Madagascar’s plague outbreak continues to spread at alarming rates, causing 57 deaths and infecting over 680 as of Oct 12. About half the cases have occurred in the capital, Antananarivo.
The country normally experiences around 400 cases of plague each year, mostly during the rainy season between November and March – however health officials say this year is different – with infections starting much earlier than usual, and located in urban vs. typically rural areas. Also worrisome to officials is the numbers of easily spreading pmeumonic plague vs. bubonic plague.
Of the 684 cases, 484 were pneumonic, 156 bubonic and 1 septicemic plague. 54 cases were not classified, according to WHO.
The fact that the plague is spreading in urban areas before the rainy season is a serious concern. “The rains drive the rodents out,” said Bausch, which also explains why cases are usually the bubonic form.
Though the country is endemic for the plague, the surprising occurrence of cases in cities as well as them presenting earlier than usual meant health authorities weren’t ready — fueling a rapid spread of the disease, according to Dr. Charlotte Ndiaye, WHO representative in Madagascar.
How does it spread?
Plague is caused by infection with the bacterium Yersinia pestis and is typically spread through the bite of infected fleas, frequently carried by rats, causing bubonic plague. Symptoms include painful, swollen lymph nodes, called bubos, as well as fever, chills and coughing.
Pneumonic plague is more virulent or damaging and is an advanced form characterized by a severe lung infection. The infection can be transmitted from person to person via airborne droplets — coughing or sneezing. The incubation period is short, and an infected person may die within 12 to 24 hours.
Third world problems
Perhaps the most shocking part of this outbreak is the fact that the plague is easily treated with antibiotics. The government of Madagascar has mobilized resources to disinfect schools and other public areas, and people have been lining up at local pharmacies in the capital for medication and protection.
“The international community is taking this very seriously,” said Daniel Bausch, director of the UK Public Health Rapid Support Team. Launched in 2016, this team consists of clinicians, scientists and academics deployed to tackle outbreaks of disease around the world within 48 hours.
WHO delivered over 1.2 million doses of antibiotics to combat the plague earlier this month, and the Red Cross has committed over $1 million, and mobilized over 1,000 volunteers to help with the situation.
Low risk of a pandemic
While it appears this plague outbreak is going to be particularly hard on Madagascar, WHO scientist Dr. Charlotte Ndiaye said “the risk of international spread is low, because generally, people with plague are too sick to travel.”
Regardless, WHO is working closely with Madagascar authorities to ensure airports are not vectors.
It’s “important to recognize that, unlike Ebola, plague is easily treated with antibiotics,” said Bausch. “With very good outcomes, as long as detected and treated early.”
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