Madagascar's 'worst plague outbreak in 50 years' is finally on the decline

For the first time since August, there has been a clear decline in new cases

Officials in Madagascar have warned residents not to exhume bodies of dead loved ones and dance with them because the ritual could contribute to the spread of plague (Photo: Metro)
Officials in Madagascar have warned residents not to exhume bodies of dead loved ones and dance with them because the ritual could contribute to the spread of plague (Photo: Metro)

The plague in outbreak in Madagascar, which began in August, has resulted in the deaths of 165 people and the infection of over 2,000.

Labeled as the “worst outbreak in 50 years”, 77% of clinically diagnosed cases were pneumonic plague, a form that can spread from person to person.

The plague is caused by the bacterium Yersinia pestis and typically spreads though the bite of infected fleas, frequently carried by rats, causing bubonic plague.

Pneumonic is often considered to be more damaging and virulent, and is an advanced form characterised by severe lung infection. It can be transmitted by means of airborne droplets from spitting, coughing or sneezing.

Following a sharp rise in new cases in the initial weeks of the outbreak, the number of new cases began declining in mid-October, said the World Health Organisation (WHO).

“After a concerted effort by the Ministry of Health and partners, we are now seeing a decline in reported plague cases, in the number of people hospitalised with plague and in geographic districts reporting new cases”, said WHO spokesman Tarik Jasarevic.

Between 30 October and 3 November, there were 41 new cases and three deaths, a sufficient decline from the 238 cases and 12 deaths the week prior.

“This trend is encouraging and shows that the quick steps taken to support the Malagasy government to contain the outbreak have been effective”, he said.

Despite the decline, nine neighbouring countries have been placed on high alert and identified by the WHO as priority countries in the African region, in terms of ensuring preparedness against the plague.

These countries are: Comoros, Kenya, Mauritius, Ethiopia, Seychelles, South Africa, Reunion Island, Mozambique and Tanzania, given that they have both travel and trade links with Madagascar.

Neighbouring countries placed on high alert (Photo: Health Medicine Network)
Neighbouring countries placed on high alert (Photo: Health Medicine Network)

Preparedness involves the increase of public awareness and enhanced surveillance for the disease, especially at ports of entry.

“It is normal that neighbouring countries and those with direct trade and travel links to review plague preparedness measures given the outbreak in Madagascar," Jasarevic said.

Plague outbreaks are somewhat typical in Madagascar, with an estimated 400 new cases every year.

The unusual spread of this pneumonic plague, however, was due to one infected person who traveled to find care in the early stages of the outbreak, infecting several people along the way.

It’s arrival in cities, along with the outbreak starting around three months earlier, further helped the spread.

"The risk to people in UK is very low, but the risk for international travellers to and those working in Madagascar is higher," said Dilys Morgan, head of emerging infections and zoonosis at Public Health England.

The overall global risk is considered low, according to the WHO, and the regional risk is moderate.

"It is important that travellers to Madagascar seek advice before traveling and are aware of the measures they can take to reduce the risk of infection," Morgan said. "Plague is no longer the threat to humans that it was centuries ago, as antibiotics work well if treatment is started early."