WHO continues to support the Ministry of Public Health and other national authorities in Madagascar to monitor and respond to the outbreak of plague. From 6 to 17 November 2017, 216 cases of plague (1 confirmed, 20 probable and 195 suspect) were reported to WHO. The date of onset of the last case of bubonic plague was 7 November 2017 and the last confirmed case of pneumonic plague was reported on 14 November 2017.

From 1 August to 17 November 2017, a cumulative total of 2 267 confirmed, probable and suspected cases of plague, including 195 deaths (case fatality rate 9%), have been reported from 55 of 114 (48%) districts in Madagascar.

Analamanga Region in central Madagascar has been the most affected, with 68% of all recorded cases. Since the beginning of this outbreak, the vast majority of cases have been treated and have recovered. As of 17 November 2017, only people were hospitalized for plague. There has been no international spread outside the country.

The majority of the reported cases (1 732, 76%) have been clinically classified as pneumonic plague, 327 have been classified as bubonic plague (14%), one was septicaemic, and 207 have not yet been classified (further classification of cases is in process). Eighty-one healthcare workers have had illness compatible with plague, none of whom have died.

Of the 1 732 clinical pneumonic cases, 389 (22%) have been confirmed, 612 (35%) are probable and 731 (42%) remain suspected (additional laboratory results are in process). Thirty isolates of Yersinia pestis have been cultured and are sensitive to all antibiotics recommended by the National Plague Control Program.

Of the 7 270 contacts identified during this outbreak, about 99% (7166) have completed their 7-day follow up and a course of prophylactic antibiotics, and eleven contacts have developed symptoms compatible with plague and became suspected cases. On 17 November 2017, all 33 contacts currently under follow-up were reached and provided with prophylactic antibiotics.

Plague is endemic on the Plateaux of Madagascar, including Ankazobe District, where the current outbreak originated.

A seasonal upsurge, predominantly of the bubonic form, usually occurs yearly between September and April. This year, the plague season began earlier than usual. The current outbreak is predominantly pneumonic and is affecting both endemic and non-endemic areas, including major urban centres such as Antananarivo (the capital city) and Toamasina (a port city).

There are three forms of plague, depending on the route of infection: bubonic, septicaemic and pneumonic (for more information, see the link http://www.who.int/mediacentre/factsheets/fs267/en/).