Bubonic plague is a bacterial disease that is primarily spread in humans by bites from infected fleas traveling on rodents. Though the plague might be most well known for killing 25 million Europeans during the Middle Ages, the disease still exists today. Most recently, an outbreak of the plague started in Madagascar at the end of August, and has infected 138 people, killing 47. The body count is feared to grow as the disease has now reached Antananarivo, Madagascar’s capital city.

The bacteria Yersinia pestis is responsible for the causing the plague. Though early intervention with antibiotics can successfully and easily treat the disease, foregoing treatment can rapidly lead to some serious symptoms. Symptoms of the plague include muscle cramps, high fever, seizures, and painfully swollen lymph glands.

The plague also comes in two other forms: septicemic and pneumonic. Septicemic plague results in gangrene in the extremities, and can develop if bubonic plague is left untreated. Pneumonic plague is transferred person-to-person through the air and can lead to respiratory failure within 24 hours. This form can be transmitted directly or develop from bubonic plague if the lungs become infected with the bacteria. Only 2% of reported cases in this outbreak have been pneumonic. The mortality rate of the plague is hard to determine, as it is directly connected to when antibiotics are administered.

The World Health Organization (WHO) reports that patient zero of this outbreak was a male living in the Soamahatamana village in the Tsiroanomandidy district. His condition was identified on August 31, and he unfortunately succumbed to the disease on September 3. Two cases of plague have been reported in the outskirts of the capital city of Antananarivo, with one fatality.

It is feared that the disease will flourish here, as there is a perfect storm of high population density, substandard housing infested with rodents, and an insufficient healthcare industry in the country. To make matters worse, the fleas transmitting the disease are now largely resistant to the insecticide that has been used to curb flea populations in the past. This will make it very difficult to reduce the number of infected fleas in an effort to curb the spread of the plague.

WHO is managing the outbreak in conjunction with the Red Cross, the Pasteur Institute of Madagascar, and the “Commune urbaine d’Antananarivo.” $200,000 USD has already been committed to controlling the outbreak through the purchase of antibiotics, insecticides, and personal protective equipment for the healthcare workers. These materials have already been made available to the affected areas to try to control the spread of the disease.

As of right now, the WHO does not recommend barring trade to and from the region. However, they urge government officials to be vigilant in monitoring disease and treating infected individuals.

[Header image: Tim Evanson via Flickr, CC BY SA 2.0]