Doctors and nurses work at a health care checkpoint in Madagascar in an attempt to educate travelers and potentially detect cases of pneumonic plague. (Photo: Getty Images)

An outbreak of bubonic and pneumonic plagues in Madagascar has the potential to spread further from an unlikely cause: fear of needles.

Plague patients are fleeing hospitals in the country because they’re afraid of getting their shots. This has health officials in the country scrambling, because the disease is highly contagious. Everyone who comes into contact with an infected person has to be treated.

At least one patient escaped and made it all the way home before being forced back into an ambulance by authorities and taken back to the hospital.

An infected patient must be given a steady drip of antibiotics for up to five days.

“People here are not used to the hospital,” explains deputy representative of UNICEF Jean Benoit Manhes to the Irish Times. “The problem of plague is not just a medical response. You can have hospitals but if people don’t come it isn’t enough.”

The World Health Organization has announced the death toll has reached 171 in the country and another 2,119 are infected.

Surrounding nations have been told to anticipate the possibility of the outbreak spreading. The disease, which returns to Madagascar every year and infects an average 600 people each season, is transmitted by coughing and sneezing.

Pneumonic plague is a severe lung infection caused by the bacterium Yersinia pestis. Symptoms can include weakness, fever, coughing, and chest pains. If gone untreated, it can be fatal within 36 hours of symptoms appearing.

What may be making matters even worse in Madagascar is an ancient tradition called Famadihana, which translates to “turning of the bones,” in which bodies of deceased relatives are dug up by their loved ones and are cleaned, shrouded, and reburied.

Efforts to safely bury the bodies of those who die from the plague have met with resistance. Health officials want to bury those who die from the disease in sealed body bags, but they run into trouble from families seeking traditional burials.

“If a person dies of pneumonic plague and is then interred in a tomb that is subsequently opened for a Famadihana, the bacteria can still be transmitted and contaminate whoever handles the body,” explains Willy Randriamarotia, the Madagascan health ministry’s chief of staff, in an interview with the Daily Mail.

Health officials have noticed that the plague’s usual season — July to October — coincides with the traditional time of year for Famadihana ceremonies.

The surrounding nations of South Africa, La Reunion, Seychelles, Mauritius, Tanzania, Comoros, Kenya, Mozambique, and Ethiopia have been told by the WHO to prepare in case the disease spreads.

The risk of the disease spreading, or worse, mutating to resist antibiotics, goes up with every outbreak.

In addition to the problem of Famadihana, misinformation about the disease has spread throughout the population on social media. As a result, some who are presumably infected stay home despite having symptoms. False rumors combined with poor education and infrastructure makes Madagascar an ideal breeding ground for infectious disease.

UNICEF has formed a team to combat the rumors and to encourage infected people to go to a hospital. But success is proving hard to achieve. Some believe the plague is a deliberate ploy by the government to collect donations before an election and that those who check themselves into hospitals will never check back out.

Making matters worse is the grinding poverty found in the country. Madagascar is among the poorest nations in the world, with 92 percent of the population living on less than $2 a day.

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