WHO continues to support the Ministry of Public Health and other national authorities in Madagascar to monitor and respond to the outbreak of plague. There has been a decline in the incidence of pneumonic plague and overall hospitalizations of patients due to plague infection since mid-October 2017 across the country.
From 1 August to 3 November 2017, a total of 1 947 confirmed, probable and suspected cases of plague, including 143 deaths (case fatality rate 7%), have been reported from 51 of 114 districts in the country. Of these, 1 437 (74%) were clinically classified as pulmonary plague, 295 (15%) were bubonic plague, one was septicaemic, and 211 were not yet classified (further classification of cases is in process). Since the beginning of the outbreak, 71 healthcare workers (with no deaths) have been affected.
Of the 1 437 clinical cases of pneumonic plague, 364 (25%) have been confirmed, 555 (39%) are probable and 518 (36%) remain suspected (additional laboratory results are in process). Twenty-three strains of Yersinia pestis have been isolated and are sensitive to antibiotics recommended by the National Program for the Control of Plague.
Overall, 16 of 22 (73%) regions in Madagascar have been affected. Analamanga Region has been the most affected, with 72% (1 405) of all recorded cases.
About 88% (6 066) of 6 908 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 3 November 2017, 513 out of 550 (93%) 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/).