11 Yersinia pestis strains have been isolated, which were sensitive to antibiotics recommended by the National Program for the Control of Plague.
Eighteen (81.2%) out of 22 regions in the country, including traditionally non-endemic areas, have been affected.
Antananarivo Renivohitra District has been the most affected. Plague is known to be endemic on the Plateaux of Madagascar (including Ankazobe District where the current outbreak originated) and a seasonal upsurge (predominantly the bubonic form) usually occurs early every year between September and April. Unlike the usual endemic pattern, the plague season began early this year, and the current outbreak has affected major urban centres, including 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/).