Madagascar plague death toll reaches 74

Health officials are struggling to contain the spread of disease after virulent pneumonic strain has infected over 800 people across the island, since August

A council worker sprays disinfectant in the city of Antananarivo, Madagascar (Photo: The Toronto Star)
A council worker sprays disinfectant in the city of Antananarivo, Madagascar (Photo: The Toronto Star)

The first fatality of Madagascar’s deadly plague outbreak – which has now claimed over 70 lives – initially went unnoticed.

In late August, according to researchers with the World Health Organisation (WHO), a 31-year-old man was visiting the island’s central highlands when he developed what appeared to be the symptoms of malaria.

A few days later, travelling on one of the island’s crowded  taxi-brousses (a minibus taxi) en route to Tamatave, the man’s condition worsended and he died.

The man’s body was prepared for burial without any precautions being taken, as no-one was aware that he had been infected by the plague.

Over the next few days, 31 people who had come into contact with him – either directly or indirectly – were infected. Four of them subsequently died.

Since that first “case zero”, the outbreak of the highly contagious strain of plague has claimed 74 lives over two months, infecting over 800 people.

Marking the outbreak as doubly dangerous, many cases have also featured the most virulent form of what was known in the Middle Ages as the Black Death – pneumonic plague.

It is initially caused when advanced bubonic plague spreads to the lungs: this slower acting and relatively less contagious form of the disease attacks the patient’s lymphatic system. Pneumonic plague spreads very easily and is deadly if untreated.

Of the 684 cases reported as of 12 October, 474 were confirmed to be pneumonic plague, 156 bubonic and one septicaemic. A further 54 were unspecified.

Although plague outbreaks in Madagascar have been an annual occurrence in recent decades, this outbreak has affected urban areas, where plague is not normally endemic. This further increases the risk of transmission.

Another feature is the timing. Whereas past cases of the disease generally occurred during the rainy season – between November and March – and were typically of the bubonic variety, this predominantly pneumonic outbreak began in August.

This has provoked a climate of fear, with WHO officials rushing to attempt to contain the outbreak, delivering 1.2m doses of antibiotics.

Their efforts were backed by interventions from health officials, who have set up medical inspections at transport hubs and banned jail visits and public gatherings.

“Normally, the people who catch the plague … live in poor areas, but in this case we find the well-to-do, the directors, the professors, people in every place in society, catching the disease,” said Dr Manitra Rakotoarivony, Madagascar’s director of health promotion.

Plague was first introduced to the island in 1898, when steamships from India brought rats infected with the disease. Within two decades or so, it virtually disappeared from Madagascar for 60 years, only to re-emerge in recent decades.

The black rats that carry plague in the highlands have gradually developed resistance to it. Burial practices that involve touching corpses are another reason the disease spreads, according to a 2015 study by scientists at Madagascar’s Pasteur Institute.

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