Highlights

• The number of new notified cases have begun to decline following six weeks of intensive outbreak response by the Madagascar Government and partners to the dual epidemics of pneumonic and bubonic plague. While the number of patients decrease, 978 people have been cured, 122 are currently on treatment, and 113 deaths have been reported.

• Between 1 August and 27 October, a total of 1,554 cases have been notified, out of which 985 are pneumonic plague, 230 bubonic plague and 339 unknown. Out of these total reported cases, 332 cases are confirmed, 495 cases are probable and 727 cases suspected. It is noteworthy that only 27 per cent of pneumonic cases have been confirmed so far, while 34 per cent remaining probable and 35 per cent suspect. Considering the current situation and the fact that the plague season in Madagascar runs through April, continued vigilance of the response is required.

• Treatment and referral capacity, data management, contact tracing and communication and sensitization have been significantly reinforced. The current focus is on rumour management, addressing stigmatization, safe and respectful burial, and clarify diagnosis of very young children who are unable to go through regular testing.

• To facilitate the reopening of schools and the return to school for 415,000 children in affected areas, on November 6 (following the precautionary closure of schools on 2 October), UNICEF has been working with the Ministry of Education on plague detection and referral protocol and related special training for more than 15,000 teachers and administrative staff to ensure that children with symptoms are properly referred to treatment centres without causing stigmatization or panic.

• UNICEF’s support to the response, is focused on improving the health case management in treatment centres, including hygiene and wash provisions; facilitating food provision for patients and families in hospitals and a continuously evolving communication response aimed at sensitizing communities on the dangers of the epidemic; advice on how to prevent and access treatment, as well as address rumours; reduce stigma and facilitate work at community level (tracing, referral, burials).

SITUATION IN NUMBERS

Data as of 27 October

1,554 Total cases notified, of which 985 cases of pneumonic plague, 230 cases of bubonic plague and 339 unknown cases, notably in the urban areas of Tamatave and Antananarivo

978 Recoveries

113 Deaths reported

40 out of 114 districts have been affected with the highest number of cases detected in the capital

Estimated required funding for UNICEF contribution to response

US$ 2.6 million

Situation Overview & Humanitarian Response Madagascar is experiencing two concurrent outbreaks of plague: a flea-transmitted bubonic plague outbreak that has spread beyond the usual rural areas where the plague is endemic, into new rural, as well as urban areas; and a second highly-contagious human to human transmitted pneumonic plague outbreak which has been spreading rapidly predominantly in the three main urban areas of the country. The number of reported cases has been steadily rising although appears to have tapered somewhat in the past 10 days. To date, 1,554 cases have been reported and the number of deaths recently exceeded 100.

The response is now in place following intense work over the past few weeks on (1) developing the necessary technical protocols for this unprecedented situation, with WHO leading the epidemiological surveillance, treatment, contact and tracing part of this work and UNICEF leading protocol development for schools, WASH and C4D (including safe and culturally appropriate burials), and (2) setting up previously non-existent treatment and care services at hospitals including antibiotics provision, triage and isolation capacity set up, proper hygiene and waste disposal, training of staff amongst other activities. Nevertheless, several factors continue to make this dual epidemic outbreak very complex to manage:

• A steadily increasing demand to assist in setting up new treatment centres given the rapid overflow of existing hospitals and the emergence of the outbreak in new areas;

• The lack of capacity of some existing centres to provide adequate isolation and hygiene;

• Complexity of data systems, with an over-estimate of “suspected” cases, irregular or incomplete data coming from the peripheral level and a constantly evolving situation

• Complexity of tracing contacts in urban, often informal, settings • False rumours causing panic and creating dangerous behaviours

• Strong pressure on Ministry of Education to re-open schools UNICEF is supporting the national response alongside the Ministry of Health, World Health Organization (WHO), National Office for Disaster Prevention and Control (BNGRC), USAID, Government of France, Institut Pasteur, International Federation of the Red Cross, Medecins du Monde, Action contre la Faim and Médecins Sans Frontières (MSF). Significant surge capacity from these international organisations has arrived from abroad in recent weeks.