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Plague outbreak confirmed in Madagascar

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WHO officials have confirmed an outbreak of plague in Madagascar, according to a press release.

On Aug. 31 a male from Soamahatamana village in the district of Tsiroanomandidy was the first case identified, and the patient died on Sept. 3. Madagascar’s Ministry of Health notified WHO of the outbreak on Nov. 4. As of Nov. 16, there have been 119 confirmed cases of plague including 40 deaths. Only 2% of cases were of the more deadly pneumonic form.

Plague cases have been reported in 16 districts of seven regions. The capital and largest city of Madagascar, Antananarivo, has recorded two cases, including one death. Because of the city’s high population and the health care system’s weakness, there is a risk for rapid spread of the disease, according to WHO. The high level of resistance to the flea insecticide deltamethrin in the country is another complicating factor.

The Madagascar government had instituted strategies to control the outbreak with support from WHO, the Pasteur Institute, the “Commune urbaine d’Antananarivo” and the Red Cross.

Plague is caused by Yersinia pestis, which primarily affects wild rodents and is spread by fleas. Humans bitten by infected fleas also usually develop bubonic plague, which produces the plague bubo. If the bacteria reaches the lungs, pneumonia can develop. The disease then can be transmitted by droplets spread by coughing.

Bubonic plague can be treated successfully with antibiotics if diagnosed early. Pneumonic plague, however, can lead to death 24 hours after infection.