Madagascar: Plague Outbreak Situation Report, 22 October 2017

Situation Report
Originally published



  • On October 4 the Government launched its response plan, mobilizing community authorities and civil servants, reducing large gatherings, and temporarily closing schools – currently until early November.

  • UNICEF Madagascar is deploying its full resources in support of the Government’s efforts to bring Madagascar’s current plague outbreak under control, working in close collaboration with the World Health Organization (WHO) and other partners. Over the past two weeks, outbreak control efforts have significantly accelerated to facilitate detection of plague cases, access to treatment and tracing of people who have come in close contact with infected individuals.

  • Madagascar experiences annual outbreaks as the plague remains endemic in rural parts of the country, however the current outbreak is particularly concerning due to the predominance of pneumonic plague among confirmed cases - the most dangerous and contagious clinical form of plague, and given the high case load found in urban centres (particularly the capital Antananarivo and the main port Tamatave)

  • As of 19 October, a total of 1,297 plague cases have been notified (among these 131 confirmed, 574 probable and 592 suspected cases), with numbers indicating two concurrent epidemics of pneumonic (human to human transmitted) and bubonic (flea-bite transmitted) plague forms: 846 pneumonic, 270 bubonic, 1 septicemic, 180 nonspecified). Among these, 102 deaths have been recorded and 39 of the country’s 114 districts are affected. The WHO currently rates the outbreak as high risk at national level, medium risk at regional level and low risk at international level.

  • UNICEF has been leading communication efforts to ensure that the population is sufficiently sensitized to report any plague symptoms early and thereby facilitate access to treatment. UNICEF interventions have further focused on supporting Ministry of Health case management and community response interventions, leading WASH interventions in hospitals and care centres, as well as providing support to the Ministry of Education to establish special prevention measures in schools.

Situation in Numbers

Total cases notified, of which 846 pneumonic plague cases reported in various locations of the country, notably the urban areas of Tamatave, and Antananarivo

Deaths reported

Out of 114 districts in Madagascar have been affected with the highest number of cases detected in the capital

US$ 2.6 million
Estimated required funding for UNICEF contribution to response

Situation Overview & Humanitarian Needs

Madagascar is one of a few countries globally where the plague remains endemic. Plague outbreaks, which occur annually in Madagascar, are usually confined to remote rural areas and triggered by the wide-spread ‘slash and burn’ practice as rats which carry the fleas carrying the bacteria Yersinia pestis move towards habitation locations thereby facilitating human infection through flea bites – resulting in the bubonic form of the plague.

The current outbreak features two concurrent epidemics: A bubonic plague outbreak and a second epidemic of the highly contagious pneumonic plague, which is spread through human to human transmission - with the majority of the reported cases being pneumonic plague. Of concern is that the majority of this year’s cases are in densely populated urban areas including the capital Antananarivo (3,724,021 population), and the two coastal towns of Tamatave (1,412,021 population) and Mahajunga (889,277 population). The recovery rate from plague infection is excellent if treated rapidly with antibiotics. However, if not diagnosed and treated immediately, death occurs within one-three days.

Given the annual recurrence of plague outbreaks, Madagascar has in place basic plague control measures and good technical expertise especially via the Institut Pasteur Madagascar. However, due to the overall weak state of the health system and the new dimension with the current outbreak being concentrated in urban centres and the much greater magnitude, the country does not have the capacity to respond to the situation without additional international technical and financial support. The WHO has to date classified the current epidemic as high risk for the country, medium risk for the region, and low risk globally.