ReliefWeb

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. The number of new cases of pulmonary plague is declining across the country. While progress has been made in response to the plague outbreak in Madagascar, sustainability of ongoing operations (during the outbreak and through the plague season usually from September to April) remains critical.

From 1 August to 30 October 2017, a total of 1 801 suspected cases of plague, including 127 deaths (case fatality rate 7%), were reported. Of these, 1 111 (62%) were clinically classified as pulmonary plague, 261 (15%) were bubonic plague, one was septicaemic, and 428 were unspecified (further classification of cases is in process). Since the beginning of the outbreak, 71 healthcare workers (with no deaths) have been affected.

Of the 1 111 clinical cases of pneumonic plague, 257 (23%) have been confirmed, 374 (34%) are probable and 480 (43%) remain suspected (additional laboratory results are in process). Fourteen strains of Yersinia pestis have been isolated and are sensitive to antibiotics recommended by the National Program for the Control of Plague.

Overall, 51 of 114 (45%) districts in 16 of 22 (73%) regions of Madagascar have been affected. Analamanga Region has been the most affected, with 64% (1 149) of all recorded cases.

About 83% (5 357) of 6 492 contacts identified thus far have completed their 7-day follow up and a course of prophylactic antibiotics. A total of nine contacts developed symptoms and became suspected cases. On 30 October 2017, 925 out of 972 (95%) 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/.